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Sleep Disturbance in Posttraumatic Stress Disorder: Epiphenomenon or Causal Factor?

  • Anxiety Disorders (A Pelissolo, Section Editor)
  • Published:
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Abstract

Purpose of Review

The goal of this review is to integrate recent findings on sleep disturbance and PTSD, examine sleep disturbance as a causal factor in the development of PTSD, and identify future directions for research, treatment, and prevention.

Recent Findings

Recent research highlights a relationship between both objective and subjective sleep disturbance and PTSD across diverse samples. Sleep disturbance also predicts PTSD over time. Finally, treatments targeting sleep disturbance lead to decreased PTSD symptoms, while standard PTSD treatments conclude with residual sleep disturbance.

Summary

Sleep disturbance may be more than a mere epiphenomenon of PTSD. Future research examining the causal role of sleep disturbance in the development of PTSD, as well as the utility of targeting sleep disturbance in prevention and treatment, is necessary to fully understand the likely bidirectional relationship between sleep disturbance and PTSD.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Baglioni C, Nanovska S, Regen W, Spiegelhalder K, Feige B, Nissen C, et al. Sleep and mental disorders: a meta-analysis of polysomnographic research. Psychol Bull. 2016;142:969–90.

    Article  PubMed  Google Scholar 

  2. Harvey AG, Murray G, Chandler RA, Soehner A. Sleep disturbance as transdiagnostic: consideration of neurobiological mechanisms. Clin Psychol Rev. 2011;31:225–35.

    Article  PubMed  Google Scholar 

  3. Pigeon WR, Pinquart M, Conner K. Meta-analysis of sleep disturbance and suicidal thoughts and behaviors. J Clin Psychiat. 2012;73:31160–e1167.

    Article  Google Scholar 

  4. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. Washington: Author; 2013.

  5. Harvey AG, Jones C, Schmidt A. Sleep and posttraumatic stress disorder: a review. Clin Psychol Rev. 2003;23:377–407.

    Article  PubMed  Google Scholar 

  6. LeBouthillier DM, McMillan KA, Thibodeau MA, Asmundson GJG. Types and number of traumas associated with suicidal ideation and suicide attempts in PTSD: findings from a U.S. nationally representative sample. J Trauma Stress. 2015;28:183–90.

    Article  PubMed  Google Scholar 

  7. Wisco BE, Marx BP, Wolf EJ, Miller MW, Southwick SM, Pietrzak RH. Posttraumatic stress disorder in the US veteran population: results from the National Health and Resilience in Veterans study. J Clin Psychiat. 2014;75:1338–46.

    Article  Google Scholar 

  8. • Straus LD, Drummond SPA, Nappi CM, Jenkins MM, Norman SB. Sleep variability in military-related PTSD: a comparison to primary insomnia and healthy controls. J Trauma Stress. 2015;28:8–16. Those with PTSD exhibit increased objective and subjective sleep disturbance compared to healthy controls and those with insomnia.

    Article  PubMed  Google Scholar 

  9. Wallace DM, Shafazand S, Ramos AR, Carvalho DZ, Gardener H, Lorenzo D, et al. Insomnia characteristics and clinical correlates in Operation Enduring Freedom/Operation Iraqi Freedom veterans with post-traumatic stress disorder and mild traumatic brain injury: an exploratory study. Sleep Med. 2011;12:850–9.

    Article  CAS  PubMed  Google Scholar 

  10. van Liempt S, van Zuiden M, Westenberg H, Super A, Vermetten E. Impact of impaired sleep on the development of PTSD symptoms in combat veterans: a prospective longitudinal cohort study. Depress Anxiety. 2013a;30:469–74.

    Article  PubMed  Google Scholar 

  11. Bertram F, Jamison AL, Slightam C, Kim S, Roth HL, Roth WT. Autonomic arousal during actigraphically estimated waking and sleep in male veterans with PTSD. J Trauma Stress. 2014;27:610–7.

    Article  PubMed  Google Scholar 

  12. Bicanic IAE, Postma RM, Sinnema G, de Roos C, Olff M, van Wesel F, et al. Salivary cortisol and dehydroepiandrosterone sulfate in adolescent rape victims with post traumatic stress disorder. Psychoneuroendocrino. 2013;38:408–15.

    Article  CAS  Google Scholar 

  13. van Wyk M, Thomas KFG, Solms M, Lipinska G. Prominence of hyperarousal symptoms explains variability of sleep disruption in posttraumatic stress disorder. Psychol Trauma-US. 2016; 1–9.

  14. Vissia EM, Giesen ME, Chalavi S, Nijenhuis ERS, Draijer N, Brand BL, et al. Is it trauma- or fantasy-based? Comparing dissociative identity disorder, post-traumatic stress disorder, simulators, and controls. Acta Psychiatr Scand. 2016;134:111–28.

    Article  CAS  PubMed  Google Scholar 

  15. van Heugten-van der Kloet D, Huntjens R, Giesbrecht T, Merckelbach H. Self-reported sleep disturbances in patients with dissociative identity disorder and post-traumatic stress disorder and how they relate to cognitive failures and fantasy proneness. Front Psychiat. 2014;5:1–5.

    Article  Google Scholar 

  16. Rao MN, Chau A, Madden E, Inslicht S, Talbot L, Richards A, et al. Hyperinsulinemic response to oral glucose challenges in individuals with posttraumatic stress disorder. Psychoneuroendocrino. 2014;49:171–81.

