Clarifying Heterogeneity of Daytime and Nighttime Symptoms of Posttraumatic Stress in Combat Veterans With Insomnia

Abstract

Daytime and nighttime symptoms of posttraumatic stress disorder (PTSD) are common among combat veterans and military service members. However, there is a great deal of heterogeneity in how symptoms are expressed. Clarifying the heterogeneity of daytime and nighttime PTSD symptoms through exploratory clustering may generate hypotheses regarding ways to optimally match evidence-based treatments to PTSD symptom profiles. We used mixture modeling to reveal clusters based on six daytime and nighttime symptoms of 154 combat veterans with insomnia and varying levels of PTSD symptoms. Three clusters with increasing symptom severity were identified (N1=50, N2=70, N3=34). These results suggest that, among veterans with insomnia, PTSD symptoms tend to exist on a continuum of severity, rather than as a categorical PTSD diagnosis. Hypotheses regarding possible targeted treatment strategies for veterans within each identified cluster, as well as ways to generalize these methods to other groups within the military, are discussed.

Post traumatic stress symptom variation associated with sleep characteristics

“…PTSD treatments require effective advanced learning and memory functions [28]. Early interventions for sleep may offer less mental health stigma compared to treatment for PTSD, reduce daily symptoms, and build therapeutic rapport and overall stability prior to engaging in more challenging trauma-focused therapies [52]. Further studies are needed to determine the optimal temporal relationship between sleep and PTSD treatments.…”

Understanding Recent Insights in Sleep and Posttraumatic Stress Disorder from a Research Domain Criteria (RDoC) Framework

“…The authors identified three distinct symptom profiles related to sleep, presence or absence of parasomnia symptoms, and a continuum of daytime PTSD symptom severity. All three profiles included poor sleep quality [62]. These preliminary data support viewing sleep and trauma-related symptoms on a spectrum and evaluating treatment effects as a function of symptom profiles rather than diagnoses.…”