BOSTON—Prolonged exposure therapy is associated with less improvement in symptoms of insomnia and post-traumatic stress disorder (PTSD) among patients with traumatic brain injury (TBI) than among patients without TBI. By the end of therapy, nightmare intensity had increased and total sleep time had decreased from baseline among patients with TBI, according to research presented at the 26th Annual Meeting of the Associated Professional Sleep Societies.
Jessica L. Beltran, a community health program representative at the University of California, San Diego, and colleagues studied 48 veterans diagnosed with PTSD and insomnia. Participants’ mean age was approximately 35, and seven were female. The researchers categorized the patients into a TBI group (25 patients) and a non-TBI group (23 patients) after screening. All subjects kept daily sleep diaries that included information about total sleep time, sleep efficiency, sleep latency, number of awakenings, wake after sleep onset, and nightmare rate and intensity.
In addition, the investigators administered several psychiatric questionnaires to the patients at baseline, including the Insomnia Severity Index, Clinician-Administered PTSD Scale (CAPS), PTSD Checklist Stressor Specific (PCL-S), and Patient Health Questionnaire (PHQ-9). After the participants had undergone prolonged exposure therapy, the researchers administered the questionnaires again. Baseline and post-therapy variables were analyzed with an independent samples t-test.
Ms. Beltran observed no statistically significant differences in sleep-diary variables and questionnaire scores between the TBI group and the non-TBI group at baseline. After treatment, mean nightmare intensity increased from approximately 6 to approximately 7 (on a 10-point scale) in the TBI group, compared with a decrease from about 6 to about 4.5 in the non-TBI group. Mean total sleep time decreased from 350 minutes to 325 minutes in the TBI group, compared with an increase from 350 minutes to 400 minutes for the non-TBI group.
For patients in the TBI group, mean CAPS score decreased from 80 to 70 after therapy, compared with a decrease from 75 to 50 for the non-TBI group. These scores indicated that the TBI group still had severe PTSD after therapy. Mean PHQ-9 score decreased from 15 to 14 for the TBI group, compared with a decrease from 17 to 7 for the non-TBI group. Patients with TBI “might benefit from a combination of multiple therapies that address their specific needs—for instance, more support during the in vivo component of prolonged exposure therapy, as well as a greater focus on cognitive difficulties,” said Ms. Beltran.