The Role of Trauma Type in the Risk for Insomnia

Abstract

Objective: Insomnia is common following exposure to trauma and can occur independently or as a feature of posttraumatic stress disorder (PTSD). However, there is limited research identifying risk factors associated with the development of insomnia following exposure to a traumatic event. The goal of this study was to evaluate the role of specifi c trauma types in the risk for insomnia in a community sample of urban African Americans young adults. Methods: A sample of 554 nonclinical, urban, young adult African Americans was recruited for a larger study from which 465 participants were utilized for this study based on their completion of all study self-report measures. Participants were initially screened by phone to determine whether they provisionally met study criteria. Once selected, participants underwent informed consent and then completed a battery of self-report measures that included the Life Events Checklist, the PTSD Checklist, the Insomnia Severity Index, and the Fear of Sleep Index. Results: Of the seven trauma categories that were endorsed by at least 20% of the sample, results from logistic regression models indicated that sexual trauma, physical assault, accidents, natural disasters, and sudden violent death predicted insomnia independent of sex. However, PTSD symptom severity and nocturnal fears differentially infl uenced the relationship between trauma type and risk for insomnia. Conclusions: Exposure to specifi c types of trauma increases the odds of insomnia twofold to threefold. Additionally, PTSD symptom severity and nocturnal fears contribute differentially to the relationship between trauma exposure and insomnia suggesting the possibility of multiple underlying pathways. Keywords: insomnia, PTSD, sleep disturbance, trauma Citation: Hall Brown TS, Akeeb A, Mellman TA. The role of trauma type in the risk for insomnia.

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

“…PTSD was a significant mediator, with a large indirect effect accounting for over half (61%) of the total effect of interpersonal PTE exposure on disturbed sleep. This is consistent with additional results from Hall Brown and colleagues [14], who found that the odds ratios for interpersonal traumas predicting endorsement of moderate to severe insomnia significantly decreased following the inclusion of PTSD and nocturnal fears into the model. We also found that AUD symptoms were a significant mediator of the relationship between interpersonal PTE exposure and sleep, although the magnitude of the indirect effect was not as high as for PTSD: AUD symptoms accounted for ~17% of the total relationship.…”

“…Many studies have examined sleep following specific traumatic events (e.g., hurricanes, earthquakes, combat), but few have looked at multiple trauma types within the same sample [14]. A recent study that examined various traumatic events in an urban young adult sample found that interpersonal traumas were potent predictors of insomnia [14], which, taken with our results, shows that findings across trauma and sleep are robust.…”

“…Our results are consistent with complimentary lines of evidence in that disturbed sleep and internalizing disorders are highly comorbid and related, in that sleep is not only a symptom of common disorders [24] but is also a predictor of future psychiatric outcomes following trauma exposure [e.g., 44]. Many studies have examined sleep following specific traumatic events (e.g., hurricanes, earthquakes, combat), but few have looked at multiple trauma types within the same sample [14]. A recent study that examined various traumatic events in an urban young adult sample found that interpersonal traumas were potent predictors of insomnia [14], which, taken with our results, shows that findings across trauma and sleep are robust.…”

“…Traumatic events can be categorized as interpersonal (e.g., physical assault, sexual assault) or accidental (e.g., natural disasters, motor vehicle accidents), with interpersonal trauma experienced more frequently by women [12] and associated with greater risk for internalizing psychiatric disorders [e.g., 13]. However, few studies have explored sleep differences (e.g., disturbed sleep, insomnia) across sub-types of trauma exposure [14], and there is a lack of research examining the general relationships between trauma and sleep among college students specifically [15], despite college being a time of increased risk for both trauma exposure and sleep problems.…”

Understanding Recent Insights in Sleep and Posttraumatic Stress Disorder from a Research Domain Criteria (RDoC) Framework

“…One study found that specific trauma types (e.g., sexual trauma, physical assault, and witnessing sudden violent death) are linked with subsequent sleep disturbance severity [59]. Also, sleep disturbance may initiate or exacerbate PTSD.…”