Predictors of insomnia symptoms and nightmares among individuals with post-traumatic stress disorder: an ecological momentary assessment study
Nicole A. Short
Department of Psychology, Florida State University, Tallahassee, FL, USA
Search for more papers by this authorNicholas P. Allan
Department of Psychology, Ohio University, Athens, OH, USA
Search for more papers by this authorLauren Stentz
Department of Psychology, Florida State University, Tallahassee, FL, USA
Search for more papers by this authorAmberly K. Portero
Department of Psychology, Florida State University, Tallahassee, FL, USA
Search for more papers by this authorCorresponding Author
Norman B. Schmidt
Department of Psychology, Florida State University, Tallahassee, FL, USA
Correspondence
Norman B. Schmidt, Department of Psychology, Florida State University, 1107 W. Call Street, Tallahassee, FL 32306-4301, USA.
Tel.: +850-645-1766;
fax: +850-644-7739;
e-mail: [email protected]
Search for more papers by this authorNicole A. Short
Department of Psychology, Florida State University, Tallahassee, FL, USA
Search for more papers by this authorNicholas P. Allan
Department of Psychology, Ohio University, Athens, OH, USA
Search for more papers by this authorLauren Stentz
Department of Psychology, Florida State University, Tallahassee, FL, USA
Search for more papers by this authorAmberly K. Portero
Department of Psychology, Florida State University, Tallahassee, FL, USA
Search for more papers by this authorCorresponding Author
Norman B. Schmidt
Department of Psychology, Florida State University, Tallahassee, FL, USA
Correspondence
Norman B. Schmidt, Department of Psychology, Florida State University, 1107 W. Call Street, Tallahassee, FL 32306-4301, USA.
Tel.: +850-645-1766;
fax: +850-644-7739;
e-mail: [email protected]
Search for more papers by this authorSummary
Despite the high levels of comorbidity between post-traumatic stress disorder (PTSD) and sleep disturbance, little research has examined the predictors of insomnia and nightmares in this population. The current study tested both PTSD-specific (i.e. PTSD symptoms, comorbid anxiety and depression, nightmares and fear of sleep) and insomnia-specific (i.e. dysfunctional beliefs about sleep, insomnia-related safety behaviours and daily stressors) predictors of sleep quality, efficiency and nightmares in a sample of 30 individuals with PTSD. Participants participated in ecological momentary assessment to determine how daily changes in PTSD- and insomnia-related factors lead to changes in sleep. Multi-level modelling analyses indicated that, after accounting for baseline PTSD symptom severity, PTSD-specific factors were associated with insomnia symptoms, but insomnia-specific factors were not. Only daytime PTSD symptoms and fear of sleep predicted nightmares. Both sleep- and PTSD-related factors play a role in maintaining insomnia among those with PTSD, while nightmares seem to be linked more closely with only PTSD-related factors.
References
- Beck, A. T. and Steer, R. A. Beck Anxiety Inventory Manual. Harcourt Brace and Company, San Antonio, TX, 1993.
- Beck, A. T., Steer, R. A. and Carbin, M. G. Psychometric properties of the Beck Depression Inventory: twenty-five years of evaluation. Clin. Psychol. Rev., 1988, 8: 77–100.
- Bell, J. F. and Malacova, E. Outliers and Multilevel Models. Sixth International Conference on Social Science Methodology: Recent Developments and Applications in Social Research Methodology, Amsterdam, the Netherlands, 2004.
- Blake, D. D., Weathers, F. W., Nagy, L. M. et al. The development of a clinician-administered PTSD scale. J. Trauma. Stress, 1995, 8: 75–90.
- Buysse, D. J., Reynolds, C. F., Monk, T. H., Bermn, S. R. and Kupfer, D. J. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res., 1989, 28: 193–213.
- Carney, C. E., Edinger, J. D., Morin, C. M. et al. Examining maladaptive beliefs about sleep across insomnia patient groups. J. Psychosom. Res., 2010, 68: 57–65.
- DeViva, J. C., Zayfert, C. and Mellman, T. A. Factors associated with insomnia among civilians seeking treatment for PTSD: an exploratory study. Behav. Sleep Med., 2004, 2004: 162–176.
10.1207/s15402010bsm0203_5 Google Scholar
- First, M. B., Williams, J. B. W., Karg, R. S. and Spitzer, R. L. Structured Clinical Interview for DSM-5—Research Version (SCID-5 for DSM-5, Research Version; SCID-5-RV). American Psychiatric Association, Arlington, VA, 2015.
- Gellis, L. A., Gehrman, P. R., Mavandadi, S. and Oslin, D. Predictors of sleep disturbances in Operation Iraqi Freedom/Operation Enduring Freedom Veterans Reporting a Trauma. Mil. Med., 2010, 175: 567–573.
- Hox, J. J. Applied Multilevel Analysis, 2nd edn. Routledge, New York, NY, 2010.
10.4324/9780203852279 Google Scholar
- King, D., Leskin, G., King, L. and Weathers, F. Confirmatory factor analysis of the Clinician-Administered PTSD Scale: evidence for the dimensionality of posttraumatic stress disorder. Psychol. Assess., 1998, 10: 90–96.
- Krakow, B. Nightmare complaints in treatment-seeking patients in clinical sleep medicine settings: diagnostic and treatment implications. Sleep, 2006, 29: 1313–1319.