    Article  CAS  Google Scholar 

  17. Richards A, Metzler TJ, Ruoff LM, Inslicht SS, Rao M, Talbot LS, et al. Sex differences in objective measures of sleep in post-traumatic stress disorder and healthy control subjects. J Sleep Res. 2013;22:679–87.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Talbot LS, Metzler TJ, Ruoff LM, Inslicht SS, Rao M, Talbot LS, et al. Metabolic risk factors and posttraumatic stress disorder: the role of sleep in young, healthy adults. Psychosom Med. 2015;77:383–91.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Nardo D, Hogberg G, Jonsson C, Jacobsson H, Hallstrom T, Pagani M. Neurobiology of sleep disturbances in PTSD patients and traumatized controls: MRI and SPECT findings. Front Psychiat. 2015;6(134):1–10.

    Google Scholar 

  20. Zuj DV, Palmer MA, Hsu CMK, Nicholson EL, Cushing PJ, Gray KE, et al. Impaired fear extinction association with PTSD increases with hours-since-waking. Depress Anxiety. 2016;33:203–10.

    Article  PubMed  Google Scholar 

  21. Cohen DJ, Begley A, Alman JJ, Cashmere DJ, Pietrone RN, Seres RJ, et al. Quantitative electroencephalography during rapid eye movement (REM) and non-REM sleep in combat-exposed veterans with and without post-traumatic stress disorder. J Sleep Res. 2013a;22:76–82.

    Article  PubMed  Google Scholar 

  22. Cohen BE, Neylan TC, Yaffe K, Samuleson KW, Li Y, Barnes DE. Posttraumatic stress disorder and cognitive function: findings from the mind your heart study. J Clin Psychiat. 2013b;74:1063–70.

    Article  Google Scholar 

  23. Macera CA, Neylan TC, Yaffe K, Samuelson KW, Li Y, Barnes DE. Do sleep problems mediate the relationship between traumatic brain injury and development of mental health symptoms after deployment? Sleep. 2013;36:83–90.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Yehuda R, Flory JD, Bierer LM, Henn-Haase C, Lehrner A, Desarnaud F, et al. Lower methylation of glucocorticoid receptor gene promoter 1F in peripheral blood of veterans with posttraumatic stress disorder. Biol Psychiat. 2015;77:356–64.

    Article  CAS  PubMed  Google Scholar 

  25. Babson KA, Badour CL, Feldner MT, Bunaciu L. The relationship of sleep quality and PTSD to anxious reactivity from idiographic traumatic event script-driven imagery. J Trauma Stress. 2012a;25:503–10.

    Article  PubMed  Google Scholar 

  26. Mazza M, Tempesta D, Pino MC, Nigri A, Catalucci A, Guadagni V, et al. Neural activity related to cognitive and emotional empathy in post-traumatic stress disorder. Behave Brain Res. 2015;282:37–45.

    Article  Google Scholar 

  27. Tempesta D, Mazza M, Iaria G, De Gennaro L, Ferrara M. A specific deficit in spatial memory acquisition in post-traumatic stress disorder and the role of sleep in its consolidation. Hippocampus. 2012;22:1154–63.

    Article  CAS  PubMed  Google Scholar 

  28. Wild J, Smith KV, Thompson E, Bear F, Lommen MJJ, Ehlers A. A prospective study of pre-trauma risk factors for post-traumatic stress disorder and depression. Psychol Med. 2016;46:2571–82.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Ait-Aoudia M, Levy PP, Bui E, Insana S, de Fouchier C, Germain A, et al. Validation of the French version of the Pittsburgh Sleep Quality Index Addendum for posttraumatic stress disorder. E J Psychotraumatol. 2013;4:19298.

    Article  Google Scholar 

  30. Dennis PA, Watkins LL, Calhoun PS, Oddone A, Sherwood A, Dennis MF, et al. Posttraumatic stress, heart rate variability, and the mediating role of behavioral health risks. Psychos Med. 2014;76:629–37.

    Article  Google Scholar 

  31. Meyerhoff DJ, Mon A, Metzler T, Neylan TC. Cortical gamma-aminobutyric acid and glutamate in posttraumatic stress disorder and their relationships to self-reported sleep quality. Sleep. 2014;37(5):893–900.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Turner JH, Neylan TC, Schiller NB, Li Y, Cohen BE. Objective evidence of myocardial ischemia in patients with posttraumatic stress disorder. Biol Psychiat. 2013;74:861–6.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Thordardottir EB, Valdimarsdottir UA, Hansdottir I, Resnick H, Shipherd JC, Gudmundsdottir B. Posttraumatic stress and other health consequences of catastrophic avalanches: a 16-year follow-up of survivors. J Anxiety Disord. 2015;32:103–11.

    Article  PubMed  Google Scholar 

  34. Babson KA, Blonigen DM, Boden MT, Drescher KD, Bonn-Miller MO. Sleep quality among U.S. military veterans with PTSD: a factor analysis and structural model of symptoms. J Trauma Stress. 2012b;25:665–74.

    Article  PubMed  Google Scholar 

  35. Bourn LE, Sexton MB, Raggio GA, Porter KE, Rauch SAM. Posttraumatic stress disorder and somatic complaints: contrasting Vietnam and OIF/OEF veterans’ experiences. J Psychosom Res. 2016;82:35–40.

