Sleep and day-to-day PTSD symptom variability: an ecological momentary assessment and actigraphy monitored study in trauma-exposed young adults

Abstract

Background: Disrupted sleep and post-traumatic stress disorder (PTSD) are bi-directionally linked and have been found to mutually reinforce each other on a day-to-day basis. However, most of the previous research has focused on subjective measures of sleep only. Objective: Here, we investigated the temporal relationship between sleep and PTSD symptoms using both subjective (sleep diary) and objective measures of sleep (actigraphy). Methods: Forty-one non-treatment seeking, trauma exposed young adults (age M = 24.68, SD = 8.15) with a range of PTSD symptom severities (PTSS, 0–53 on PCL-5) were recruited. Participants completed two surveys per day over four weeks to measure day-time PTSD symptoms (i.e. PTSS and number of intrusions) and night-time sleep subjectively, while wearing an actigraphy watch to measure sleep objectively. Results: Linear mixed models revealed that subjectively reported sleep disruptions were associated with elevated next-day PTSS and increasing number of intrusive memories both within and between participants. Similar results were found for daytime PTSD symptoms on night-time sleep. However, these associations were not found using objective sleep data. Exploratory moderator analyses including sex (male vs. female) found that these associations differed in strength between sexes but were generally in the same direction. Discussion: These results were in line with our hypothesis with regards to the sleep diary (subjective sleep), but not actigraphy (objective sleep). Several factors which have implications on both PTSD and sleep, such as the COVID-19 pandemic and/ or sleep-state misperception, may be potential reasons behind those discrepancies. However, this study had limited power and needs to be replicated in larger samples. Nonetheless, these results add to the current literature about the bi-directional relationship between sleep and PTSD and have clinical implications for treatment strategies.

Sex and gender in psychotrauma research

“…Men, 7. Women 12 qualitative or quantitative empirical study using child or adult clinical or non-clinical samples and presented CPTSD separated by gender or sex, or in one gender or sex only Yes Mellor et al ( 2021 ) Systematic review Gender (male, female); how measured is not explicitely stated 13 empirical studies in refugee and displaced treatment seeking or general populations No Nordström et al ( 2022 ) Cross-sectional (based on the fourth data collection eight years after the Utøya terror attack) Gender (male, female) 88 bereaved parents and 34 siblings aged 19 and above (59.8% female, Norway) Yes Pociunaite et al ( 2023 ) Longitudinal data from the data-archive of the Measurement Archive of Reactions to Bereavement from Longitudinal European Studies (MARBLES) project Gender (male, female) 398 bereaved adults (64.2% female, Denmark & The Netherlands) No Rasmusson et al ( 2018 ) Cross-sectional Gender (male, female) 112 patients in treatment for substance use disorders and 112 matched controls with mild to moderate mental health disorders (each group 43.8% female, Norway) Yes Schenker et al ( 2023 ) Cross-sectional Sex, biologically (use both male, female and men, women; none of the participants indicated their sex as ‘other’) 41 non-treatment seeking, trauma exposed young adults aged 18–50 years (75.6% female, Australia) Yes Søegaard et al ( 2021 ) Cross-sectional Self-reported gender (men, women) 110 traumatized patients attending a mental health outpatient clinic (61.8% female, Norway) Yes Stelzer et al ( 2019 ) Cross-sectional Gender (men, women) 50 bereaved widow(er)s and parents (58% female; USA) ...…”

“…Schenker et al ( 2023 ) examined the relationship between a range of day-to-day PTSD symptoms variability and sleep in non-treatment-seeking trauma-exposed young adults, using both objective and subjective measures. Exploratory analyses indicated that sex moderated the bi-directional relationships between night-time sleep and day-time PTSD symptoms, with longer sleep onset latency and lower sleep efficiency being related to worse PTSD symptoms the next day in women, but not in men.…”

Post-traumatic stress disorder: the role of the amygdala and potential therapeutic interventions – a review

“…Specifically, decreases in amygdala nuclei volumes have been reported to be associated with symptoms of PTSD ( 21 , 24 , 29 ). Reduced grey matter volume in limbic brain regions including the amygdala are correlated with sleep disturbances (insomnia and nightmares) in patients with PTSD ( 30 ), which may contribute to symptom severity ( 31 , 32 ). Analysis of links between BLA and centrocorticomedial complex volumes with PTSD symptom severity in 47 young survivors from the 2011 Norwegian terror attack revealed an inverse relationship between symptom severity and amygdala nuclei volume 24–36 months post-trauma ( 21 ), supporting associations between these factors and PTSD.…”