Learn how an integrated behavioral sleep medicine approach combining CBT-I, CPT, and ACT helped a client with more than 40 years of PTSD-related sleep maintenance insomnia achieve meaningful improvements in sleep and PTSD symptoms over six treatment sessions.
Sleep disturbance is one of the most persistent and impairing symptoms experienced by individuals with PTSD. Many people spend years, or even decades, believing that frequent nighttime awakenings are simply an unavoidable consequence of trauma.
Recently, I completed treatment with a client who had experienced more than 40 years of difficulty maintaining sleep in the context of PTSD-related hypervigilance. Following a comprehensive assessment, we implemented an individualized treatment plan integrating Cognitive Behavioral Therapy for Insomnia (CBT-I), Cognitive Processing Therapy (CPT), and Acceptance and Commitment Therapy (ACT).
After six treatment sessions, the client reported that all treatment goals had been met.
This represents improvement from subthreshold insomnia to the absence of clinically significant insomnia.
This represents a 28-point reduction in PTSD symptoms. For context, reductions of 10 points or more on the PCL-5 are generally considered clinically meaningful.
Sleep disturbance is frequently viewed as merely a symptom of PTSD. While PTSD certainly contributes to disrupted sleep, chronic insomnia often develops into its own self-perpetuating disorder through conditioned arousal, maladaptive sleep behaviors, cognitive factors, and persistent hypervigilance.
This case illustrates the value of addressing both conditions in an integrated manner. By combining evidence-based insomnia treatment with trauma-focused therapy and ACT principles, improvements occurred not only in objective sleep metrics but also in overall PTSD symptom severity.
Although every client is unique and treatment outcomes naturally vary, this case serves as another reminder that even individuals with decades-long histories of sleep disruption can experience meaningful recovery when treatment targets the mechanisms maintaining both insomnia and trauma-related distress.
- Brian Curtis, PhD, DBSM
