Residual insomnia following cognitive behavioral therapy for PTSD

Abstract

This study examined whether insomnia persisted after completion of cognitive behavioral therapy (CBT) for PTSD and whether persistence of insomnia was associated with continuing nightmares, vigilance, depression, childhood abuse history, or having been traumatized in a sleep-related context. A retrospective analysis of posttreatment Clinician-Administered PTSD Scale (CAPS) data from 27 patients who no longer met PTSD diagnosis following CBT for PTSD revealed that 48% reported residual insomnia. For the large majority, insomnia persisted in the absence of continuing nightmares and hypervigilance. Experiencing trauma in a sleep-related context was associated with greater risk for residual insomnia, whereas childhood abuse history and depression were not. These findings suggest that interventions to address factors maintaining insomnia residual to PTSD warrant study.

Treatment of sleep disturbances in posttraumatic stress disorder: A review

“…However, sleep disturbances often persist despite relief or moderation of other symptoms. As many as one-half of positive responders to PTSD treatment continue to have residual sleep disturbance * (Zayfert and DeViva [17]). It is therefore important to thoroughly assess and treat sleep disturbances experienced by patients with PTSD.…”

“…However, research indicates that although traumafocused therapies improve sleep in some cases, sleep problems often do not remit after otherwise successful treatment of posttraumatic symptoms (Belleville et al [37], Zayfert and DeViva [17]). The simplest explanation for this is based on a well-accepted model of the development and maintenance of insomnia by Spielman and colleagues (Spielman et al [38]).…”

“…Trauma that occurs in the bed, bedroom, or darkness may cause a conditioned fear response in the sleep setting, which is incompatible with sleep (Zayfert and DeViva [17]). For example, the experience of nighttime combat during a military deployment or being awoken in the middle of the night during childhood by an abuser may associate the sleep setting with arousal and promote hypervigilance before and during sleep.…”

“…These studies generally conclude that, despite an absence of interventions specifically targeting sleep, trauma-focused CBT is generally associated with improvements in sleep. Some studies have found that over half of patients completing traumafocused CBT also experienced significant improvement in sleep (Cooper and Clum [41], Zayfert and DeViva [17]), though one other study found that only 30 percent of patients no longer reported sleep problems after treatment completion (Belleville et al [37]). One study comparing the effects of CPT and PE on sleep found that both interventions resulted in significant improvements in sleep, though posttreatment assessment means were above an established cutoff for poor sleep quality in both conditions (Galovski et al [42]).…”

“…In a study of female rape victims with PTSD, CBT resulted in remission of PTSD symptoms, which was associated with a reduction of heart rate variability (indicator of sympathetic activity) during REM sleep (Nishith et al [43]). Zayfert and DeViva [17] found that disturbed sleep and anger problems are the two most frequently reported residual symptoms following successful treatment of PTSD. Zayfert and DeViva also found that trauma-focused CBT was associated with a large decrease in nightmares and that of the patients who reported continued sleep problems after treatment, less than a quarter were still reporting nightmares of sufficient severity to be coded as a clinical symptom.…”