    Article  PubMed  Google Scholar 

  36. Davidson CL, Babson KA, Bonn-Miller MO, Souter T, Vannoy S. The impact of exercise on suicide risk: examining pathways through depression, PTSD, and sleep in an inpatient sample of veterans. Suicide Life Threat. 2013;43(3):279–89.

    Article  Google Scholar 

  37. Short NA, Ennis CR, Oglesby ME, Boffa JW, Joiner TE, Schmidt NB. The mediating role of sleep disturbances in the relationship between posttraumatic stress disorder and self-injurious behavior. J Anxiety Disord. 2015a;35:68–74.

    Article  PubMed  Google Scholar 

  38. Casement MD, Harrington KM, Miller MW, Resick PA. Associations between Pittsburgh Sleep Quality Index factors and health outcomes in women with posttraumatic stress disorder. Sleep Med. 2012;13:752–8.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Bryan CJ, Gonzales J, Rudd MD, Bryan AO, Clemans TA, Ray-Sannerud B, et al. Depression mediates the relation of insomnia severity with suicide risk in three clinical samples of U. S. military personnel. Depress Anxiety. 2015;32:647–55.

    Article  PubMed  Google Scholar 

  40. Bryan CJ. Repetitive traumatic brain injury (or concussion) increases severity of sleep disturbance among deployed military personnel. Sleep. 2013;36(6):941–6.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Chao LL, Mohlenhoff BS, Weiner MW, Neylan TC. Associations between subjective sleep quality and brain volume in Gulf War veterans. Sleep. 2014;37(3):445–52.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Farrell-Carnahan L, Franke L, Graham C, McNamee S. Subjective sleep disturbance in veterans receiving care in the veterans affairs polytrauma system following blast-related mild traumatic brain injury. Mil Med. 2013;178(9):951–6.

    Article  PubMed  Google Scholar 

  43. Insana SP, Hall M, Buysse DJ, German A. Validation of the Pittsburgh Sleep Quality Index Addendum for posttraumatic stress disorder (PSQI-A) in U. S. male military veterans. J Trauma Stress. 2013;26:192–200.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Lang KP, Veazey-Morris K, Andrasik F. Exploring the role of insomnia in the relation between PTSD and pain in veterans with polytrauma injuries. J Head Trauma Rehabil. 2014;29(1):44–53.

    Article  PubMed  Google Scholar 

  45. Martindale SL, Morissette SB, Rowland JA, Dolan SL. Sleep quality affects cognitive functioning in returning combat veterans beyond combat exposure, PTSD, and mild TBI history. Neuropsychol 2016.

  46. Plumb TR, Peachey JT, Zelman DC. Sleep disturbance is common among service members and veterans of Operations Enduring Freedom and Iraqi Freedom. Psychol Serv. 2014;11(2):209–19.

    Article  PubMed  Google Scholar 

  47. Quartana PJ, Wilk JE, Balkin TJ, Hoge CW. Indirect associations of combat exposure with post-deployment physical symptoms in U. S. soldiers: roles of post-traumatic stress disorder, depression, and insomnia. J Psychosom Res. 2015;78:478–83.

    Article  PubMed  Google Scholar 

  48. Swinkels CM, Ulmer CS, Beckham JC, Buse N, the VA-Mid-Atlantic MIRECC Registry Workgroup, Calhoun PS. The association of sleep duration, mental health, and health risk behavior among U. S. Afghanistan/Iraq era veterans. Sleep. 2013;36(7):1019–25.

    PubMed  PubMed Central  Google Scholar 

  49. Talbot LS, Neylan TC, Metzler TJ, Cohen BE. The mediating effect of sleep quality on the relationship between PTSD and physical activity. J Clin Sleep Med. 2014a;10(7):795–801.

    PubMed  PubMed Central  Google Scholar 

  50. Waldron-Perrine B, Hennrick H, Spencer RJ, Pangilinan PH, Bieliauskas LA. Postconcussive symptom report in polytrauma: influences of mild traumatic brain injury and psychiatric distress. Mil Med. 2014;179(8):856–64.

    Article  PubMed  Google Scholar 

  51. Giosan C, Malta LS, Wyka K, Jayasinghe N, Evans S, Difede J, et al. Sleep disturbance, disability, and posttraumatic stress disorder in utility workers. J Clin Psychol. 2015;71(1):72–84.

    Article  PubMed  Google Scholar 

  52. Inslicht SS, Otte C, McCaslin SE, Apfel BA, Henn-Haase C, Metzler T, et al. Cortisol awakening response prospectively predicts peritraumatic and acute stress reactions in police officers. Biol Psychiat. 2011;70:1055–62.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  53. Yun JA, Ahn TS, Jeong KS, Joo EJ, Choi KS. The relationship between chronotype and sleep quality in Korean firefighters. Clin Psychopharmacol Neurosci. 2015;13(2):201–8.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Andersen TE, Andersen LC, Andersen PG. Chronic pain patients with possible co-morbid post-traumatic stress disorder admitted to multidisciplinary pain rehabilitation—a 1-year cohort study. Eur J Psychotraumatol. 2014;5:23235.

