🚧 Website Maintenance in Progress: Thank you for visiting! We are currently in the process of enhancing our website to serve you better. Please check back soon for our new and improved website.

jamie-street-WvZ4dTE7dLI-unsplash.jpgThe comorbidity of posttraumatic stress disorder (PTSD) and sleep disorders is staggeringly ‎high, with 70 - 91% of individuals with PTSD reporting sleep disturbances. 1 The most common ‎sleep disturbances include insomnia,2 obstructive sleep apnea (OSA) 3, 4 and nightmares,2 with ‎prevalence rates in individuals with PTSD considerably higher than in unaffected individuals. ‎Examined temporally, there is evidence that sleep disturbances may predict who will develop ‎PTSD following a trauma.Additionally, poor sleep may make other PTSD symptoms more ‎severe6 and may not remit following effective PTSD treatment.7 Finally, while the presence of ‎nightmares and insomnia do not seem to interfere with effective evidence-based PTSD ‎treatments, untreated OSA does.8,9 Taken together, targeted treatment of sleep disorders in the ‎context of PTSD offers a unique and underutilized opportunity to advance clinical care and ‎research. ‎

Insomnia: Among individuals with PTSD, approximately 35-93.3% report insomnia.1,3,10 ‎Although “trouble falling and staying asleep” are symptoms of PTSD, insomnia may be best ‎considered a co-occurring and independent disorder. For instance, insomnia may precede the ‎trauma and predict the development of PTSD.11 Further, when insomnia initially occurs as a ‎symptom of PTSD, it can become an independent disorder when the behavioral and cognitive ‎responses to acute insomnia lead to perpetuating factors (e.g., napping, sleeping pills). This ‎suggests that insomnia needs to be assessed and treated separately from, or in conjunction with, ‎PTSD.‎

Cognitive behavioral therapy for insomnia (CBT-I) is the front-line treatment for insomnia and is effective in ‎PTSD patients.12 CBT-I is a protocol typically involving: 1) sleep restriction, or limiting ‎patients’ time in bed to more closely correspond to the amount of sleep they are able to ‎generate; and 2) stimulus control, or instructing patients to use bed for sleep only in order to ‎strengthen the association between bed and sleep. CBT-I can be delivered individually or in ‎group format over four to eight weeks. Integrated CBT-I and PTSD treatment has shown ‎promise in addressing two clinically meaningful disorders in one treatment.13 ‎

Nightmares: 50-96% of individuals with PTSD report nightmares.2 Nightmares in PTSD have ‎been shown to increase anxiety, depression and suicide. Similar to both insomnia and OSA, ‎there is evidence that nightmares may precede PTSD.2 Nightmares may also influence insomnia ‎through conditioned arousal (e.g., chronic nightmares pair the bed with arousal) and OSA (e.g., ‎nighttime fragmentation leading to increased AHI). However, nightmares have been shown to ‎significantly decrease with evidence-based PTSD treatment,14 insomnia treatment15 and OSA ‎treatment.16 So, while there are effective nightmare treatments such as Imagery Rehearsal ‎Therapy (IRT) and Exposure, Relaxation, and Rescripting Therapy (ERRT), they are often used ‎for residual nightmares following sleep and trauma treatments or if nightmares are the primary ‎complaint of a client.‎

Obstructive Sleep Apnea: Approximately 50–75.7% of individuals with PTSD have OSA.3,4,17 ‎OSA is defined by repeated episodes of apneas (pauses in breathing) and hypopneas (shallow ‎breathing) with decreases in blood oxygenation during sleep. Interestingly, there is increasing ‎evidence that the classic predictors of OSA, such as body mass index (BMI), blood pressure and ‎age, may not apply to younger veterans with PTSD. Two recent studies found 67.3%–69.2% of  ‎younger veterans (mean age = 33.40 - 35.1 years) with lower BMI (BMI = 19.08 - 28.9)4,18 were ‎at high risk of OSA. Unfortunately, this means that the self-report questionnaires commonly ‎used to screen that rely on age/BMI do not accurately predict OSA risk19 and require objective ‎overnight testing (i.e., a “sleep study”). Using a positive airway pressure (PAP) device is the ‎most effective treatment for OSA, but often requires a desensitization class to help individuals ‎with PTSD get used to wearing the PAP device. ‎

Research is still needed to create screening protocols, determine optimal order of treatment and ‎understand treatment mechanisms. Addressing sleep disturbances alongside PTSD treatment has ‎the potential to improve clinical outcomes and quality of life in patients with trauma histories. ‎The Sleep Disorders and Traumatic Stress Special Interest Group (SIG) strives to foster ‎advocacy and organize for improvements in research, prevention/intervention, diagnosis, ‎treatment, services and life outcomes for individuals impacted by trauma.‎

The Sleep Disorders and Traumatic Stress SIG is chaired by myself (Peter Colvonen), Laura ‎Straus (Co-Chair), and student chairs Guadalupe Rivera and Christopher McGrory. My fellow ‎SIG chairs and I hope you reach out to us with questions and consider joining us as we advance ‎these incredibly important research and clinical efforts The primary goal of the Sleep Disorders ‎and Traumatic Stress SIG is to advance theory, research, assessment and evidence-based ‎treatments in traumatic stress and sleep disorders. We hold dissemination, networking and ‎collaboration as key to advancing science and clinical practice. Our diverse group provides ‎opportunities for clinicians, researchers and scientists interested in different aspects of sleep and ‎trauma research to learn from one another. We publish a newsletter, and host at least one ‎networking event for those interested in learning more about and/or collaborating on projects ‎related to sleep and trauma. Please consider joining the Sleep Disorders and Traumatic Stress ‎SIG if you’re interested in learning more!‎

