A Solution to Sleep Problems from Post-War Trauma

A new pilot study shows a treatment approach that combines cognitive-behavioral therapy with image rehearsal can help shell-shocked veterans find more peaceful sleep. PTSD affects nearly 1 in 4 veterans who served in either Afghanistan or Iraq. Once they return home, as many as 91 percent of veterans report having trouble falling asleep or staying asleep.

The study involved a group of 22 veterans with sleep problems related to symptoms of post-traumatic stress disorder (PTSD). Half of the veterans received a combination of cognitive-behavioral for insomnia and image rehearsal therapy for PTSD-related nightmares. The control group was assigned prescription drugs including sleeping pills, antidepressants and other mood stabilizers. Both treatments lasted about twelve weeks.

Short term results show the group who received CBT and image rehearsal therapy saw significant improvements in sleep and PTSD symptoms. Due to the sample size and the nature of the pilot study, further research is needed to demonstrate the effectiveness of the approach.

The study was published in the February issue of Journal of Clinical Sleep Medicine, the official journal of the American Academy of Sleep Medicine.

The approach used in the study combines two commonly used treatments for related conditions. Cognitive behavioral therapy is considered the front line treatment for long-term insomnia. And behavioral sleep specialists use image rehearsal therapy to treat nightmare disorder. Both sleep disorders bare similarities to the sleep-related symptoms of PTSD.

Another recent study proposed a more radical treatment for PTSD - sleep avoidance after a traumatic event. The authors theorize the trauma won’t go into memory if you don’t sleep. Sleep after all plays an important role in the development of memories.

Learn more about sleep and memory.

Sleep Suffers in Wartime Deployment

Despite months or even years of preparation, many troops will struggle to sleep for some time after they arrive in Iraq or Afghanistan. Insomnia affects about 28 percent of deployed American troops, a study in the December issue of the journal SLEEP suggests.

The symptoms may not improve when the tour of duty is over. 21 percent of troops reported difficulty sleeping after returning home to the United States. Troops may have twice the risk of insomnia if they had poor health or mental health problems such as depression or posttraumatic stress disorder prior to deployment.

The study involved 41,225 troops from all service branches and components of the U.S. military, including active duty and Reserve/National Guide personnel. The participants completed a baseline survey with questions about sleep and overall health prior to deployment. About a quarter of the troops responded to a follow-up survey three years later, either in Iraq or Afghanistan, or after returning from either warzone.

Sleep duration was limited even for the troops who did not have insomnia. The average sleep time during wartime was 6.5 hours - slightly less than the recommended amount of sleep for adults. The AASM reports adults require 7 to 8 hours to be fully alert during the daytime.
Insomnia or not, lost sleep may have dire consequences. While military personnel are trained to function on little to no sleep, a single mistake may be fatal.

For us in the civilian world, the findings should come as no surprise. It’s hard to image trying to sleep to the sound of gunfire and explosions or even the prospect of an attack.

As a side note, the study also looked at mothers of young children and pregnant women who served in the military. On average, the women slept less than six hours. The authors speculate that the possibility of future deployment and separation from their families may multiply the normal stress of pregnancy and motherhood.

Photo courtesy United States Marine Corps