Troublesome Triad: Trauma, Insomnia, and Alcohol

Alcohol Use Predicts Longer But More Fragmented Sleep: A Daily Diary Study of Alcohol, Sleep, and PTSD in Nurses

BACKGROUND

Due to the demanding nature of their profession, nurses are at risk of experiencing irregular sleep patterns, substance use, and fatigue. Evidence supports a reciprocal relationship between alcohol use and sleep disturbances; however, no research has examined such a link in a sample of nurses. One factor that may further impact the dynamic between alcohol and sleep patterns is posttraumatic stress disorder (PTSD) symptoms. We investigated the daily bidirectional associations between alcohol use and several sleep domains (i.e., self-report and actigraphy-determined sleep), and moderation by baseline PTSD symptom severity.

METHOD

Over a 14-day period, 392 nurses (92% female; 78% White) completed sleep diaries and actigraphy to assess alcohol use and sleep patterns. Within-person bidirectional associations between alcohol and sleep were examined using multilevel models, with symptoms of PTSD as a cross-level moderator.

RESULTS

Daily alcohol use (i.e., ≥ 1 alcoholic beverage; 25.76%) was associated with shorter self-reported sleep onset latency (b = -4.21, p = .003) but longer self-reported wake after sleep onset (b = 2.36, p = .009). Additionally, days with any alcohol use were associated with longer self-reported sleep duration (b = 15.60, p = .006) and actigraphy-determined sleep duration (b = 10.06, p = .037). No sleep variables were associated with next-day alcohol use. Bidirectional associations between alcohol consumption and sleep were similar regardless of baseline PTSD symptoms.

CONCLUSION

Our results suggested that on days when nurses drank alcohol, they experienced longer but also more fragmented sleep.

Mediating effect of depression and acute stress between exposure to Israel-Gaza war media coverage and insomnia: a multinational study from five arab countries

BACKGROUND

In the context of persistent wars and conflicts worldwide, the impact of acute, excessive and constant exposure to media coverage of such events on mental health outcomes becomes a serious problem for public health, and requires therefore urgent investigation to inform an effective prevention and management response. The objective of the present study was to test the hypothesis that war-related media exposure is directly and indirectly associated with insomnia through depression and perceived stress among adults from the general population of different Arab countries.

METHODS

A cross-sectional study was carried-out two weeks after the beginning of Israel-Gaza war on the 7th of October 2023. An anonymous online survey and a snowball sampling method were adopted to collect data. A sample of 2635 general population adults (mean age of 23.98 ± 7.55 years, 73.1% females) took part of this study.

RESULTS

The results of the mediation analysis showed that, after adjusting over potential confounders, depression and perceived stress fully mediated the association between war media exposure and insomnia; higher war media exposure was significantly associated with higher depression (Beta = 0.13; p < .001) and perceived stress (Beta = 0.07; p < .001), whereas higher depression (Beta = 0.43; p < .001) and perceived stress (Beta = 0.31; p < .001) were significantly associated with higher insomnia. It is of note that war media exposure was not significantly and directly associated with insomnia (Beta = - 0.01; p = .178 and Beta = 0.02; p = .098 respectively).

CONCLUSION

The present study is the first to provide evidence that more time spent viewing the horrors of war is significantly associated with insomnia. In addition, symptoms of stress and depression were present as early as two weeks following the beginning of the war, and played a significant role in mediating the association between war media coverage and insomnia. These findings suggest that timely screening for, and management of depression and stress symptoms in clinical and preventive programs might be beneficial for community adults who have been heavily and indirectly exposed to war through media, and present with insomnia.

Latent profiles of posttraumatic stress disorder symptoms and sleep disturbances in relation to drinking to cope motives among college students

BACKGROUND

Posttraumatic stress disorder (PTSD), sleep disturbances, and problematic alcohol use are frequently comorbid. Research shows that individuals with more PTSD symptom severity and poorer sleep are highly susceptible to drinking alcohol to cope with negative affect. The current study examined the number and nature of different subgroups of trauma-exposed college students based on endorsed PTSD symptoms and sleep disturbances; and how such subgroups relate to drinking to cope motives.

