title: A multi-component cognitive-behavioral intervention for sleep disturbance in veterans with PTSD: a pilot study.
abstract: OBJECTIVE
  A significant portion of US military personnel are returning from deployment with trauma-related sleep disturbance, and disrupted sleep has been proposed as a mechanism for the development of medical conditions in those with posttraumatic stress disorder (PTSD). Although individuals with PTSD may realize improved sleep with either PTSD treatment or CBT for insomnia, many continue to experience residual sleep difficulties. Newly developed interventions designed to address nightmares are effective to this end, but often do not fully remove all aspects of PTSD-related sleep difficulties when used in isolation. A combined intervention involving both a nightmare-specific intervention and CBT for insomnia may lead to more marked reductions in PTSD-related sleep disturbances.
  
  
  METHODS
  Twenty-two veterans meeting criteria for PTSD were enrolled in the study. A combined intervention comprised of CBT for insomnia and imagery rehearsal therapy was evaluated against a usual care comparison group.
  
  
  RESULTS
  Intent-to-treat analyses revealed medium to large treatment effect sizes for all sleep diary outcomes, and very large treatment effects for insomnia severity, sleep quality, and PTSD symptoms.
  
  
  CONCLUSIONS
  Findings demonstrate that an intervention targeting trauma-specific sleep disturbance produces large short-term effects, including substantial reductions in PTSD symptoms and insomnia severity. Future research should focus on the optimal approach to the treatment of comorbid PTSD and sleep disturbance in terms of sequencing, and should assure that sleep-focused interventions are available and acceptable to our younger veterans, who were more likely to drop out of treatment.
authors.affiliation: Durham Veterans Affairs Medical Center, Durham, NC 27705, USA. christi.ulmer@va.gov
authors.forename: Christi S
authors.initials: CS
authors.lastname: Ulmer
authors.forename: Jack D
authors.initials: JD
authors.lastname: Edinger
authors.forename: Patrick S
authors.initials: PS
authors.lastname: Calhoun
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001521:Behavior Therapy / Q000379:methods*; D015928:Cognitive Behavioral Therapy / Q000379:methods; D003131:Combined Modality Therapy; D004325:Dreams / Q000523:psychology; D020920:Dyssomnias / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D017060:Patient Satisfaction; D010865:Pilot Projects; D012016:Reference Values; D018570:Risk Assessment; D012720:Severity of Illness Index; D007319:Sleep Initiation and Maintenance Disorders / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D012893:Sleep Wake Disorders / Q000209:etiology* / Q000523:psychology / Q000628:therapy*; D013313:Stress Disorders, Post-Traumatic / Q000150:complications* / Q000175:diagnosis / Q000523:psychology; D016896:Treatment Outcome; D014481:United States; D014728:Veterans / Q000706:statistics & numerical data; D014857:Warfare