Blood Pressure, Heart Rate Variability & Sleep in Veterans With PTSD

Sleep disturbance is one of the most common complaints of recently deployed Veterans, with
as many as 64% of those deployed to Iraq or Afghanistan returning with insomnia. The sleep
complaints of these younger Veterans and military personnel are likely explained by a
combination of factors, including: the sleep schedule variability required for military
service; the vigilance necessary to remain alert in combat situations; and the sleep
disturbance that stems directly from traumatic combat experiences; to name only a few. Among
those deployed to Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF/OND), up
to 30% meet criteria for posttraumatic stress disorder (PTSD) upon their return or shortly
thereafter, and most of these Veterans (up to 90%) are likely to endorse sleep maintenance
problems. Indeed, PTSD often manifests as a combination of insomnia, short sleep duration,
and nightmares.

There is a burgeoning literature showing an association between insomnia and hypertension,
with some research suggesting that those with insomnia are at triple the risk of HTN
relative to normal sleepers, and that the combination of insomnia and short sleep duration
increases this risk to more than five times that of normal sleepers. These findings suggest
that recently deployed Veterans with insomnia may be at increased risk of developing HTN,
and research on Veterans from earlier eras of military service are consistent with this
possibility. Vietnam era Veterans with combat-related PTSD assessed in 1985 were twice as
likely to have died of early-onset heart disease relative to their non-PTSD counterparts
when reassessed in 2000. In spite of these findings of significant sleep disturbance in
young adults, and the historical evidence of increased cardiovascular disease in Vietnam-era
Veterans with PTSD, data on sleep disturbance and blood pressure in this younger and
ever-increasing population of recently deployed Veterans is lacking. Evidence for impaired
cardiac function in individuals with PTSD has been demonstrated across several studies,
including those examining heart rate variability (HRV). Individuals with PTSD have been
found to have lower HRV and higher resting heart rate. The PI of the proposed study has
conducted pilot research demonstrating that an intervention for trauma-related sleep
disturbance improves sleep in Veterans with PTSD. The purpose of the proposed project is to
further this line of research by determining if treating sleep disturbance improves blood
pressure and heart rate variability in young adults with PTSD.

Inclusion Criteria: Eligible Veterans will: 1) provide informed consent; 2) be OEF/OIF/OND
Veterans who were deployed to Iraq/Afghanistan at least once in a war zone; 3) meet
DSM-IV-R criteria for a diagnosis of current PTSD; 4) endorse nightmares at a frequency of
at least one per week; 5) meet DSM-5 diagnostic criteria for Insomnia; and 6) score
greater than 14 on the Insomnia Severity Index.

Exclusion Criteria: Ineligible Veterans: 1) score <23 on the Montreal Cognitive Assessment
(MoCA) suggesting inadequate cognitive abilities to successfully participate in this
research; 2) have received CBT for insomnia in the past; 2) endorse a current diagnosis of
sleep apnea; 3) Screen positive for Sleep Apnea on the STOP Questionnaire; 4) meet
criteria for Bipolar Disorder (current or lifetime); 5) meet criteria for a Psychotic
Disorder (Current); meet criteria for current Alcohol dependence; 6) meet criteria for
current Substance Use Disorder or Substance Dependence; and 7) meet criteria for lifetime
Substance Dependence.