Investigating the Role of Sleep Disturbances in Posttraumatic Stress Disorder Symptoms and Alcohol Problems in a Veteran Population

Objective: Posttraumatic Stress Disorder (PTSD) is a serious concern facing veterans returning from Iraq and Afghanistan. Rates of comorbidity between PTSD and alcohol use are high among veterans, and pose great challenges to treatment. Sleep disturbances and alcohol misuse often co-occur in those diagnosed with PTSD. Previous research suggests that there are complex biological and behavioral links between sleep disturbances, PTSD, and alcohol use. Mechanisms that explain the associations between sleep, PTSD, and alcohol outcomes warrant further investigation. Methods: In the current study, we tested a path model of the associations between PTSD symptom clusters (avoidance, intrusion, arousal, negative mood and cognition), sleep disturbances and alcohol consumption, and related problems among 168 Iraq and Afghanistan veterans. Results: The association between negative mood and cognition and alcohol problems was significantly mediated by sleep impairment and alcohol use. Arousal was also directly associated with alcohol problems, over and above sleep, alcohol use, and the other PTSD clusters. Intrusion, arousal and avoidance symptoms were not significantly associated with sleep disturbances. Conclusion: These results indicate that negative alterations in mood and cognition may be a key cluster to focus future interventions in an attempt to decrease problematic drinking in veterans with PTSD symptoms.