    Article  Google Scholar 

  55. Cyders MA, Burris JL, Carlson CR. Disaggregating the relationship between posttraumatic stress disorder symptom clusters and chronic orofacial with PTSD symptom clusters. Ann Behav Med. 2011;41:1–12.

    Article  PubMed  Google Scholar 

  56. Shaffer JA, Kronish IM, Burg M, Clemow L, Edmondson D. Association of acute coronary syndrome-induced posttraumatic stress disorder symptoms with self-reported sleep. Ann Behav Med. 2013;46:349–57.

    Article  PubMed  Google Scholar 

  57. Swanson LM, Hamilton L, Muzik M. The role of childhood trauma and PTSD in postpartum sleep disturbance. J Trauma Stress. 2014;27:689–94.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Brown TH, Mellman TA. The influence of PTSD, sleep fears, and neighborhood stress on insomnia and short sleep duration in urban, young adult. African Americans Behav Sleep Med. 2014;12(3):198–206.

    Article  Google Scholar 

  59. Fairholme CP, Nosen EL, Nillni YI, Schumacher JA, Tull MT, Coffey SF. Sleep disturbance and emotion dysregulation as transdiagnostic processes in a comorbid sample. Behav Res Ther. 2013;51:540–6.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Bronstein I, Montgomery P. Sleeping patterns of Afghan unaccompanied asylum-seeking adolescents: a large observational study. PLoS One. 2013; 8(2).

  61. Jiang S, Yan Z, Jing P, Li C, Zheng T, He J. Relationships between sleep problems and psychiatric comorbidities among China’s Wenchuan earthquake survivors remaining in temporary housing camps. Front Psychol. 2016;7:1552.

    PubMed  PubMed Central  Google Scholar 

  62. Golding S, Nadorff MR, Winer ES, Ward KC. Unpacking sleep and suicide in older adults in a combined online sample. J Clin Sleep Med. 2015;11(12):1385–92.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Lee JS, Lee SW, Choi SK, Chung US, Jeong B. Differential mediating effects of PTSD symptom clusters on alcohol use and sleep in university students with trauma experiences: a multi-group analysis. Pers Indiv Differ. 2015;85:1–6.

    Article  Google Scholar 

  64. McCubbin JA, Zinzow HM, Hibdon MA, Nathan AW, Morrison AV, Hayden GW, et al. Subclinical posttraumatic stress disorder symptoms: relationships with blood pressure, hostility, and sleep. Cardiovasc Psychiatry Neurol. 2016.

  65. Pickett SM, Barbaro N, Mello D. The relationship between subjective sleep disturbance, sleep quality, and emotion regulation difficulties in a sample of college students reporting trauma exposure. Psychol Trauma-US. 2016;8(1):25–33.

    Article  Google Scholar 

  66. Qu Z, Wang X, Tian D, Zhao Y, Zhang Q, He H, et al. Posttraumatic stress disorder and depression among new mothers at 8 months for later of the 2008 Sichuan earthquake in China. Arch Womens Ment Health. 2012;15:49–55.

    Article  PubMed  Google Scholar 

  67. Troxel WM, Germain A. Insecure attachment is an independent correlate of objective sleep disturbances in military veterans. Sleep Med. 2011;12:860–5.

    Article  PubMed  PubMed Central  Google Scholar 

  68. Krakow B, Krakow J, Ulibarri VA, Krakow J. Nocturnal time monitoring behavior (“clock-watching”) in patients presenting to a sleep medical center with insomnia and posttraumatic stress symptoms. J Nerv Ment Dis. 2012;200(9):821–5.

    Article  PubMed  Google Scholar 

  69. Collen JF, Lettieri CJ, Hoffman M. The impact of posttraumatic stress disorder on CPAP adherence in patients with obstructive sleep apnea. J Clin Sleep Med. 2012;8(6):667–72.

    PubMed  PubMed Central  Google Scholar 

  70. Mysliwiec V, Matsangas P, Gill J, Baxter T, O’Reilly B, Collen JF, et al. A comparative analysis of sleep disordered breathing in active duty service members with and without combat-related posttraumatic stress disorder. J Clin Sleep Med. 2015;11(12):1393–401.

    Article  PubMed  PubMed Central  Google Scholar 

  71. Taylor DJ, Pruiksma KE, Hale WJ, Kelly K, Maurer D, Peterson AL, et al. Prevalence, correlates, and predictors of insomnia in the U. S. army prior to deployment. Sleep. 2016;39(10):1795–806.

    Article  PubMed  PubMed Central  Google Scholar 

  72. Parsons EC, Hough CL, Vitiello MV, Zatzick D, Davydow DS. Insomnia is associated with quality of life impairment in medical-surgical intensive care unit survivors. Heart Lung. 2015;44:89–94.

    Article  PubMed  Google Scholar 

  73. Boscarino JA, Kirchner HL, Hoffman SN, Erlich PM. Predicting PTSD using the New York risk score with genotype data: potential clinical and research opportunities. Neuropsych Dis Treat. 2013;9:517–27.

    Article  Google Scholar 

  74. Kobayashi I, Delahanty DL. Gender differences in subjective sleep after trauma and the development of posttraumatic stress disorder symptoms: a pilot study. J Trauma Stress. 2013;26:467–74.

    Article  PubMed  Google Scholar 

  75. Hall Brown TS, Akeeb A, Mellman TA. The role of trauma type in the risk for insomnia. J Clin Sleep Med. 2015;11(7):735–9.

