Changes in sleep disruption in the treatment of co-occurring posttraumatic stress disorder and substance use disorders.

Sleep disruption appears not only to reflect a symptom of posttraumatic stress disorder (PTSD), but also a unique vulnerability for its development and maintenance. Studies examining the impact of psychosocial treatments for PTSD on sleep symptoms are few and no studies to date have examined this question in samples with co-occurring substance use disorders. This study is a secondary analysis of a large clinical trial comparing two psychological treatments for co-occurring PTSD and substance use disorders (National Drug Abuse Treatment Clinical Trials Network protocol CTN-0015, “Women’s Treatment for Trauma and Substance Use Disorders”). Women (n=353) completed measures of PTSD at baseline, end of treatment, and 3-, 6-, and 12-month follow-ups. Results indicated that the prevalence of insomnia, but not nightmares, decreased during treatment, and that 63.8% of participants reported at least 1 clinical-level sleep symptom at the end of treatment. Improvement in sleep symptoms during treatment was associated with better overall PTSD outcomes over time.

Conclusions: These results extend the existing literature to suggest that residual sleep disruption following PTSD treatment is common in women with co-occurring PTSD and substance use disorders. Although based on the design of the study, no causal conclusions can be drawn, the findings imply that among those with clinical-level residual sleep disruption, risk for continuation or exacerbation of overall PTSD symptoms may be higher. Consideration of the addition of interventions targeted to sleep disruption may be indicated in those with PTSD and SUD, or considered as an adjunctive intervention if residual sleep disruption is present at the time of treatment completion.

Related protocols: CTN-0015