Cognitive Behavioral Therapy for Insomnia and Probable PTSD May Benefit Women Veterans

A serious mid adult female soldier talks to a male mental health professional about hard situations while serving overseas.
Researchers sought to compare the benefits of cognitive behavioral therapy for insomnia for sleep, mental health symptoms, and quality of life in women veterans with and without probable PTSD with insomnia.

For women veterans who have insomnia and probable posttraumatic stress disorder (PTSD), cognitive behavioral therapy (CBT) for insomnia was found to improve symptoms of insomnia, mental health symptoms, and quality of life (QoL), according to study findings published in Women’s Health Issues.

CBT for insomnia (CBT-I) has previously been found to be effective at improving sleep and mental health problems among predominantly male veterans. The current study aimed to focus on the efficacy of CBT-I among women veterans.

Researchers conducted a secondary analysis of data from 73 women veterans who were assigned to have CBT-I. Study participants were recruited via an insomnia postal survey and the trial was conducted at a single Veterans Affairs center. The CBT-I program comprised 5 weekly 60 minute sessions about sleep restriction, stimulus control, cognitive therapy exercises, sleep hygiene recommendations, and relaxation strategies. Outcomes were assessed using a wrist actigraph and participants were asked to keep a sleep diary. Symptoms of PTSD were assessed using the PTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition and QoL using the 12-Item Short Form Health Survey.

The study participants were aged mean 48.01 (standard deviation [SD], 13.46) years, 41.10% were White, 36.99% Black, 76.47% were heterosexual, 44.12% married, 30.88% single, and 53.42% employed.

A total of 30 had probable PTSD. Women with probable PTSD had higher insomnia total scores (P <.001), depression scores (P <.001), anxiety scores (P <.001), PTSD scores (P <.001), more nightmares per week (P <.001), and lower mental (P =.001) and physical (P =.01) QoL.

At a 3-month follow-up, both women with and without probable PTSD had significant improvements to insomnia total scores, sleep quality, daily sleep efficiency, diary total sleep time, depression, anxiety, and mental QoL (all P £.007). The women with PTSD also had improvement to the number of nightmares per week (P <.001). Neither group had significant effects to objective sleep efficiency or physical QoL.

Compared between groups at 3 months, there was a significant interaction between CBT-I and PTSD for the number of weekly nightmares (mean difference, -1.72; 95% CI, -2.95 to -0.49; P =.006) and diary total sleep time (mean difference, 36.79; 95% CI, 3.77-69.81 min; P =.029).

At 3 months, there were significant changes to the PTSD symptom clusters of intrusion symptoms (P <.001) and changes to arousal and reactivity (P <.001).

These findings should be viewed as exploratory as no adjustments for multiple testing were performed.

This study was the first to assess CBT-I among women veterans. The researchers found that CBT-I may be beneficial for women with suspected PTSD and symptoms of insomnia, decreasing weekly nightmares and increasing diary total sleep time. Additional study is needed among this patient population to assess whether incorporating trauma-informed enhancements to CBT-I curriculum is effective.

“Our present results suggest that sleep duration may contribute to cognitive function, and future studies should include objective sleep measurements and focus on the potential cognitive benefits of improving sleep to further elucidate this association,” the researchers concluded.


Carlson GC, Kelly MR, Mitchell M, et al. Benefits of Cognitive Behavioral Therapy for Insomnia for Women Veterans with and without Probable Post-Traumatic Stress Disorder. Womens Health Issues. Published online November 20, 2021. doi:10.1016/j.whi.2021.10.007

This article originally appeared on Neurology Advisor