Sleepiness and fatigue associated with avoidance behavior in moderately severe PTSD patients presenting to a community-based sleep medical center

BACKGROUND: Avoidance behavior in PTSD patients leads to disengagement from activities and emotions, impeding healing. Research suggests sleep disturbances and resulting sleep-related impairment (daytime fatigue and sleepiness) may increase avoidance behavior. This pilot study explored whether fatigue and sleepiness were associated with avoidance behaviors in 310 adult patients with moderate to severe posttraumatic stress symptoms seeking treatment at a community sleep center. METHODS: Patients responded to sub-queries devised to assess perceptions on how trauma, fatigue, and sleepiness influenced standard avoidance items on the PSS-SR.RESULTS: Chart review data revealed sleepiness and fatigue explained 29% and 31% of the variance in avoidance, respectively. Further, fatigue and sleepiness were independently associated with different aspects of avoidance. In supplementary analyses, fatigue and sleepiness mediated and moderated the relation between trauma and avoidance, suggesting these symptoms influence how trauma is associated with avoidance.CONCLUSIONS: Our exploratory findings suggest a need to determine how sleep complaints fit into the clinical evaluation of trauma survivors. Speculatively, the results indicate a potential value in determining whether fatigue and sleepiness are exclusively trauma-related characteristics of the posttraumatic process or evidence of comorbid, possibly independent sleep disorders in PTSD patients.