Exploring Predictors of Sleep State Misperception in Women with Posttraumatic Stress Disorder

ABSTRACT

Objectives

Insomnia is a common symptom of posttraumatic stress disorder (PTSD) that is resistant to first-line cognitive behavioral interventions. However, research suggests that, among individuals with PTSD, self-reported sleep impairment is typically more severe than what is objectively observed, a phenomenon termed sleep state misperception. Relatively little research has examined which individuals with PTSD are most likely to exhibit sleep state misperception. This study explored clinical predictors of sleep state misperception in a sample of 43 women with PTSD and clinically significant sleep impairment.

Method

During a baseline assessment, participants’ PTSD symptoms were assessed using a clinical interview and their sleep was assessed using the Pittsburgh Sleep Quality Index (PSQI). Objective sleep, self-reported sleep, and PTSD symptoms were then assessed over a 1-week period using actigraphy and daily diaries.

Results

Consistent with previous research, women in the study exhibited total sleep time (TST), sleep efficiency (SE), and sleep onset latency (SOL) sleep state misperception. For TST and SE, but not SOL, discrepancies between actigraphy and the PSQI were associated with each clinician-rated PTSD symptom cluster, whereas discrepancies between actigraphy and daily diary were only associated with clinician-rated reexperiencing symptoms. The only self-reported PTSD symptom that was uniquely associated with sleep state misperception was nightmares. This association was no longer significant after controlling for sleep-related anxiety.

Conclusions

Results suggest that women with more severe reexperiencing symptoms of PTSD, particularly nightmares, may be more likely to exhibit TST and SE sleep state misperception, perhaps due to associated sleep-related anxiety.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Supplementary material

Supplemental data for this article can be accessed on the publisher’s website.

Notes

¹ To assess for potential multicollinearity, we examined zero-order correlations among daily diary PTSD symptoms. Results are presented in Supplement Table S2. Strong correlations (≥.80) were found between difficulty relating to others and emotional numbing, anhedonia, and feeling like one’s life course has changed, as well as between anhedonia and feeling like one’s life course has changed. Rerunning the regression model including each of these symptoms without the other three (e.g., including difficulty relating to others, but excluding emotional numbing, anhedonia, and feeling like one’s life course has changed) did not alter the pattern of results.

Additional information

Funding

This research was supported by the National Center for Complementary and Alternative Medicine Grant [1R21AT004079] (PI: Galovski). The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs or the United States Government.