Increased sleep disturbances and pain in veterans with comorbid traumatic brain injury and posttraumatic stress disorder

Nadir M. Balba, Jonathan E. Elliott, Kris B. Weymann, Ryan A. Opel, Joseph W. Duke, Barry S. Oken, Benjamin J. Morasco, Mary M. Heinricher, Miranda M. Lim

Research output: Contribution to journalArticlepeer-review

46 Scopus citations


Study Objectives: Veterans are at an increased risk for traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD), both of which are associated with sleep disturbances and increased pain. Furthermore, sleep disturbances and pain are reciprocally related such that each can exacerbate the other. Although both TBI and PTSD are independently linked to sleep disturbances and pain, it remains unclear whether Veterans with comorbid TBI+PTSD show worse sleep disturbances and pain compared to those with only TBI or PTSD. We hypothesized that sleep and pain would be worse in Veterans with comorbid TBI+PTSD compared to Veterans with only TBI or PTSD. Methods: Veterans (n = 639) from the VA Portland Health Care System completed overnight polysomnography and self-report questionnaires. Primary outcome variables were self-reported sleep disturbances and current pain intensity. Participants were categorized into four trauma-exposure groups: (1) neither: without TBI or PTSD (n = 383); (2) TBI: only TBI (n = 67); (3) PTSD: only PTSD (n = 126); and (4) TBI+PTSD: TBI and PTSD (n = 63). Results: The PTSD and TBI+PTSD groups reported worse sleep compared to the TBI and neither groups. The TBI+PTSD group reported the greatest pain intensity compared to the other groups. Conclusions: These data suggest sleep and pain are worst in Veterans with TBI and PTSD, and that sleep is similarly impaired in Veterans with PTSD despite not having as much pain. Thus, although this is a complex relationship, these data suggest PTSD may be driving sleep disturbances, and the added effect of TBI in the comorbid group may be driving pain in this population.

Original languageEnglish (US)
Pages (from-to)1865-1878
Number of pages14
JournalJournal of Clinical Sleep Medicine
Issue number11
StatePublished - Nov 15 2018


  • Concussion
  • Headaches
  • Insomnia
  • Polytrauma clinical triad
  • Sensory sensitivity
  • Sleep-wake disturbances

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Neurology
  • Clinical Neurology


Dive into the research topics of 'Increased sleep disturbances and pain in veterans with comorbid traumatic brain injury and posttraumatic stress disorder'. Together they form a unique fingerprint.

Cite this