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Study Shows Intervention Targeting Trauma-Specific Sleep Disturbances Reduces PTSD Symptoms and Insomnia Severity among Veterans


Approximately 21% of the soldiers in OEF/OIF will receive a diagnosis of PTSD following their service, and most of these Veterans (70-90%) will likely report difficulty initiating or maintaining sleep. Insomnia and nightmares are the two primary complaints of Veterans with PTSD. Although improved sleep may occur with either PTSD treatment or cognitive behavioral therapy (CBT) for insomnia, many continue to experience residual sleep difficulties. Imagery rehearsal therapy (IRT), which uses enhanced imagery skills to “rescript” nightmares, also has been shown to reduce the frequency and severity of nightmares. This pilot study sought to determine whether or not the combined effects of CBT for insomnia and IRT for nightmares would produce significantly greater improvements in sleep disturbance than usual care alone. Investigators recruited 22 Veterans (15 men, 7 women) meeting criteria for PTSD and insomnia from one VA hospital and community Veteran Center between 1/08 and 12/09. Veterans were randomized to the usual care group or the sleep intervention group. Veterans in the sleep intervention group received the same treatment as those in the usual care group (e.g., hypnotics, antidepressants, anxiolytics, referral to mental health clinic), in addition to three sessions of CBT and three sessions of IRT over a 12-week period.

Findings show that the sleep intervention produced large short-term effects, including substantial reductions in PTSD symptoms, including the frequency of nightmares and insomnia severity. In contrast, none of the participants in the usual care group responded or remitted from insomnia or PTSD, and did not improve from baseline on sleep quality. Groups did not differ on the percentage engaged in mental health treatment or medication management during the study period. Four of the 22 participants dropped out of the intervention group before completing the study: all were young, male, and OEF/OIF Veterans. With many younger Veterans returning from deployment with trauma-related sleep disturbance, it will be critical to identify sleep interventions that are not only effective, but accessible. The authors suggest that sleep and trauma researchers should also attempt to determine the optimal sequence of treatment for those with PTSD (e.g., should sleep disturbance be addressed before, after, or concurrent with PTSD treatment?).

PubMed Logo Ulmer C, Edinger J, and Calhoun P. A multi-component cognitive-behavioral intervention for sleep disturbance in Veterans with PTSD: A pilot study. Journal of Clinical Sleep Medicine February 15, 2011;7(1):57-68.

Dr. Ulmer was supported by an HSR&D Career Development Award. All authors are part of HSR&D’s Center for Health Services Research in Primary Care, Durham, NC.

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What are HSR&D Publication Briefs?

HSR&D requires notification by HSR&D-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR&D and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR&D based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR&D published articles. Visit the HSR&D citations database for a complete listing of HSR&D articles and presentations.