METHOD

The sample included 474 trauma-exposed college students (Mage = 20.69 years; 75.50% female) who completed self-report surveys.

RESULTS

Latent profile analyses revealed three subgroups: High PTSD-Sleep Disturbances (n = 71), Moderate PTSD-Sleep Disturbances (n = 135), and Low PTSD-Sleep Disturbances (n = 268). Results indicated that college students in the Low PTSD-Sleep Disturbances group endorsed the lowest amount of coping-related drinking motives; however, college students in the Moderate PTSD-Sleep Disturbances group did not endorse significantly different levels of coping-related drinking motives than college students in the High PTSD-Sleep Disturbances group.

CONCLUSIONS

College students with subclinical presentations of psychopathology are at risk for endorsing risky drinking motives. As they adjust to a stressful environment with a culture of heavy drinking, providing context-relevant intervention efforts such as adaptive coping strategies, relaxation skills designed to facilitate restful sleep, and trauma-informed care may be highly beneficial for college students.

Investigating the effects of suicide exposure among a clinical sample of active duty service members

Suicide exposure warrants further investigation as a risk factor for suicide among military service members. This study aimed to examine associations among suicide exposure, suicidal ideation (SI), and psychological symptoms in a clinical sample of service members (N = 1,565, 64.4% suicide-exposed) and identify how one's relationship with the deceased impacts suicidality and psychological health in exposed individuals. A secondary analysis of cross-sectional survey data was conducted. Generalized linear regression analyses were used to identify associations between suicide exposure and both current SI and psychological symptoms among all participants; the associations between suicide exposure characteristics and psychological symptoms were only examined among exposed individuals. Exposure was not significantly associated with higher SI, β = .007, SE = .16, p = .965, but was associated with PTSD, β = 1.60, SE = 0.49, p = .001; anxiety, β = .68, SE = .31, p = .031; and insomnia symptoms, β = .98, SE = .25, p < .001. Among participants who had been exposed, high/long impact of exposure was positively associated with SI, β = 0.94, SE = .26, p < .001, and psychological symptoms, PTSD: β = 2.32, SE = .77, p = .002; anxiety: β = 1.39, SE = .50, p = .005; insomnia: β = .96, SE = .39, p = .015. Results illustrate the significant issue of suicide exposure within the military and show consideration of suicide exposure as a potential risk factor for adverse psychological outcomes is warranted.

Exploratory Structural Equation Modeling Analysis and Validity of the Family Needs Screener

Assessment that accurately categorizes families' risk for family violence (i.e., intimate partner violence and child maltreatment) and identifies areas of family need is essential for prevention program planning, practice, and resource allocation. The Family Needs Screener (FNS) assesses risk for intimate partner violence and child maltreatment. It is used as a tool to prioritize those who are in the greatest need of services as well as plan prevention efforts in selected prevention services offered to military families. To date, no peer-reviewed studies examine the factor structure of the FNS. In this study, we examined measurement aspects of the FNS as an assessment tool in identifying risk of family violence. Data were drawn from Army families (N = 18,159) who were screened between 2009 and 2013 and matched to substantiated cases of family violence. Exploratory structural equation modeling (ESEM) was used to examine the factor structure, measurement invariance, and predictive validity of the FNS. Results supported a shortened measure with a five-factor structure and full gender invariance. In particular, relationship issues were predictive of both intimate partner violence and child maltreatment. In addition, family of origin/history of family violence was predictive of substantiated cases of child maltreatment. Findings support the use of the FNS to assess risk, allocate, and plan for services in an Army population. Implications for scale modifications and use, as well as prevention efforts, are discussed.

