Treatment of comorbid sleep disorders and posttraumatic stress disorder in U.S. active duty military personnel: a pilot randomized clinical trial
Open accessAbstract
Insomnia and nightmares are common in patients with posttraumatic stress disorder (PTSD). They are associated with worse psychological and physical health and worse PTSD treatment outcomes. In addition, they are resistant to PTSD treatments, which do not typically address sleep disorders. Cognitive behavioral therapy for insomnia and nightmares (CBT-I&N) and cognitive processing therapy (CPT) for PTSD are first-line treatments, but limited evidence exists guiding the treatment of individuals with all three disorders. The current study randomized U.S. military personnel (N = 93) to one of three conditions: CBT-I&N delivered before CPT, CBT-I&N delivered after CPT, or CPT alone; all groups received 18 sessions. Across groups, participants demonstrated significantly improved PTSD symptoms. Because the study was terminated prematurely due to challenges with recruitment and retention, it was underpowered to answer the initially intended research questions. Nonetheless, statistical findings and relevant clinically meaningful changes were observed. Compared to participants who received CPT alone, those who received CBT-I&N and CPT, regardless of sequencing, demonstrated larger improvements in PTSD symptoms, d = -0.36; insomnia, d = -0.77; sleep efficiency, d = 0.62; and nightmares, d = -.53. Compared to participants who received CBT-I&N delivered before CPT, those who received CBT-I&N delivered after CPT demonstrated larger improvements in PTSD symptoms, d = 0.48, and sleep efficiency, d = -0.44. This pilot study suggests that treating comorbid insomnia, nightmares, and PTSD symptoms results in clinically meaningful advantages in improvement for all three concerns compared to treating PTSD alone.
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There is no clear consensus in the literature regarding whether it makes sense to target sleep problems as a prelude to addressing trauma related mental health symptoms versus addressing trauma related symptoms first and then treating any residual sleep problems following treatment for PTSD.
“Finally, there is no clear consensus in the literature regarding whether it makes sense to target sleep problems as a prelude to addressing trauma related mental health symptoms vs. addressing trauma related symptoms first and then treating any residual sleep problems following treatment for PTSD [see (94) for discussion of this issue].”
From Pilot outcomes and exploration of treatment mechanisms using a culturally adapted version of the unified protocol for transdiagnostic treatment of emotional disorders to improve mental health symptoms, alcohol misuse, functional outcomes, and sleep quality in emergency responders (2025) · cites this paper as [94]
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Meyer, E. C., Roth, S. G., Coe, E., Taylor, D. J., & Gulliver, S. B. (2025) · Frontiers in Health Services · doi:10.3389/frhs.2025.1452976 · Cited by 2 · see citing works
Self-citation
- Authors
- Taylor, D. J., Pruiksma, K. E., Mintz, J., Slavish, D. C., Wardle‐Pinkston, S., Dietch, J. R., Dondanville, K. A., Young‐McCaughan, S., Nicholson, K. L., Litz, B. T., Keane, T. M., Peterson, A. L., Resick, P. A., & Consortium to Alleviate PTSD
- Affiliations
- University of Arizona (US)
- The University of Texas at San Antonio Health Science Center (US)
- University of North Texas (US)
- Oregon State University (US)
- Carl R. Darnall Army Medical Center (US)
- Boston University (US)
- Duke University (US)
- Corresponding author
- Taylor, Daniel J.
- ORCID
- Venue
- Journal of Traumatic Stress
- Publisher
- Wiley
- Published
- 2023-06-15
- Volume
- 36
- Issue
- 4
- Pages
- 712-726
- ISSN
- 0894-9867 (ISSN-L)
- 1573-6598
- PMC
- PMC11057368
- OpenAlex
- W4380872083
- Cited by
- 37
- References
- 44
- Citations by year
- 2026: 10 · 2025: 19 · 2024: 5 · 2023: 3
- FWCI
- 9.57
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Traumatic Stress (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- U.S. Department of Veterans Affairs (I01CX001136‐01)
- U.S. Department of Defense (W81XWH‐13‐2‐0065)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Social Sciences › Psychology › Clinical Psychology › Migration, Health and Trauma
- Keywords
- post-traumatic stress disorder, insomnia, nightmares, sleep disorders, cognitive processing therapy, comorbid sleep disorders, military personnel, treatment sequencing, sleep efficiency
- MeSH terms
- Humans, Sleep Initiation and Maintenance Disorders, Military Personnel, Pilot Projects, Sleep, Sleep Wake Disorders, Stress Disorders, Post-Traumatic, Treatment Outcome
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