Treating Insomnia First May Be Key to Effective PTSD Therapy, with Peter Colvonen, PhD

At SLEEP 2025, the 39th annual Associated Professional Sleep Societies meeting in Seattle, Washington, Peter Colvonen, PhD, presented on disordered sleep and PTSD development. There, HCPLive sat down with Colvonen, an associate clinical professor at the University of California, San Diego, to discuss common, underrecognized sleep disturbances in individuals with PTSD and how to treat these patients.

“Historically, sleep was integrated into the definition of PTSD, so it was assumed that if you treat PTSD, the insomnia would go down, whereas, in fact, what we're seeing now is that's not the case,” Colvonen explained. “About 80% of veterans who go through the very best PTSD treatments still have insomnia on the other side. What we're seeing is actually an independent disorder, a fully independent disorder for insomnia.”

Colvonen added that fragmented sleep due to insomnia directly interferes with PTSD treatments. Insomnia interferes with treatments for various areas—anxiety, depression, learning, memory, recall, encoding, emotional processing, emotional coping, substance use, and suicidality.

“It makes insomnia a critically important disorder to go after if you want to be effective with PTSD [treatment,” he said.

He continued by saying that sleep improves emotional memory learning, which, in turn, improves PTSD symptoms. If a patient experiences insomnia and PTSD, Colvonen recommends ordering cognitive behavior therapy for insomnia (CBT-I) first.

“PTSD treatments really hard,” Colvonen said. “It's asking you to kind of relive and go through some of your worst memories. So, if you get that trust with helping out the CBTI, [they’ll] sleep right in the first 4 or 5 weeks, they're much more likely to walk with you in talking about their trauma as a clinician. I think that would be the take-home [message].”

When it comes to sleep disturbances in patients with PTSD, not only is insomnia common, but also obstructive sleep apnea (OSA). Several studies have shown that untreated OSA directly interferes with cognitive processing therapy and prolonged exposure.

“[With] making sure you're addressing the fragmented sleep of obstructive sleep apnea, you're going to have much better trajectories, both clinically… and statistically significant on your treatment.”