Evening Binge Alcohol Disrupts Cardiovagal Tone and Baroreflex Function During Polysomnographic Sleep

STUDY OBJECTIVES

Binge alcohol consumption is associated with increased cardiovascular risk. The effects of evening binge alcohol consumption (i.e., 4-5 beverages within two hours) on the vagal components of HRV and cardiovagal baroreflex sensitivity (cvBRS) during sleep remain largely equivocal. The present study examined the effects of evening binge alcohol consumption on nocturnal cardiac vagal tone and baroreflex sensitivity during stage N2, slow wave (SWS), and rapid eye movement (REM) sleep. We hypothesized that evening binge drinking would reduce HRV and cvBRS in each sleep stage.

METHODS

Following a familiarization night within the laboratory, twenty-three participants were examined following a night of binge alcohol consumption and a fluid control (randomized, crossover design). A quality nocturnal beat-to-beat blood pressure signal was obtained in both conditions in 16 participants (7 men, 9 women; 25±1 years).

RESULTS

Binge drinking reduced both the high frequency (HF) and time-domain components (i.e., pNN50 and RMSSD) of HRV in stage N2 sleep, SWS, and REM. In addition, cvBRS up-up (vagal activation) was reduced following binge alcohol consumption in stage N2 (21±3 vs. 15±3 ms/mmHg, P=0.035) and REM (15[11-28] vs. 11[9-18] ms/mmHg, P=0.009). Binge alcohol consumption reduced cvBRS down-down (vagal withdrawal) in stage N2 (23±2 vs. 14±2 ms/mmHg, P<0.001), SWS (20[14-30] vs. 14[9-17] ms/mmHg, P=0.022), and REM (14[11-24] vs. 10[7-15] ms/mmHg, P=0.006).

CONCLUSIONS

Evening binge alcohol consumption disrupts cardiac vagal tone and baroreflex function during nearly all sleep stages. These findings provide mechanistic insight into the potential role of binge drinking and alcohol abuse on cardiovascular risk.

Examining sleep over time in a randomized control trial comparing two integrated PTSD and alcohol use disorder treatments

STUDY OBJECTIVES

Insomnia is highly co-occurring with both posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD). This is concerning since insomnia contributes to worse substance abuse and PTSD, and a host of negative health consequences. No study has tracked how sleep indices and insomnia change related to integrated PTSD and AUD treatment using evidence-based exposure therapy. This study examined how insomnia changes over time in a randomized control trial of two integrated PTSD and AUD treatments.

METHODS

Participants were 119 adult veterans (90 % male) seeking treatment for AUD and PTSD at a large urban VA. Participants were randomized to either COPE (integrated treatment using prolonged exposure) or Seeking Safety (integrated therapy using cognitive behavioral, interpersonal techniques and case management). Assessments were done at pre- and post-treatment and include: Clinician Administered PTSD Scale, Timeline Follow-back calendar-assisted interview for AU, insomnia severity index (ISI), sleep diary and actigraphy for 7 days.

RESULTS

ISI showed significant decreases, but a majority remained above the clinical cutoff at post-treatment. Wake after sleep onset decreased, but only by 8 min, remaining above clinical thresholds. Decreases in PTSD, but not in heavy drinking, predicted change in ISI. No significant changes were observed in other sleep variables measured.

CONCLUSIONS

Findings suggested some statistical improvements in sleep quality, but sleep indices remained above clinical cut-offs. This study provides evidence that insomnia is an independent disorder and not responsive to PTSD or AUD treatments alone. Sleep symptoms should be assessed and treated in patients with comorbid mental health conditions.

Sleep and timing of death by suicide among U.S. Veterans 2006–2015: analysis of the American Time Use Survey and the National Violent Death Reporting System

Study Objectives

Suicide is a top public health priority, and U.S. Veterans are recognized to be at particularly elevated risk. Sleep disturbances are an independent risk factor for suicide; recent empirical data suggest that nocturnal wakefulness may be a key mechanism underlying this association. Given higher rates of sleep disturbances among U.S. Veterans compared with civilians, we examined associations between nocturnal wakefulness and timing of death by suicide in U.S. Veterans and civilians to determine whether temporal suicide patterns differed.

