Sleep disturbances associated with posttraumatic stress disorder and alcohol dependence

Abstract

Sleep disturbances commonly appear in the context of both posttraumatic stress disorder (PTSD) and alcohol use disorders. Sleep symptoms typically reported among clinical populations include delayed sleep onset, poor sleep continuity, early morning awakening, and disturbed sleep architecture. The aim of the present study was to examine multiple forms of sleep disturbances among individuals with comorbid PTSD and alcohol dependence, PTSD only, alcohol dependence only, and a control group. Both PTSD and alcohol dependence diagnoses were associated with multiple forms of sleep disturbance, but comorbidity of the two disorders did not appear to increase the risk over and above either single disorder for reporting any of the sleep difficulties examined. As PTSD symptom severity increased, so did sleep latency, mid-sleep wakening, and early morning wakening. However, contrary to our hypothesis, no significant direct relationship between severity of alcohol use and sleep disturbances was revealed. These findings suggest a need for thorough assessment of sleep symptoms in patients presenting with PTSD or alcohol dependence. Keywordsposttraumatic stress disorder; alcoholism; sleep; insomnia Sleep disturbances frequently co-occur with psychiatric disorders, including substance use disorders (SUDs) and posttraumatic stress disorder (PTSD) (Foster & Peters, 1999). Sleep symptoms typically reported among clinical populations include delayed sleep onset, poor sleep continuity, early morning awakening, and disturbed sleep architecture (Pressman & Orr, 1997). Sleep disruption can occur with acute or chronic alcohol consumption, but the pattern and severity of symptoms depends on the amount and timing of alcohol use (Vitiello, 1997). As a central nervous system depressant, alcohol can reduce sleep latency through its sedative effects. However, alcohol consumption tends to disrupt the first half of the sleep period with increases in slow wave sleep and decreases in rapid eye movement (REM) sleep. In the second half of the sleep period, even relatively low alcohol doses tend to result in increased REM sleep, more frequent episodes of wakefulness, and more frequent shifts between sleep stages (Stone, 1980). Over a number of days of consistent alcohol use near bedtime, the initial sleep Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. , 1997). In patients with alcohol use disorders, insomnia is often part of the withdrawal syndrome and increases risk for relapse (Crum, Ford, Storr, & Chan, 2004;Vitiello, 1997). NIH Public AccessThe self-medication hypothesis suggests that the high com...

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