Treating Co-Morbid Sleep Difficulties in Veterans With Posttraumatic Stress Disorder (PTSD): A Pilot Study
| Status: | Completed |
|---|---|
| Conditions: | Insomnia Sleep Studies, Psychiatric, Psychiatric |
| Therapuetic Areas: | Psychiatry / Psychology |
| Healthy: | No |
| Age Range: | Any |
| Updated: | 4/21/2016 |
| Start Date: | January 2008 |
| End Date: | December 2009 |
Treating Co-Morbid Sleep Difficulties in Veterans With PTSD: A Pilot Study
A substantial number of US Veterans are suffering from Posttraumatic Stress Disorder (PTSD)
following deployment in recent military conflicts, and sleep disturbance is a primary
complaint of Veterans presenting to the VA with PTSD. Veterans with PTSD have more
self-reported and physician-rated health problems, and health status is associated with PTSD
symptom severity. Most Veterans meeting criteria for PTSD report difficulty initiating or
maintaining sleep (70-91%), and increased PTSD severity is associated with increased sleep
disturbance. Even after receiving treatment for PTSD, Veterans continue to experience
residual insomnia at a rate of about 50%, in spite of having achieved PTSD remission.
There are currently no PTSD-specific sleep interventions available, excepting an
intervention that is specific to nightmares. Given the prevalence of sleep disturbance in
Veterans with PTSD, the absence of interventions for PTSD-related sleep problems, and the
increasing number of post-deployment Veterans with trauma-related sleep difficulties, such
interventions are desperately needed. In this study, we will test the effectiveness of a
multi-component cognitive-behavioral sleep intervention for PTSD that targets both
nightmares and insomnia for improving the overall sleep experience of Operation Iraqi
Freedom (OIF) and Operation Enduring Freedom (OEF) Veterans with PTSD who are also receiving
usual care. The primary objective is to pilot test the intervention for efficacy in reducing
sleep disturbance. The secondary objective is to examine the relative impact of the
intervention on PTSD symptoms. The project is a prospective, randomized, clinical
intervention trial. Participants will be randomly assigned to a multi-component
cognitive-behavioral sleep intervention for PTSD + Usual Care, or Usual Care alone. We are
hypothesizing that 1) Veterans receiving the sleep intervention plus usual care will produce
greater improvements (reduced total wake time, increased sleep efficiency, etc) in
subjective sleep measures than will Usual Care alone; 2) Veterans receiving the sleep
intervention plus usual care will produce greater improvements in nightmare frequency and
severity than will Usual Care alone; and 3) the relationship between PTSD symptoms and
treatment group will be significantly related to sleep quality in the period intervening
baseline and follow-up.
following deployment in recent military conflicts, and sleep disturbance is a primary
complaint of Veterans presenting to the VA with PTSD. Veterans with PTSD have more
self-reported and physician-rated health problems, and health status is associated with PTSD
symptom severity. Most Veterans meeting criteria for PTSD report difficulty initiating or
maintaining sleep (70-91%), and increased PTSD severity is associated with increased sleep
disturbance. Even after receiving treatment for PTSD, Veterans continue to experience
residual insomnia at a rate of about 50%, in spite of having achieved PTSD remission.
There are currently no PTSD-specific sleep interventions available, excepting an
intervention that is specific to nightmares. Given the prevalence of sleep disturbance in
Veterans with PTSD, the absence of interventions for PTSD-related sleep problems, and the
increasing number of post-deployment Veterans with trauma-related sleep difficulties, such
interventions are desperately needed. In this study, we will test the effectiveness of a
multi-component cognitive-behavioral sleep intervention for PTSD that targets both
nightmares and insomnia for improving the overall sleep experience of Operation Iraqi
Freedom (OIF) and Operation Enduring Freedom (OEF) Veterans with PTSD who are also receiving
usual care. The primary objective is to pilot test the intervention for efficacy in reducing
sleep disturbance. The secondary objective is to examine the relative impact of the
intervention on PTSD symptoms. The project is a prospective, randomized, clinical
intervention trial. Participants will be randomly assigned to a multi-component
cognitive-behavioral sleep intervention for PTSD + Usual Care, or Usual Care alone. We are
hypothesizing that 1) Veterans receiving the sleep intervention plus usual care will produce
greater improvements (reduced total wake time, increased sleep efficiency, etc) in
subjective sleep measures than will Usual Care alone; 2) Veterans receiving the sleep
intervention plus usual care will produce greater improvements in nightmare frequency and
severity than will Usual Care alone; and 3) the relationship between PTSD symptoms and
treatment group will be significantly related to sleep quality in the period intervening
baseline and follow-up.
Inclusion Criteria: Participants will be recruited from the population of Operation Iraqi
Freedom/Operation Enduring Freedom veterans referred to the Posttraumatic Stress Disorder
(PTSD) clinic for evaluation and treatment, and volunteers participating in the Mental
Illness Research, Education and Clinical Centers (MIRECC) registry who agreed to be
recontacted for future studies. All study participants will have: 1) provided informed
consent; 2) utilize Durham VA Medical Center health care services as their primary source
of health care; 3) will meet the Diagnostic and Statistical Manual (DSM-IV-R) criteria for
a diagnosis of PTSD; 4) will screen positive for an Insomnia Disorder on the Duke
Structured Sleep Interview for Sleep Disorders (DSISD); 5) and will score greater than 14
on the Insomnia Severity Index (ISI).
Exclusion Criteria: Patients who screen positive on the DSISD for symptoms of Sleep Apnea,
Narcolepsy, Restless Legs Syndrome or Circadian Disorders will be excluded from the study.
Participants with active drug or alcohol abuse or dependence will be excluded as well.
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