Changes in Sleep Disruption in the Treatment of Co‐Occurring Posttraumatic Stress Disorder and Substance Use Disorders

Abstract

Sleep disruption appears not only to reflect a symptom of posttraumatic stress disorder (PTSD), but also a unique vulnerability for its development and maintenance. Studies examining the impact of psychosocial treatments for PTSD on sleep symptoms are few and no studies to date of which we are aware have examined this question in samples with co-occurring substance use disorders. The current study is a secondary analysis of a large clinical trial comparing 2 psychological treatments for co-occurring PTSD and substance use disorders. Women (N = 353) completed measures of PTSD at baseline, end of treatment, and 3-, 6-, and 12-month follow-ups. Results indicated that the prevalence of insomnia, but not nightmares, decreased during treatment, and that 63.8% of participants reported at least 1 clinical-level sleep symptom at the end of treatment. Improvement in sleep symptoms during treatment was associated with better overall PTSD outcomes over time, χ2(1) = 33.81, p < .001. These results extend the existing literature to suggest that residual sleep disruption following PTSD treatment is common in women with co-occurring PTSD and substance use disorders. Research on the benefits of adding sleep-specific intervention for those with residual sleep disruption in this population may be a promising future direction.

Residual Sleep Problems Predict Reduced Response to Prolonged Exposure among Veterans with PTSD

“…However, the present study found an interaction between these two factors (residual sleep disruptions post-treatment and synergistic relations) that also influenced treatment, in that smaller improvements in sleep symptoms were predictive of smaller improvements in symptoms of PTSD and MDD above and beyond other factors. These findings add to the growing literature on comorbid or co-occurring sleep disorders and related residual sleep disturbances following evidence-based psychotherapies for various psychiatric disorders (Pruiksma et al, 2016; McHugh et al, 2014) as well as medical conditions (Stepanski & Rybarczyk, 2006). …”

Examining Insomnia and PTSD Over Time in Veterans in Residential Treatment for Substance Use Disorders and PTSD

“…Only one study has examined sleep, over time, for participants that have both PTSD and SUDs. McHugh et al (2014) found that insomnia decreased during treatment and that lower insomnia severity at the end of treatment predicted lower PTSD severity at follow-up. This finding is in opposition to many of the findings that suggest insomnia does not decrease during treatment for PTSD (e.g., Keane, Fairbank, Caddell, & Zimering, 1989), decreased but still had clinical insomnia (e.g., Cooper & Clum, 1989; Galovski, Monson, Bruce, & Resick, 2009; Gutner, Casement, Gilbert, & Resick, 2013), or had a substantial number of participants with clinical insomnia (e.g., Belleville, Guay, & Marchand, 2011; Zayfert & DeViva, 2004).…”

Relationships between potentially traumatic events, sleep disturbances, and symptoms of PTSD and alcohol use disorder in a young adult sample

“…Further, sleep issues often linger in studies that treat PTSD symptoms or alcohol symptoms alone, without a more targeted sleep-intervention [45]. A recent study examining sleep symptoms following psychosocial treatment for co-morbid PTSD and substance use disorders (SUDs) did find improvement in insomnia, but residual sleep disturbances remained for many participants and there was evidence that improved sleep had a positive influence on PTSD, but not SUD, outcomes [53]. Thus, a more holistic treatment plan that incorporates the triad of related issues established in this paper (i.e., sleep issues, AUD symptoms, and PTSD symptoms) may more effectively address these concerns.…”