- Krakow, B., Artar, A., Warner, T. D. et al. Sleep disorder, depression and suicidality in female sexual assault survivors. Crisis, 2000, 21: 163–170.
- Morin, C. M., Vallières, A. and Ivers, H. Dysfunctional beliefs and attitudes about sleep (DBAS): validation of a brief version (DBAS-16). Sleep, 2007, 30: 1547–1554.
- Morin, C. M., Belleville, G., Bélanger, L. and Ivers, H. The Insomnia Severity Index: psychometric indicators to detect insomnia cases and evaluate treatment response. Sleep, 2011, 34: 601–608.
- Muthén, L. K. and Muthén, B. O. Mplus User's Guide, 7th edn. Muthén & Muthén, Los Angeles, CA, 1998–2012.
- Neylan, T. C., Marmar, C. R., Metzler, T. J. et al. Sleep disturbances in the Vietnam generation: findings from a nationally representative sample of male Vietnam veterans. Am. J. Psychiatry, 1998, 155: 929–933.
- Peugh, J. L. A practical guide to multilevel modeling. J. Sch. Psychol., 2010, 48: 85–112.
- Possemato, K., Kaier, E., Wade, M., Lantinga, L. J., Maisto, S. A. and Ouimette, P. Assessing daily fluctuations in posttraumatic stress disorder symptoms and substance use with interactive voice response technology: protocol compliance and reactions. Psychol. Serv., 2012, 9: 185–196.
- Pruiksma, K. E., Taylor, D. J., Ruggero, C. et al. A psychometric study of the Fear of Sleep Inventory-Short Form (FoSI-SF). J. Clin. Sleep Med., 2014, 10: 551–558.
- Ree, M. J. and Harvey, A. G. Investigating safety behaviours in insomnia: the development of the Insomnia-related Behaviours Questionnaire (SRBQ). Behav. Change, 2004, 21: 26–36.
- Ross, R. J., Ball, W. A., Sullivan, K. A. and Caroff, S. N. Sleep disturbance as the hallmark of posttraumatic stress disorder. Am. J. Psychiatry, 1989, 146: 697–707.
- Schafer, J. L. and Graham, J. W. Missing data: our view of the state of the art. Psychol. Methods, 2002, 7: 147–177.
- Schmidt, N. B., Norr, A. M., Allan, N. P., Raines, A. M. and Capron, D. W. Randomized clinical trial evaluating the efficacy of an automated intervention targeting anxiety sensitivity cognitive concerns for patients with suicidal ideation. J. Consult. Clin. Psychol., 2016, 82: 1023–1033.
- Schredl, M. Effects of state and trait factors on nightmare frequency. Eur. Arch. Psychiatry Clin. Neurosci., 2003, 253: 241–247.
- Short, N. A., Raines, A. M., Oglesby, M. E., Zvolensky, M. J. and Schmidt, N. B. Insomnia and emotion dysregulation: independent and interactive associations with posttraumatic stress symptoms among trauma-exposed smokers. J. Affect. Disord., 2014, 165: 159–165.
- Singer, J. D. and Willet, J. B. A framework for investigating change over time. Applied Longitudinal Data Analysis: Modeling Change and Event Occurrence. Oxford University Press, New York, NY, 2003: 3–15.
10.1093/acprof:oso/9780195152968.003.0001 Google Scholar
- Spielberger, C. D. State-Trait Anxiety Inventory. John Wiley & Sons Inc., New York, NY, 2010.
10.1002/9780470479216.corpsy0943 Google Scholar
- Straus, L. D., Drummond, S., Nappi, C. M., Jenkins, M. M. and Norman, S. B. Sleep variability in military-related PTSD: a comparison to primary insomnia and healthy controls. J. Trauma. Stress, 2015, 28: 8–16.
- Talbot, L. S., Maguen, S., Metzler, T. J. et al. Cognitive behavioral therapy for insomnia in posttraumatic stress disorder: a randomized controlled trial. Sleep, 2014, 37: 327–341.
- US Department of Veterans Affairs. PTSD Checklist for DSM-5 (PCL-5). National Center for Post-traumatic Stress Disorder, Washington, DC, 2016.
- Vigneau, F. and Cormier, S. The factor structure of the State-Trait Anxiety Inventory: an alternative view. J. Pers. Assess., 2008, 90: 280–285.
- Weathers, F., Litz, B., Herman, D., Huska, J. and Keane, T. The PTSD Checklist (PCL): Reliability, Validity, and Diagnostic Utility. Annual Convention of the International Society for Traumatic Stress Studies, San Antonio, TX, 1993.
- Woodward, S. H., Murburg, M. M. and Bliwise, D. L. PTSD-related hyperarousal assessed during sleep. Physiol. Behav., 2000a, 70: 197–203.
- Woodward, S. H., Arsenault, N. J., Murray, C. and Bliwise, D. L. Laboratory sleep correlates of nightmare complaint in PTSD inpatients. Biol. Psychiatry, 2000b, 48: 1081–1087.
- Zayfert, C. and DeViva, J. C. Residual insomnia following cognitive behavioral therapy for PTSD. J. Trauma. Stress, 2004, 17: 69–73.
- Zinkhan, M., Berger, K., Hense, S. et al. Agreement of different methods for assessing sleep characteristics: a comparison of two actigraphs, wrist and hip placement, and self-report with polysomnography. Sleep Med., 2014, 15: 1107–1114.