PTSD Symptom Screening Important for Those With Insomnia, Especially Women

The relationship between posttraumatic stress disorder (PTSD) symptoms and insomnia might be specific to sex, and it is very important to screen patients diagnosed with chronic insomnia for PTSD, according to Frontiers in Sleep.

Insomnia is extremely prevalent in the general population and is usually linked with somatic and psychiatric comorbidities, but the origins of insomnia aren’t well understood. Adverse childhood events (ACE), including traumatic experiences, have recently been discovered to be significantly associated with insomnia and PTSD.

Despite this, less is known about traumatic childhood experiences in patients with insomnia and PTSD.

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This exploratory study evaluated a cohort of 43 patients (14 males, 29 females) clinically diagnosed with chronic insomnia at a sleep center, and systematically analyzed their condition using the trauma history questionnaire (THQ) and the PTSD checklist (PCL-5).

The results displayed that 83.7% of patients with insomnia reported at least 1 traumatic event, while PTSD symptom prevalence was 53.5%. A total of 11.6% of patients indicated that insomnia began in childhood, and for 27.1%, it started in adolescence. Scores on the PCL-5 were associated with higher Insomnia Severity Index (ISI) scores but not trauma. Women also possessed higher ISI scores and positive relationships were seen between ISI scores, PCL-5 scores, and the number of self-reported traumatic events among women.

The high prevalence of historical traumatic events in the researchers’ sample consisted of the main finding. They found 83.7% of patients diagnosed with chronic insomnia had experienced traumatic events, and over experienced provisional PTSD.

The results also showed that even though PTSD scores were higher for patients who had been exposed to trauma, age at first trauma was not linked with a higher prevalence or PTSD or more severe symptoms.

A second finding was that none of the patients with insomnia had been diagnosed with PTSD, and none were being treated for it, suggesting that it would be of benefit to inform practitioners about trauma during their Behavioral Sleep Medicine Training.

“Furthermore, in the context of clinical care, our study highlights the importance of embedding psychologists and/or psychiatrists in sleep centers,” continued the researchers.

Thirdly, researchers discovered that sex could influence the relationship between self-reported experience of trauma, PTSD symptoms, and ISI. The number of self-reported traumas, PTSD symptoms, and ISI severity displayed positive correlations only in women.

Additionally, sex impacted ISI scores, where women reported a subjectively higher level of insomnia.

“However, the current results should be regarded as exploratory ones and it is important to recognize that the non-significance of correlation coefficients for men might be due to the smaller sample size of men than of women,” expanded the researchers.

The researchers stated that since there are known differences with respect to PTSD, a need exists to review the role of sex in the connection between insomnia and PTSD symptoms severity more closely.

Finally, this study had several limitations. First, there was a small sample size. Second, men were underrepresented, which might explain the differences seen in the significance of correlations between sexes.

“Even if we cannot yet directly claim that PTSD is the etiology of insomnia, it seems relevant to explore whether treating a patient for PTSD symptoms could help in the treatment of insomnia in cases where PTSD and insomnia are associated, and vice-versa,” concluded the researchers.

Reference

Lardant E, Vialatte F, Ramdani C, et al. Chronic insomnia: are patients also suffering from PTSD symptoms? Front Sleep. Published online September 6, 2023. doi:10.3389/frsle.2023.1207232