Pre-sleep arousal and fear of sleep in trauma-related sleep disturbances: A cluster-analytic approach

Werner, Gabriela G. ; Danböck, Sarah K. ; Metodiev, Stanislav ; Kunze, Anna E.

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URN: urn:nbn:de:bsz:180-madoc-652895
Document Type: Article
Year of publication: 2020
The title of a journal, publication series: Clinical Psychology in Europe
Volume: 2
Issue number: 2
Page range: 1-20
Place of publication: Trier
Publishing house: PsychOpen
ISSN: 2625-3410
Publication language: English
Institution: School of Social Sciences > Klinische u. Biologische Psychologie u. Psychotherapie (Alpers 2010-)
Pre-existing license: Creative Commons Attribution 4.0 International (CC BY 4.0)
Subject: 150 Psychology
610 Medicine and health
Keywords (English): trauma-related sleep disturbances , pre-sleep arousal , insomnia , nightmares , fear of sleep , posttraumatic stress disorder , cluster analysis
Abstract: Background: Trauma-related sleep disturbances constitute critical symptoms of posttraumatic stress disorder (PTSD), but sleep symptoms often reside even after successful trauma-focused psychotherapy. Therefore, currently unattended factors – like fear of sleep (FoS) – might play a crucial role in the development and maintenance of residual sleep disturbances. However, it is unclear whether trauma-exposed individuals exhibit different symptomatic profiles of sleep disturbances that could inform individualized therapeutic approaches and eventually enhance treatment efficacy. Method: In a large online study, a two-step cluster analysis and a hierarchical cluster analysis using Ward’s method were performed to explore subgroups among trauma-exposed individuals (N = 471) in terms of FoS, different aspects of trauma-related sleep disturbances (e.g., insomnia symptoms, nightmares, arousal), and PTSD symptoms. These variables were compared between resulting clusters using ANOVAs and Scheffé’s post-hoc tests. Results: The hierarchical cluster analysis supported 3- and 4-cluster solutions. The 3-cluster solution consisted of one “healthy” (n = 199), one “subclinical” (n = 223), and one “clinical” (n = 49) cluster, with overall low, medium, and high symptomatology on all used variables. In the 4-cluster solution, the clinical cluster was further divided into two subgroups (n = 38, n = 11), where one cluster was specifically characterized by elevated somatic pre-sleep arousal and high levels of FoS. Conclusions: A subgroup of trauma-exposed individuals with PTSD and sleep disturbances suffers from increased pre-sleep arousal and FoS, which has been suggested as one possible explanation for residual sleep disturbances. In these patients, FoS might be a relevant treatment target.

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