Methods

The American Time Use Survey and the National Violent Death Reporting System were analyzed (2006–2015) to determine whether sleep and temporal suicide patterns differed between age-stratified groups (18–39, 40–64, and ≥65) of U.S. Veterans and civilians. Observed temporal suicide patterns were reported and standardized incidence ratios (SIRs) calculated to compare the percentage of suicides observed with those expected, given the proportion of the population awake, across clock hours.

Results

The raw proportion of Veteran suicides peaks between the hours of 1000–1200; however, the peak prevalence of suicide after accounting for the population awake is between 0000 and 0300 hr (p < .00001, ϕ = .88). The highest SIR was at midnight; U.S. Veterans were eight times more likely to die by suicide than expected given the population awake (SIR = 8.17; 95% CI = 7.45–8.94).

Conclusions

Nocturnal wakefulness is associated with increased risk for suicide in U.S. Veterans. Overall patterns of observed suicides by clock hour were similar between U.S. Veterans and civilians. However, Veteran-specific SIRs suggest differences in magnitude of risk by clock hour across age groups. Future research examining female and Post-9/11 U.S. Veterans is warranted.

Prospective associations between insomnia symptoms and alcohol use problems among former and current military service personnel

BACKGROUND

Despite evidence that insomnia symptoms exacerbate alcohol use disorder symptoms, there is a dearth of prospective research testing bidirectional associations between these variables. Furthermore, no studies have prospectively examined these associations among military personnel, a vulnerable population for sleep- and alcohol-related problems. Thus, the current study examined whether insomnia symptoms prospectively predicted increased alcohol use disorder symptoms among a sample of military service members and veterans over a 6-month follow-up period, as well as whether alcohol use disorder symptoms led to increases in insomnia.

METHOD

Hypotheses were tested among a sample of 274 current and past military service members who participated in a baseline and 6-month assessment using self-report measures.

RESULTS

Path analyses revealed that insomnia symptoms significantly prospectively predicted increased month-6 heavy drinking and alcohol-related problems, but not days drinking or being bothered by drinking. None of the alcohol variables significantly predicted insomnia.

CONCLUSION

Results support a model in which insomnia symptoms exacerbate alcohol use disorder symptoms, specifically heavy drinking and alcohol-related problems. Future research should seek to examine these findings in diverse populations and test potential mechanisms and clinical implications of these results.

Alcohol Biomarkers Associated with Obstructive Sleep Apnea

The views expressed in this presentation are those of the author and do not reflect the official policy of the Department of the Army/Navy/Air Force or the Department of Defense The identification of specific products or scientific instrumentation does not constitute an endorsement or implied endorsement on the part of the authors, DoD, or any component agency. While we generally excise references to products, companies, manufacturers, organizations, etc. in government produced works, the abstracts produced and other similarly situated researchers presents a special circumstance when such product inclusions become an integral part of the scientific endeavor.

