Fear of sleep in first responders: associations with trauma types, psychopathology, and sleep disturbances

Anthony N Reffi; David A Kalmbach; Philip Cheng; Peter Tappenden; Jennifer Valentine; Christopher L Drake; Wilfred R Pigeon; Scott M Pickett; Michelle M Lilly

doi:10.1093/sleepadvances/zpad053

Fear of sleep in first responders: associations with trauma types, psychopathology, and sleep disturbances

Sleep Adv. 2023 Dec 1;4(1):zpad053. doi: 10.1093/sleepadvances/zpad053. eCollection 2023.

Authors

Anthony N Reffi¹, David A Kalmbach¹, Philip Cheng¹, Peter Tappenden², Jennifer Valentine², Christopher L Drake¹, Wilfred R Pigeon^{3

4}, Scott M Pickett⁵, Michelle M Lilly²

Affiliations

¹ Thomas Roth Sleep Disorders and Research Center, Henry Ford Health, Detroit, MI, USA.
² Department of Psychology, Northern Illinois University, DeKalb, IL, USA.
³ U.S. Department of Veterans Affairs, VISN 2 Center of Excellence for Suicide Prevention, Canandaigua, NY, USA.
⁴ Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA.
⁵ Center for Translational Behavioral Science, Florida State University College of Medicine, Tallahassee, FL, USA.

Abstract

Study objectives: Fear of sleep contributes to insomnia in some individuals with posttraumatic stress disorder (PTSD) but remains uncharacterized in first responders, a population with high rates of insomnia and PTSD. We evaluated the clinical relevance of fear of sleep in first responders by (1) examining its relationship with trauma types and clinical symptoms and (2) assessing differences in fear of sleep severity between those reporting provisional PTSD, insomnia, or both.

Methods: A cross-sectional study of 242 first responders across the United States (59.2% male, 86.4% white, 56.2% law enforcement officers, 98.7% active duty, and M_{years of service} = 17). Participants completed the Fear of Sleep Inventory-Short Form and measures of trauma history, psychopathology (e.g. PTSD), and sleep disturbances (insomnia and trauma-related nightmares).

Results: Fear of sleep was associated with trauma types characterized by interpersonal violence and victimization, as well as symptoms of PTSD, depression, anxiety, stress, alcohol use problems, insomnia, and trauma-related nightmares. Fear of sleep was most pronounced among first responders reporting provisional PTSD comorbid with insomnia compared to those with PTSD or insomnia only. Post hoc analyses revealed PTSD hyperarousal symptoms and trauma-related nightmares were independently associated with fear of sleep, even after adjusting for the remaining PTSD clusters, insomnia, sex, and years of service.

Conclusions: Fear of sleep is a clinically relevant construct in first responders that is associated with a broad range of psychopathology symptoms and is most severe among those with cooccurring PTSD and insomnia. Fear of sleep may merit targeted treatment in first responders. This paper is part of the Sleep and Circadian Health in the Justice System Collection.

Keywords: emergency responders; nocturnal vigilance; occupational trauma; public safety; trauma-induced insomnia.