To join the Sleep Disorders and Traumatic Stress SIG: ‎
‎1.‎    Log in and go to your ISTSS member profile. ‎
‎2.‎    Go to the Listservs/Communities tab and select the SIG(s) you want to join from the ‎dropdown. ‎
‎3.‎    Scroll down and click “next,” then “save changes.”‎


‎1.‎    Jenkins MM, Colvonen PJ, Norman SB, Afari N, Allard CB, Drummond SP. Prevalence ‎and mental health correlates of insomnia in first-encounter veterans with and without ‎military sexual trauma. Sleep. 2015;38(10):1547-54.‎
‎2.‎    Neylan TC, Marmar CR, Metzler TJ, et al. Sleep disturbances in the Vietnam ‎generation: findings from a nationally representative sample of male Vietnam veterans. ‎Sleep. 1998;155(7).‎
‎3.‎    Krakow B, Melendrez D, Johnston L, et al. Sleep-disordered breathing, psychiatric ‎distress, and quality of life impairment in sexual assault survivors. The Journal of ‎nervous and mental disease. 2002;190(7):442-52.‎
‎4.‎    Colvonen PJ, Masino T, Drummond SP, Myers US, Angkaw AC, Norman SB. ‎Obstructive Sleep Apnea and Posttraumatic Stress Disorder among OEF/OIF/OND ‎Veterans. Journal of clinical sleep medicine. 2015;11(5):513-18.‎
‎5.‎    Neylan TC, Kessler RC, Ressler KJ, et al. Prior sleep problems and adverse post-‎traumatic neuropsychiatric sequelae of motor vehicle collision in the AURORA study. ‎Sleep. 2021;44(3):zsaa200.‎
‎6.‎    Nadorff MR, Nazem S, Fiske A. Insomnia symptoms, nightmares, and suicidal ideation ‎in a college student sample. Sleep. 2011;34(1):93.‎
‎7.‎    Pruiksma KE, Taylor DJ, Wachen JS, et al. Residual sleep disturbances following PTSD ‎treatment in active duty military personnel. Psychological Trauma: Theory, Research, ‎Practice, and Policy. 2016;8(6):697.‎
‎8.‎    Mesa F, Dickstein BD, Wooten VD, Chard KM. Response to Cognitive Processing ‎Therapy in Veterans With and Without Obstructive Sleep Apnea. Journal of traumatic ‎stress. 2017;30(6):646-55.‎
‎9.‎    Reist C, Gory A, Hollifield M. Sleep‐Disordered Breathing Impact on Efficacy of ‎Prolonged Exposure Therapy for Posttraumatic Stress Disorder. Journal of traumatic ‎stress. 2017;30(2):186-89.‎
‎10.‎    Colvonen PJ, Almklov E, Tripp JC, Ulmer CS, Pittman JOE, Afari N. Prevalence rates ‎and correlates of insomnia disorder in post-9/11 veterans enrolling in VA healthcare. ‎Sleep. 2020;43(12):zsaa119.‎
‎11.‎    Gehrman P, Seelig AD, Jacobson IG, 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.‎
‎12.‎    Talbot LS, Maguen S, Metzler TJ, et al. Cognitive behavioral therapy for insomnia in ‎posttraumatic stress disorder: a randomized controlled trial. Sleep. 2014;37(2):327-41.‎
‎13.‎    Colvonen PJ, Drummond SP, Angkaw AC, Norman SB. Piloting Cognitive Behavioral ‎Therapy for Insomnia Integrated with Prolonged Exposure. . Psychological Trauma: ‎Theory, Research, Practice, and Policy. 2019.‎
‎14.‎    Zayfert C, DeViva JC. Residual insomnia following cognitive behavioral therapy for ‎PTSD. Journal of Traumatic Stress. 2004;17(1):69-73.‎
‎15.‎    Woodward E, Hackmann A, Wild J, Grey N, Clark DM, Ehlers A. Effects of ‎psychotherapies for posttraumatic stress disorder on sleep disturbances: Results from a ‎randomized clinical trial. Behaviour research and therapy. 2017;97:75-85.‎
‎16.‎    Krakow B, Germain A, Tandberg D, et al. Sleep breathing and sleep movement ‎disorders masquerading as insomnia in sexual-assault survivors. Comprehensive ‎Psychiatry. 2000;41(1):49-56.‎
‎17.‎    Zhang Y, Weed JG, Ren R, Tang X, Zhang W. Prevalence of obstructive sleep apnea in ‎patients with posttraumatic stress disorder and its impact on adherence to continuous ‎positive airway pressure therapy: a meta-analysis. Sleep medicine. 2017;36:125-32.‎
‎18.‎    Williams SG, Collen J, Orr N, Holley AB, Lettieri CJ. Sleep disorders in combat-related ‎PTSD. Sleep and Breathing. 2015;19(1):175-82.‎
‎19.‎    Lyons R, Barbir L, Norman SB, Owens R, Colvonen PJ. Examining the association ‎between subjective and objective measures of obstructive sleep apnea risk in veterans ‎with posttraumatic stress disorder and insomnia. 2020.‎