# Improving Sleep and Functioning in Veterans with Posttraumatic Stress Disorder

> **NIH VA IK2** · VETERANS AFFAIRS MED CTR SAN FRANCISCO · 2022 · —

## Abstract

Sleep disturbance is the most common symptom among Veterans with posttraumatic stress disorder
(PTSD), with prevalence rates of over 90% for insomnia and around 70% for obstructive sleep apnea (OSA).
Beyond symptom-driven distress, PTSD, OSA, and insomnia are problematic because of their effects on
physical health, functional outcomes, and quality of life. While there are effective treatments available for OSA
and insomnia, current treatments for these disorders have not been adapted to the needs of the large number
of Veterans experiencing PTSD. This adaptation is necessary to target the problems that are particularly
detrimental to this group of Veterans. For example, patients with PTSD have lower positive airway pressure
therapy (PAP) adherence than those without PTSD, which is significant because increased adherence to PAP
is associated not only with reduced nightmares but also with improved PTSD symptoms overall. In addition,
though behavioral treatments for insomnia have been studied in those with PTSD with promising results, little
is known about how to address comorbid OSA and insomnia because patients with OSA are typically excluded
from insomnia trials in spite of high levels of comorbidity. Moreover, insomnia itself is associated with
decreased PAP adherence. Currently, there is no integrated approach to treating Veterans with these
comorbidities concurrently, and existing treatment is often not coordinated between different treatment clinics
and consequently may be more prolonged than needed. The proposed project allows for the evaluation of a
treatment that addresses OSA and insomnia in tandem and within the context of PTSD, which can serve to
consolidate treatment for Veterans with these issues.
 The proposed CDA-2 consists of a pilot randomized controlled trial evaluating the efficacy, feasibility,
and acceptability of Apnea and Insomnia Relief (AIR), a behavioral intervention that combines elements of
psychoeducation, motivational interviewing, cognitive behavioral therapy for insomnia, and PAP
desensitization. The trial will compare AIR (n = 40) with sleep education (control condition; n = 40) among
Veterans with OSA, insomnia, and PTSD. Treatment will be administered partially in person (sessions 1-2) and
partially via telehealth (sessions 3-6) to enhance Veteran engagement and broaden access to care. Functional
outcomes will be quality of life (primary outcome) and sleep-related functioning at post-treatment and three-
month follow-up (Aim 1). We will also measure change in insomnia and PTSD symptoms as well as PAP
adherence. Insomnia symptoms will be assessed using subjective and objective sleep measurement. Aim 2
will consist of a multifaceted assessment of the acceptability and feasibility of AIR. Veterans will complete self-
report questionnaires and a follow-up interview to assess satisfaction with treatment, both in terms of content
and method of delivery (i.e., in-person and telehealth). We will also measure treatment dr...

## Key facts

- **NIH application ID:** 10508495
- **Project number:** 5IK2RX002952-04
- **Recipient organization:** VETERANS AFFAIRS MED CTR SAN FRANCISCO
- **Principal Investigator:** lizabeth goldstein
- **Activity code:** IK2 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2022
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2019-10-01 → 2024-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10508495

## Citation

> US National Institutes of Health, RePORTER application 10508495, Improving Sleep and Functioning in Veterans with Posttraumatic Stress Disorder (5IK2RX002952-04). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10508495. Licensed CC0.

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