Document Type



Doctor of Philosophy



Date of Defense


Graduate Advisor

Michael G. Griffin, Ph.D.


Tara E. Galovski

George Taylor

Joseph M. Ojile


Sleep disturbance is often reported after a traumatic event and is included in the American Psychiatric Association Diagnostic and Statistical Manual criteria for posttraumatic stress disorder (PTSD). Subjective reports from trauma survivors have consistently indicated difficulties in sleep onset, sleep maintenance, overall quality and quantity of sleep. However, objective physiological research has yielded inconsistent findings in PTSD-related sleep impairment. Studies investigating subjective and objective assessments concordantly support a theory of sleep state misperception – subjective over-estimation of sleep disturbance – in PTSD. The majority of these previous investigations have been limited to male, veteran cohorts and have not accounted for the effects of psychiatric comorbidity, such as major depression. The current study examines PTSD-related sleep disturbance in a female interpersonal violence cohort (N=51) assessing subjective and objective physiological (actigraphy) sleep measures concurrently. Specific aims of the study addressed the presence of sleep state misperception in a female PTSD cohort and the effect of comorbid depression symptoms and diagnosis on PTSD-related sleep impairment. Analyses revealed an overall subjective over-reporting of sleep disturbance when compared to objective physiological measurement. Subjective reports of sleep onset latency were significantly higher than objective measures (t (50) = 4.59, p < .001), and subjective sleep quality (t (50) = 6.03, p < .001) and sleep quantity (t (50) = 4.52, p < .001) were significantly lower than objective assessment. No significant differences were displayed between PTSD-only and PTSD/MDD groups across subjective, objective and sleep state misperception scores for any of the target sleep parameters. However, 24% of the variability in sleep state misperception was predicted by the regression model including re-experiencing symptoms and depressive symptoms as significant contributors (p < .01). Re-experiencing symptoms accounted for 13% of the variance in sleep state misperception, and depressive symptoms contributed a unique 9% of variance (p < .05). Avoidance and, surprisingly, hyperarousal symptoms, were not significant predictors of sleep state misperception. Overall, findings support the existence of sleep state misperception in a PTSD-positive female cohort. Results also point to the importance of accounting for depressive and re-experiencing symptoms as predictors of subjective sleep impairment in a PTSD cohort. Findings are discussed in terms of implications for understanding sleep impairment in PTSD.

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