Psychotherapy Interventions for Comorbid Sleep Disorders and Posttraumatic Stress Disorder

Abstract

Sleep difficulties, including problems such as falling and staying asleep and recurring disturbing dreams, are some of the most frequently reported symptoms of posttraumatic stress disorder (PTSD). Although efficacious treatments for PTSD, such as prolonged exposure (PE), cognitive processing therapy (CPT), and eye movement desensitization and reprocessing (EMDR), are available, the extent to which these treatments address trauma-related sleep difficulties is unclear. This chapter provides an overview of evidence-based treatments for PTSD and interventions targeting sleep disturbance. There is some indication that insomnia and nightmares related to trauma may be resistant to PTSD treatments. However, approaches for trauma-related sleep disturbances, including cognitive behavioral therapy for insomnia (CBT-I), imagery rehearsal therapy (IRT), and exposure, relaxation, and rescripting therapy (ERRT), have been developed to address these symptoms. Research findings generally indicate that these approaches are helpful in reducing sleep difficulties and broader PTSD symptoms. These findings suggest that sleep disturbances should be conceptualized as co-occurring primary conditions requiring clinical attention, rather than symptoms secondary to PTSD. Potential methods for combining treatments for daytime and nighttime PTSD symptoms are discussed. Further research is needed to (1) more adequately determine changes in sleep and nightmares in response to treatments for PTSD; (2) examine predictors of positive sleep outcomes in response to PTSD treatments and sleep-specific treatments; and (3) examine optimal integration of approaches for treating both daytime and nighttime PTSD symptoms.