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.

中文翻译：

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在一项随机对照试验中检查睡眠随时间的变化，比较两种综合创伤后应激障碍和酒精使用障碍治疗方法。


研究目标 失眠与创伤后应激障碍 (PTSD) 和酒精使用障碍 (AUD) 高度共存。这是令人担忧的，因为失眠会导致更严重的药物滥用和创伤后应激障碍，以及一系列负面的健康后果。尚无研究追踪睡眠指数和失眠变化如何与使用基于证据的暴露疗法的 PTSD 和 AUD 综合治疗相关。本研究通过两项 PTSD 和 AUD 综合治疗的随机对照试验研究了失眠如何随时间变化。方法 参与者为 119 名成年退伍军人（90% 为男性），他们在大型城市退伍军人管理局寻求 AUD 和 PTSD 治疗。参与者被随机分配接受 COPE（使用长时间暴露的综合治疗）或寻求安全（使用认知行为、人际交往技术和病例管理的综合治疗）。在治疗前和治疗后进行评估，包括：临床医生管理的 PTSD 量表、AU 时间线随访日历辅助访谈、失眠严重程度指数 (ISI)、睡眠日记和 7 天体动记录仪。结果 ISI 显示显着下降，但大多数在治疗后仍高于临床临界值。入睡后觉醒减少，但仅减少了 8 分钟，仍高于临床阈值。创伤后应激障碍（PTSD）的减少，但酗酒的减少，预示着 ISI 的变化。测量的其他睡眠变量没有观察到显着变化。结论 研究结果表明睡眠质量在统计学上有所改善，但睡眠指数仍高于临床临界值。这项研究提供的证据表明，失眠是一种独立的疾病，单独对 PTSD 或 AUD 治疗没有反应。对于患有共存心理健康问题的患者，应评估和治疗睡眠症状。