Approximately 10% to 18% of post-9/11 service members and veterans have developed posttraumatic stress disorder (PTSD). The vast majority of these individuals - 68% to 93% - also suffer from insomnia and nightmares.

While sleep disturbances typically are seen as secondary symptoms of PTSD, research indicates that they likely are independent conditions that hinder recovery from PTSD and can make it worse.

One reason may be that insomnia and nightmares significantly disrupt both rapid eye movement (REM) sleep and slow wave sleep (SWS). REM and SWS are thought to be particularly important to the normal consolidation of memory and emotional experiences into long-term memory. That consolidation of memory and emotion is crucial for recovery from posttraumatic stress.

Unfortunately, therapists have no scientific data available on how best to treat individuals suffering from all three disorders. Cognitive behavioral therapies of PTSD, insomnia and nightmares are the first-line treatments for these conditions, but PTSD treatments do not typically address insomnia or nightmares, and insomnia and nightmare treatments do not typically address PTSD.

Daniel Taylor, PhD, of the University of North Texas leads a research team conducting a study for the Consortium to Alleviate PTSD that aims to improve treatment for people with co-occurring PTSD, insomnia, and nightmares. The study at the Carl R. Darnall Army Medical Center at Fort Hood, Texas, will include 222 active duty and recently discharged veterans suffering from a combination of PTSD, insomnia, and nightmares.

Study aims

The double-blind study involves two forms of cognitive-behavioral therapy in treating people suffering from PTSD and comorbid insomnia and nightmares, as well as variations in treatment delivery. From this, investigators aim to determine which variation of the treatment leads to the greatest improvements in both PTSD and related sleep problems.

As part of the study, investigators also seek to identify biomarkers -- measurable factors, such as genes, sleep stages and levels of certain biological substances associated with inflammation in the body -- to assess whether any biomarkers can help clinicians identify co-occurring PTSD and sleep disturbances, predict how well an individual will respond to treatment, and/or assess how well a therapy is working.

Expected benefits

If successful, the proposed study will significantly advance treatment strategies for co-occurring PTSD, insomnia, and nightmares. It also could identify biomarkers that will aid in diagnosis, prognosis and measurement of the efficacy of treatment. No study has targeted the treatment of insomnia/nightmares before or after evidence based treatment of PTSD as a way to improve long-term outcomes of PTSD therapy.