Despite the well-known association between posttraumatic stress disorder (PTSD) and sleep disturbance, surprisingly little research has examined predictors of sleep disturbances among those with PTSD. Extent studies typically have relied upon cross-sectional data and have not incorporated theoretically-driven predictors of insomnia among those with PTSD. The current study tests PTSD- and sleep-related predictors of insomnia symptoms and nightmares among those with PTSD (N = 30) using ecological momentary assessment (EMA).
Participants were mostly women (61.3%), with ages ranging from 18 to 60 (M = 38.03, SD = 15.14). The majority of the sample was White (64.5%), with a large minority identifying as Black (29.0%). At baseline, participants self-reported their dysfunctional beliefs about sleep (DBAS), sleep-related safety behaviors (SBQ), and fear of sleep (FOS). During the EMA period (8 days, 4 assessments per day), participants self-reported on their sleep quality, efficiency, and nightmares each morning, and their PTSD symptoms four times daily using an abbreviated version of the PTSD Checklist (PCL-C).
Results from multilevel modeling analyses indicated that DBAS (B = .11, SE = .05, p < .05), SBQ (B = .01, SE = .01, p < .01), FOS (B = .02, SE = .01, p < .001), and daily PTSD symptoms (B = .04, SE = .02, p < .05) were associated with poor sleep quality. SBQ (B = -.01, SE < .01, p < .05), FOS (B = -.01, SE < .01, p < .05), and daily nightmares (B = -.08, SE = .04, p < .05) were associated with poor sleep efficiency. Finally, FOS (B = .01, SE < .01, p < .01) and daily PTSD symptoms (B = .02, SE = .01, p < .001) predicted increased nightmares.
Results of the current study are in line with conceptualizations of sleep disturbance in PTSD: both PTSD-related factors (e.g., symptoms, FOS, nightmares), and sleep-related factors (DBAS, SBQ) each contribute to poor sleep. Future research could incorporate actigraphy to objectively measure sleep, and assess daily levels of DBAS, SBQ, and FOS. Clinically, results imply that integrating treatment of fear of sleep could be beneficial when treating sleep disturbance for those with PTSD.
Nicole Short– Clinical Psychology Graduate Student, Florida State University, Tallahassee, Florida
Nicholas Allan– Assistant Professor, Ohio University
Lauren Stentz– Florida State University
Amberly Portero– Research Assitant, Florida State University, Tallahassee, Florida
Norman Schmidt– Professor, Florida State University
Clinical Psychology Graduate Student
Florida State University