Trauma-induced insomnia: A novel model for trauma and sleep research

Traumatic events have been increasingly recognized as important precipitants of clinically significant insomnia. Trauma is an extreme form of stressful life event that generates a sustained neurobiological response triggering the onset and maintenance of insomnia. Trauma may disrupt the normal sleep-wake regulatory mechanism by sensitizing the central nervous system's arousal centers, leading to pronounced central and physiological hyperarousal. The central concept of hyperarousal has been linked to both the pathogenesis of insomnia and to the neurobiological changes in the aftermath of traumatic events, and may be a neurobiological commonality underlying trauma and insomnia. This paper presents evidence for trauma-induced insomnia and advances a model of it as an important nosological and neurobiological entity. Trauma-induced insomnia may occur in the absence of full-blown posttraumatic stress disorder (PTSD), and may also be a precursor of subsequent PTSD development. Converging lines of evidence from the neuroscience of insomnia with the neurobiology and psychophysiology of stress, fear, trauma and PTSD will be integrated to advance understanding of the condition. Preclinical and clinical stress and fear paradigms have informed the neurobiological pathways mediating the production of insomnia by trauma. Elucidating the underlying neurobiological substrates can establish novel biological markers to identify persons at risk for the condition, and help optimize treatment of the trauma-insomnia interface. Early identification and treatment of trauma-induced insomnia may prevent the development of PTSD, as well as other important sequelae such as depression, substance dependence, and other medical conditions.

Treatment for insomnia in combat-exposed OEF/OIF/OND military veterans: preliminary randomized controlled trial

Chronic insomnia is highly prevalent among military personnel returning from Iraq and Afghanistan. We evaluated the effects of a military version of a brief behavioral treatment of insomnia (BBTI-MV) compared to an information only control (IC) condition in combat-exposed Veterans of Operations Enduring/Iraqi Freedom or Operation New Dawn (OEF/OIF/OND) on insomnia, sleep quality, and daytime symptoms of anxiety and depression. Forty OEF/OIF/OND Veterans (Mean age = 38.4 years old, s.d. = 11.69; 85% men; 77.5% white) were randomized to one of two conditions. BBTI-MV consisted of two in-person sessions and two telephone contacts delivered over four weeks, and included personalized recommendations to reduce insomnia. The IC condition also consisted of 2 in-person sessions two telephone contacts delivered over four weeks, and Veterans were encouraged to read written information about sleep-promoting behaviors. The Insomnia Severity Index, Pittsburgh Sleep Quality Index, PTSD Checklist, and Beck Depression and Anxiety Inventories were completed at baseline, post-treatment, and at the six-month follow-up. Both interventions were associated with clinically significant improvements in insomnia, although the magnitude of improvements in sleep and rates of treatment response and remission were greater for BBTI-MV compared to IC from pre- to post-treatment. Both BBTI-MV and the provision of information were associated with clinically significant improvements in insomnia among Veterans. Despite the preliminary nature of the findings and limitations inherent to small controlled trials, the findings suggest that both approaches may provide viable options in a stepped-care approach to the treatment of insomnia in retuning combat-exposed Veterans. Larger, confirmatory effectiveness trials are required.

CLINICALTRIALSGOV IDENTIFIER

NCT00840255.

Psychometric Analysis of the Pittsburgh Insomnia Rating Scale among University Population of Poor Sleepers in India

Background:

Pittsburgh insomnia rating scale is a 65 item self administered open source questionnaire. The scale is widely used in clinical practice but its psychometric properties are not well established. Therefore keeping in mind this lacuna the current study was designed for university population of poor sleepers in India.

Aims:

The purpose of this study was to establish the Pittsburgh sleep Quality Index test- retest reliability, validity and internal consistency of Pittsburgh insomnia rating scale.

Materials and Methods:

Twenty five subjects were randomly chosen from the screened population of poor sleepers. Pittsburgh insomnia rating scale, Pittsburgh sleep quality index and Insomnia severity index were administered on test day. Retest was administered after one week.

Results:

Eight males and seventeen females with mean age 24 + 7.04 were recruited. The test retest reliability for Pittsburgh insomnia rating scale total score showed excellent reliability (ICC_2,1-0.93). The results also show that the total score is moderately correlated with Pittsburgh sleep Quality Index (r-0.31) and moderately correlated with Insomnia severity index (r-0.49). Internal consistency for the test was excellent (Cronbach's alpha- 0.930)

Conclusion:

The study findings suggest that Pittsburgh insomnia rating scale has excellent internal consistency, test-retest reliability and good validity for university population of poor sleepers in India. It is an important first line of assessment scale for screening of sleep problems.