    PubMed  PubMed Central  Google Scholar 

  76. Graham J, Legarreta M, North L, DiMuzio J, McGlade E, Yurgelun-Todd D. A preliminary study of DSM-5 PTSD symptom patterns in veterans by trauma type. Mil Psychol. 2016;28(2):115–22.

    Article  Google Scholar 

  77. Jenkins MM, Colvonen PJ, Norman SB, Afari N, Allard CB, Drummond SPA. Prevalence and mental health correlates of insomnia in first-encounter veterans with and without military sexual trauma. Sleep. 2015;38(10):1547–54.

    Article  PubMed  PubMed Central  Google Scholar 

  78. Elklit A, Hyland P, Shevlin M. Evidence of symptom profiles consistent with posttraumatic stress disorder and complex posttraumatic stress disorder in different trauma samples. Eur J Psychotraumatol. 2014.

  79. Armour C, Elklit A, Lauterbach D, Elhai JD. The DSM-5 dissociative-PTSD subtype: can levels of depression, anxiety, hostility, and sleeping difficulties differentiate between dissociative-PTSD and PTSD in rape and sexual assault victims? J Anxiety Disord. 2014;28:418–26.

    Article  PubMed  Google Scholar 

  80. Lindal E, Stefansson JG. The long-term psychological effect of fatal accidents at sea on survivors: a cross-sectional study of North-Atlantic seamen. Soc Psychiatry Psychiatr Epidemiol. 2011;46:239–46.

    Article  CAS  PubMed  Google Scholar 

  81. Usami M, Iwadare Y, Kodaira M, Watanabe K, Aoki M, Katsumi C, et al. Sleep duration among children eight months after the 2011 Japan earthquake and tsunami. PLoS ONE. 2013; 8(5).

  82. Elliot R, McKinley S, Fien M, Elliot D. Posttraumatic stress symptoms in intensive care patients: an exploration of associated factors. Rehabil Psychol. 2016;61(2):141–50.

    Article  Google Scholar 

  83. McKinley S, Fien M, Elliott R, Elliott D. Sleep and psychological health during early recovery from critical illness: an observational study. J Psychosom Res. 2013;75:539–45.

    Article  PubMed  Google Scholar 

  84. Hall Brown T, Mellman TA, Alfano CA, Weems CF. Sleep fears, sleep disturbance, and PTSD symptoms in minority youth exposed to Hurricane Katrina. J Trauma Stress. 2011;24(5):575–80.

    Article  Google Scholar 

  85. Fan F, Zhou Y, Liu X. Sleep disturbance predicts posttraumatic stress disorder and depressive symptoms: a cohort study of Chinese adolescents. J Clin Psychiat. 2016.

  86. Thormar SB, Gersons BPR, Juen B, Djakababa MN, Karlsson T, Olff M. The impact of disaster work on community volunteers: the role of peri-traumatic distress, level of personal affectedness, sleep quality, and resource loss, on post-traumatic stress disorder symptoms and subjective health. J Anxiety Disord. 2014;28:971–7.

    Article  PubMed  Google Scholar 

  87. Zhang J, Zhu S, Du C, Zhang Y. Posttraumatic stress disorder and somatic symptoms among child and adolescent survivors following the Lushan earthquake in China: a six-month longitudinal study. J Psychosom Res. 2015;79:100–6.

    Article  PubMed  Google Scholar 

  88. • Koffel E, Polusny MA, Arbisi PA, Erbes CR. Pre-deployment daytime and nighttime sleep complaints as predictors of post-deployment PTSD and depression in National Guard troops. J Anxiety Disord. 2013;27:512–9. Pre-deployment sleep disturbance predicts post-deployment PTSD symptoms over and above the effect of baseline symptoms.

    Article  PubMed  Google Scholar 

  89. • Gehrman P, Seelig AD, Jacobson IG, Boyko EJ, Hooper TI, Gackstetter GD, et al. Predeployment sleep duration and insomnia symptoms as risk factors for new-onset mental health disorders following military deployment. Sleep. 2013;36(7):1009–18. Pre-deployment sleep disturbance associated with increased odds of developing sleep disturbance post-deployment.

    Article  PubMed  PubMed Central  Google Scholar 

  90. Pigeon WR, Campbell CE, Possemato K, Ouimette P. Longitudinal relationships of insomnia, nightmares, and PTSD severity in recent combat veterans. J Psychosom Res. 2013;75:546–50.

    Article  PubMed  Google Scholar 

  91. Wright KM, Britt TW, Bliese PD, Adler AB, Picchioni D, Moore D. Insomnia as predictor versus outcome of PTSD and depression among Iraq combat veterans. J Clin Psychol. 2011;67:1240–58.

    Article  PubMed  Google Scholar 

  92. Gerhart JI, Hall BJ, Russ EU, Canetti D, Hobfoll SE. Sleep disturbances predict later trauma-related distress: cross-panel investigation amidst violent turmoil. Health Psychol. 2014;33(4):365–72.

    Article  PubMed  Google Scholar 

  93. Garthus-Niegel S, Ayers S, von Soest T, Torgersen L, Eberhard-Gran M. Maintaining factors of posttraumatic stress ymptoms following childbirth: a population-based, two-year follow-up study. J Affect Disord. 2015;172:146–52.

