Integrated treatment for sleep and PTSD (TMT) produced superior objective sleep outcomes compared to exposure alone (CPE), with the most meaningful improvements in sleep observed 6 months after treatment completion.
Key Findings
Results
Both treatment groups showed negligible to small changes in actigraphy-based sleep measures at posttreatment compared to baseline.
Active-duty service members with PTSD (n = 82) were randomly assigned to Compressed Prolonged Exposure (CPE) or Trauma Management Therapy (TMT)
Sleep was measured using actigraphy at baseline, posttreatment, 3-month, and 6-month follow-up
Neither group showed meaningful sleep improvements immediately following treatment completion
The lack of immediate posttreatment sleep gains was observed across both the exposure-only and integrated treatment conditions
Results
The TMT group showed improvements in most sleep parameters by the 3- and 6-month follow-up assessments, while sleep health generally worsened in the CPE group over time.
TMT integrates exposure therapy with sleep hygiene training and other skills-based interventions
CPE consists of exposure therapy alone without integrated sleep components
Sleep improvements in TMT continued to emerge after treatment ended, suggesting delayed or progressive effects
The diverging trajectories between groups became more pronounced at the longer follow-up intervals
Results
At 3-month follow-up, TMT participants showed better sleep efficiency and sleep onset latency compared to CPE participants.
Sleep efficiency between-group effect size: g = 0.24 in favor of TMT
Sleep onset latency between-group effect size: g = -0.34 in favor of TMT
These between-group differences were not present at the immediate posttreatment assessment
Effect sizes were in the small-to-moderate range at 3-month follow-up
Results
At 6-month follow-up, TMT participants demonstrated better sleep quality, sleep efficiency, and wake after sleep onset compared to CPE participants.
Sleep quality between-group effect size: g = 0.70 in favor of TMT
Sleep efficiency between-group effect size: g = 0.51 in favor of TMT
Wake after sleep onset between-group effect size: g = -0.52 in favor of TMT
The 6-month follow-up effect sizes were larger than those observed at 3-month follow-up, indicating continued divergence
Sleep quality showed the largest between-group difference (g = 0.70) at the final assessment point
Results
Poorer sleep at the 6-month follow-up was correlated with greater PTSD symptom severity at the same time point in both treatment groups.
The correlation between sleep and PTSD symptoms was observed within both the TMT and CPE groups
This relationship was assessed at the 6-month follow-up time point
The finding suggests a concurrent association between residual sleep disturbance and PTSD symptom severity regardless of treatment type
The correlation was measured between actigraphy-based sleep parameters and PTSD symptom severity scores
Background
Prior research on integrated sleep and PTSD treatment has been limited by reliance on subjective sleep measures and lack of long-term follow-up.
The current study used actigraphy-based (objective) sleep measurement to address prior methodological limitations
Follow-up assessments extended to 6 months post-treatment, which is longer than most prior studies in this area
Trauma-induced sleep disturbances are noted to often persist after successful PTSD treatment
The study sample consisted specifically of active-duty service members with PTSD (n = 82)
What This Means
This research suggests that combining sleep-focused skills training with standard PTSD exposure therapy leads to better long-term sleep outcomes than exposure therapy alone for active-duty military service members with PTSD. In the study, 82 service members were randomly assigned to either standard Compressed Prolonged Exposure (CPE) therapy or Trauma Management Therapy (TMT), which added sleep hygiene training and other skills to the exposure-based approach. Sleep was tracked objectively using wrist-worn actigraphy devices at the start of treatment, at the end of treatment, and again at 3 and 6 months later.
Neither group showed notable sleep improvements right after treatment ended. However, over the following months, a clear difference emerged: the TMT group's sleep continued to improve, while the CPE group's sleep generally got worse. By 6 months after treatment, TMT participants had meaningfully better sleep quality, sleep efficiency, and less time spent awake during the night compared to those who received CPE alone. The effect sizes at the 6-month mark were moderate to large, suggesting these differences were clinically meaningful, not just statistically detectable.
The study also found that in both groups, worse sleep at the 6-month follow-up was linked to more severe PTSD symptoms at the same time point, highlighting the ongoing connection between sleep health and PTSD recovery. This research suggests that integrating sleep-specific interventions into PTSD treatment may produce sleep benefits that grow over time rather than appearing immediately, and that using objective sleep measurement and longer follow-up periods is important for capturing the full impact of PTSD treatments on sleep.
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Cifre A, Myers A, Jou Y, Gallagher M, Alfano C, Grover C, et al.. (2026). Improving Sleep and PTSD Outcomes in Service Members: A Randomized Controlled Trial Examining the Long-Term Effects of an Integrated Treatment.. Behavior therapy. https://doi.org/10.1016/j.beth.2026.04.003