Posttraumatic stress disorder symptoms and sleep in the daily lives of World Trade Center responders.

Abstract

Sleep disturbances are common in posttraumatic stress disorder (PTSD) and can have major impacts on workplace performance and functioning. Although effects between PTSD and sleep broadly have been documented, little work has tested their day-to-day temporal relationship particularly in those exposed to occupational trauma. The present study examined daily, bidirectional associations between PTSD symptoms and self-reported sleep duration and quality in World Trade Center (WTC) responders oversampled for PTSD. WTC responders (N = 202; 19.3% with current PTSD diagnosis) were recruited from the Long Island site of the WTC health program. Participants were administered the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM–IV; SCID; First, Spitzer, Gibbon, & Williams, 1997) and completed daily assessments of PTSD symptoms, sleep duration and sleep quality for 7 days. PTSD symptoms on a given day were prospectively associated with shorter sleep duration (β = −.13) and worse sleep quality (β = −.18) later that night. Reverse effects were also significant but smaller, with reduced sleep duration (not quality) predicting increased PTSD the next day (β = −.04). Effects of PTSD on sleep duration and quality were driven by numbing symptoms, whereas effects of sleep duration on PTSD were largely based on intrusion symptoms. PTSD symptoms and sleep have bidirectional associations that occur on a daily basis, representing potential targets to disrupt maintenance of each. Improving PTSD numbing symptoms may improve sleep, and increasing sleep duration may improve intrusion symptoms in individuals with exposure to work-related traumatic events.

Post traumatic stress symptom variation associated with sleep characteristics

“…Specifically, shorter sleep duration, more trouble falling asleep, and more difficulty staying asleep the previous night predicted higher PTSS the following day and more difficulty staying asleep on average predicted higher PTSS. Our initial analyses examined each sleep characteristic in a separate single predictor model similar to those used by Short et al [38] and Dietch et al [37]. We found previous night's sleep duration, sleep quality, trouble falling asleep, and difficulty staying asleep predicted next day PTSS.…”

“…Findings from the prior studies are not consistent and do not provide a clear understanding of the relationship between previous night's sleep disturbance and next day's PTSS; Short et al [38] found sleep efficiency and quality but not duration or nightmares predict PTSS and Dietch et al [37] found sleep duration but not quality predict PTSS. Thus, additional research is needed to understand the temporal relationship between previous night's sleep disturbance and PTSS the following day.…”

“…Ecological momentary assessment (EMA), a method of repeated experience sampling of subjects in their natural environment, is well-suited to assessing change in symptoms over time [30,31]. Recent studies have used EMAs to examine PTSS from day to day [32][33][34][35], sleep diaries to examine sleep disturbance from night to night [8,36], and EMAs and sleep diaries combined to examine the temporal relationship between sleep disturbance and PTSS [37][38][39].…”

“…In another study that used the same sample but changed the direction of the analyses, Short et al [39] examined the relationship between PTSS and subsequent sleep disturbance (i.e., sleep efficiency, quality, and nightmares) and found elevated PTSS predicted increased nightmares (but not sleep efficiency or quality) the following night. Dietch et al [37] examined the bidirectional relationship between sleep disturbance (i.e., sleep duration and quality) and PTSS in a sample of World Trade Center responders oversampled for PTSD (N = 202; 82.7% male; 19.3% with PTSD) and found reduced sleep duration (but not sleep quality) predicted increased PTSS the following day and increased PTSS predicted reduced sleep duration and quality the following night.…”

Sleep problems are a strong predictor of stress-related metabolic changes in police officers. A prospective study

“…Data from the Workplace Bullying and Harassment cohort in Denmark also found evidence for a reciprocal association [75]. A small reverse effect, with reduced sleep duration (but not sleep quality) predicting increased post-traumatic stress, was also observed in World Trade Center (WTC) responders [76].…”