    Article  PubMed  Google Scholar 

  94. Suliman S, Stein DJ, Seedat S. Clinical and neuropsychological predictors posttraumatic stress disorder. Medicine. 2014; 93(22).

  95. van Liempt S, Arends J, Cluitmans PJM, Westenberg HGM, Kahn RS, Vermetten E. Sympathetic activity and hypothalamo-pituitary-adrenal axis activity during sleep in post-traumatic stress disorder: a study assessing polysomnography with simultaneous blood sampling. Psychoneuroendocrino. 2013b;38:155–65.

    Article  CAS  Google Scholar 

  96. • Ribeiro JD, Pease JL, Gutierrez PM, Silva C, Bernert RA, Rudd MD, et al. Sleep problems outperform depression and hopelessness as cross-sectional and longitudinal predictors of suicidal ideation and behavior in young adults in the military. J Affect Disord. 2012;136:743–50. Insomnia is associated with suicidal ideation in a military sample, controlling for depression, hopelessness, and PTSD symptoms, and predicts suicide attempts over 1 month controlling for depression, hopelessness, and baseline insomnia.

    Article  PubMed  Google Scholar 

  97. Betts KS, Williams GM, Najman JM, Alati R. The role of sleep disturbance in the relationship between post-traumatic stress disorder and suicidal ideation. J Anxiety Disord. 2013;27:735–41.

    Article  PubMed  Google Scholar 

  98. Littlewood DL, Gooding PA, Panagioti M, Kyle SD. Nightmares and suicide in posttraumatic stress disorder: the mediating role of defeat, entrapment, and hopelessness. J Clin Sleep Med. 2016;12(3):393–9.

    Article  PubMed  PubMed Central  Google Scholar 

  99. Richardson JD, St. Cyr K, Nelson C, Elhai JD, Sareen J. Sleep disturbances and suicidal ideation in a sample of treatment-seeking Canadian Forces members and veterans. Psychiat Res. 2014;218:118–23.

    Article  Google Scholar 

  100. Rossa KR, Smith SS, Allan AC, Sullivan KA. The effects of sleep restriction on executive inhibitory control and affect in young adults. J Adolesc Health. 2013;55:287–92.

    Article  Google Scholar 

  101. Mauss IB, Troy AS, LeBourgeois MK. Poorer sleep quality is associated with lower emotion-regulation ability in a laboratory paradigm. Cog Emot. 2013;27:567–76.

    Article  Google Scholar 

  102. Babson KA, Boden MT, Woodward S, Alvarez J, Bonn-Miller M. Anxiety sensitivity and sleep quality: independent and interactive predictors of posttraumatic stress disorder symptoms. J Nerv Ment Dis. 2013;201(1):48–51.

    Article  PubMed  Google Scholar 

  103. Short NA, Raines AM, Oglesby ME, Zvolensky MJ, Schmidt NB. Insomnia and emotion dysregulation: independent interactive associations with posttraumatic stress symptoms among trauma-exposed smokers. J Affect Disord. 2014;165:159–65.

  104. LaMotte AD, Taft CT, Weatherill RP, Casement MD, Creech SK, Milberg WP, et al.. Sleep problems and physical pain as moderators of the relationship between PTSD symptoms and aggression in returning veterans. Psychol Trauma-US. 2016.

  105. Grossman ES, Hoffman Y, Bodner E, Palgi Y, Gottlieb M, Mesika O, et al. Psychological effects following the Iran nuclear deal: Iranian nuclear threat salience moderates the relationship between PTSD symptoms and sleep problems. Psychiat Res. 2016;243:292–4.

    Article  Google Scholar 

  106. Short NA, Babson KA, Boden MT, Bonn-Miller MO. Sleep quality, problematic cannabis use and posttraumatic stress symptoms among medical cannabis users. Addict Res Theory. 2015b;23(3):246–52.

    Article  Google Scholar 

  107. Borders A, Rothman DJ, McAndrew LM. Sleep problems may mediate associations between rumination and PTSD and depressive symptoms among OIF/OEF veterans. Psychol Trauma-US. 2015;7(1):76–84.

    Article  Google Scholar 

  108. van Liempt S, Vermetten E, Lentjes E, Arends J, Westenberg H. Decreased nocturnal growth hormone secretion and sleep fragmentation in combat-related posttraumatic stress disorder: potential predictors of impaired memory consolidation. Psychoneuroendocrino. 2011;36:1361–9.

    Article  CAS  Google Scholar 

  109. Lipinska M, Timol R, Kaminer D, Thomas KDF. Disrupted rapid eye movement sleep predicts poor declarative memory performance in post-traumatic stress disorder. J Sleep Res. 2014;23:311–9.

    Article  Google Scholar 

  110. Fisher AJ, Woodward SH. Cardiac stability at differing levels of temporal analysis in panic disorder, post-traumatic stress disorder, and healthy controls. Psychophysiol. 2014;51:80–7.

    Article  Google Scholar 

  111. Kobayashi I, Lavela J, Bell K, Mellman TA. The impact of posttraumatic stress disorder versus resilience on nocturnal autonomic nervous system activity as functions of sleep stage and time of sleep. Physiol Behav. 2016;164:11–8.

    Article  CAS  PubMed  Google Scholar 

  112. Cowdin N, Kobayashi I, Mellman TA. Theta frequency activity during rapid eye movement (REM) sleep is greater in people with resilience versus PTSD. Exp Brain Res. 2014;232:1479–85.

    Article  PubMed  PubMed Central  Google Scholar 

  113. Kobayashi I, Lavela J, Mellman TA. Nocturnal autonomic balance and sleep in PTSD and resilience. J Trauma Stress. 2014;27:712–6.

    Article  PubMed  Google Scholar 

  114. Kobayashi I, Mellman TA. Gender differences in sleep during the aftermath of trauma and the development of posttraumatic stress disorder. Behav Sleep Med. 2012;10(3):180–90.

    Article  PubMed  PubMed Central  Google Scholar 

  115. Bixler EO, Papaliaga MN, Vgontzas AN, Lin H, Pejovic S, Karataraki M, et al. Women sleep objectively better than men and the sleep of young women is more resilient to external stressors: effects of age and menopause. J Sleep Res. 2009;18:221–8.

    Article  PubMed  PubMed Central  Google Scholar 

  116. Mellman TA, Kobayashi I, Lavela J, Wilson B, Hall Brown TS. A relationship between REM sleep measures and the duration of posttraumatic stress disorder in a young adult urban minority population. Sleep. 2014;37(8):1321–6.

    Article  PubMed  PubMed Central  Google Scholar 

  117. Brownlow JA, Hall Brown TS, Mellman TA. Relationships of posttraumatic stress symptoms and sleep measures to cognitive performances in young-adult African Americans. J Trauma Stress. 2014;27:217–23.

    Article  PubMed  Google Scholar 

  118. Capaldi VF, Guerrero ML, Killgore WDS. Sleep disruptions among returning combat veterans from Iraq and Afghanistan. Mil Med. 2011;176(8):879–88.

    Article  PubMed  Google Scholar 

  119. Ebdlahad S, Nofzinger EA, James JA, Buysse DJ, Price JC, Germain A. Comparing neural correlates of REM sleep in posttraumatic stress disorder and depression: a neuroimaging study. Psychiat Res-Neuroim. 2013;214:422–8.

    Article  Google Scholar 

  120. Baker FC, Maloney S, Driver HS. A comparison of subjective estimates of sleep with objective polysomnographic data in healthy men and women. J Psychosom Res. 1999;47:335–41.

    Article  CAS  PubMed  Google Scholar 

  121. Rotenberg VS, Indursky P, Kayumov L, Sirota P, Melamed Y. The relationship between subjective sleep estimation and objective sleep variables in depressed patients. Int J Psychophysiol. 2000;37:291–7.

    Article  CAS  PubMed  Google Scholar 

  122. Werner KB, Griffin MG, Galovski TE. Objective and subjective measurement of sleep disturbance in female trauma survivors with posttraumatic stress disorder. Psychiat Res. 2016;240:234–40.

  123. Ghadami MR, Khaledi-Paveh B, Nasouri M, Khazaie H. PTSD-related paradoxical insomnia: an actigraphic study among veterans with chronic PTSD. J Inj Violence Res. 2014.

  124. Kobayashi I, Huntley E, Lavela J, Mellman TA. Subjectively and objectively measured sleep with and without posttraumatic stress disorder and trauma exposure. Sleep. 2012;35(7):957–65.

    PubMed  PubMed Central  Google Scholar 

  125. Lipinska G, Baldwin DS, Thomas KGF. Pharmacology for sleep disturbance in PTSD. Hum Psychopharm Clin. 2016;31:156–63.

    Article  CAS  Google Scholar 

  126. Difede J, Cukor J, Wyka K, Olden M, Hoffman H, Lee FA, et al. D-cycloserine augmentation of exposure therapy for post-traumatic stress disorder: a pilot randomized clinical trial. Neuropsychopharmacol. 2014;39:1052–8.

    Article  CAS  Google Scholar 

  127. Haynes PL, Kelly M, Warner L, Quan SF, Krakow B, Bootzin RR. Cognitive behavioral social rhythm group therapy for veterans with posttraumatic stress disorder, depression, and sleep disturbance: results form an open trial. J Affect Disord. 2016;192:234–43.

    Article  PubMed  Google Scholar 

  128. Lommen MJJ, Grey N, Clark DM, Wild J, Stott R, Ehlers A. Sleep and treatment outcome in posttraumatic stress disorder: results from an effectiveness study. Depress Anxiety. 2016;33:575–83.

    Article  PubMed  Google Scholar 

  129. Jindani F, Turner N, Khalsa SBS. A yoga intervention for posttraumatic stress: a preliminary randomized control trial. eCAM. 2015.

  130. Raboni MR, Alonso FFD, Tufik S, Suchecki D. Improvement of mood and sleep alterations in posttraumatic stress disorder patients by eye movement desensitization and reprocessing. Front Behave Neruosci. 2014;8

  131. Beck D, Holt LC, Burkard J, Andrews T, Liu L, Heppner P, et al. Efficacy of the mantram repetition program for insomnia in veterans with posttraumatic stress disorder. Adv Nurs Sci. 2016;0:1–12.

    Article  Google Scholar 

  132. Margolies SO, Rybarczyk B, Vrana SR, Leszczyszyn DJ, Lynch J. Efficacy of a cognitive-behavioral treatment for insomnia and nightmares in Afghanistan and Iraq veterans with PTSD. J Clin Psychol. 2013;69(10):1026–42.

    Article  PubMed  Google Scholar 

  133. Talbot LS, Maguen S, Metzler TJ, Schmitz M, McCaslin SE, Richards A, et al. Cognitive behavioral therapy for insomnia in posttraumatic stress disorder: a randomized controlled trial. Sleep. 2014b;37(2):327–41.

    Article  PubMed  PubMed Central  Google Scholar 

  134. • Galovski TE, Harik JM, Blain LM, Elwood L, Gloth C, Fletcher TD. Augmenting cognitive processing therapy to improve sleep impairment in PTSD: a randomized controlled trial. J Couns Psychol. 2016;84(2):167–77. Improvements in sleep disturbance predicted improvements in PTSD symptoms.

    Google Scholar 

  135. Rusch HL, Gill JM. Effect of acute sleep disturbance and recovery on insulin-like growth factor-1 (IGF-1): possible connections and clinical implications. J Clin Sleep Med. 2015;11(10):1245–6.

    Article  PubMed  PubMed Central  Google Scholar 

  136. Rosenbaum S, Sherrington C, Tiedemann A. Exercise augmentation compared with usual care for post-traumatic stress disorder: a randomized controlled trial. Acta Psychiatr Scand. 2015;131:350–9.

    Article  CAS  PubMed  Google Scholar 

  137. Babson KA, Heinz AJ, Ramirez G, Puckett M, Irons JG, Bonn-Miller MO, et al. The interactive role of exercise and sleep on veteran recovery from symptoms of PTSD. Ment Health Phys Act. 2015;8:15–20.

    Article  Google Scholar 

  138. van Schagen AM, Lancee J, de Groot IW, Spoormaker VI, van den Bout J. Imagery rehearsal therapy in addition to treatment as usual for patients with diverse psychiatric diagnoses suffering from nightmares: a randomized controlled trial. J Clin Psychiat. 2015;76(9):e1105–13.

    Article  Google Scholar 

  139. Thordardottir K, Gudmundsdottir R, Zoega H, Valdimarsdottir UA, Gudmundsdottir B. Effects of yoga practice on stress-related symptoms in the aftermath of an earthquake: a community-based controlled trial. Complement Ther Med. 2014;22:226–34.

    Article  PubMed  Google Scholar 

  140. Ahmadi K, Hazrati M, Ahmadizadeh M, Noohi S. REM desensitization as a new therapeutic method for posttraumatic stress disorder: a randomized controlled trial. Acta Med Indones. 2015;47(2):111–9.

    PubMed  Google Scholar 

  141. Germain A, Richardson R, Stocker R, Mammen O, Hall M, Bramoweth AD, et al. Treatment for insomnia in combat-exposed OEF/OIF/OND military veterans: preliminary randomized controlled trial. Behav Res Ther. 2014;61:78–88.

    Article  PubMed  PubMed Central  Google Scholar 

  142. Gutner CA, Casement MD, Gilbert KS, Resick PA. Change in sleep symptoms across cognitive processing therapy and prolonged exposure: a longitudinal perspective. Behav Res Ther. 2013;51:817–22.

    Article  PubMed  Google Scholar 

  143. • Pruiksma KE, Taylor DJ, Wachen JS, Mintz J, Young-McCaughan S, Peterson AL, et al. Residual sleep disturbances following PTSD treatment in active duty military personnel. Psychol Trauma-US. 2016;8(6):697–701. Following treatment, 57% of individuals with remitted PTSD continue to report sleep disturbance.

    Article  Google Scholar 

  144. Omisade A, Buxton OM, Rusak B. Impact of acute sleep restriction on cortisol and leptin levels in young women. Physical Behav. 2010;99:651–6.

    Article  CAS  Google Scholar 

  145. Drummond SPA, Paulus MP, Tapert SF. Effects of two nights sleep deprivation and two nights recovery sleep on response inhibition. J Sleep Res. 2006;15:261–5.

    Article  PubMed  Google Scholar 

  146. Dinges DF, Pack F, Williams K, Gillen KA, Powell JW, Ott GE, et al. Cumulative sleepiness, mood disturbance, and psychomotor vigilance performance decrements during a week of sleep restricted to 4-5 hours per night. Sleep. 1997;20:267–77.

    CAS  PubMed  Google Scholar 

  147. Yoo SS, Gujar N, Hu P, Jolesz FA, Walker MP. The human emotional brain without sleep: a prefrontal amygdala disconnect. Curr Biol. 2010;17:877–8.

    Article  CAS  Google Scholar 

  148. Minkel JD, Banks S, Htaik O, Moreta MC, Jones CW, McGlinchey EL, et al. Sleep deprivation and stressors: evidence for elevated negative affect in response to mild stressors when sleep deprived. Emotion. 2012;12:1015–20.

    Article  PubMed  PubMed Central  Google Scholar 

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  1. Department of Psychology, Vanderbilt University, 301 Wilson Hall, 111 21st Avenue South, Nashville, TN, 37240, USA

    Rebecca C. Cox, Breanna M. Tuck & Bunmi O. Olatunji

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Cox, R.C., Tuck, B.M. & Olatunji, B.O. Sleep Disturbance in Posttraumatic Stress Disorder: Epiphenomenon or Causal Factor?. Curr Psychiatry Rep 19, 22 (2017). https://doi.org/10.1007/s11920-017-0773-y

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