New research has reinforced the positive impact that cognitive behavioural sleep treatments can have on veterans with trauma-related sleep disturbances. The study, carried out by Gallipoli Medical Research Foundation’s research team, explored whether Cognitive Behavioural Therapy for Insomnia (CBT-I) and Imagery Rehearsal Therapy (IRT) could assist veterans who experience sleep disturbances, including nightmares. The treatments address thoughts, behaviours and nightmares that contribute to sleep disturbances.

“GMRF researchers appreciate how important sleep is to our health and wellbeing and wanted to contribute to better understanding these treatments for veterans,” said Dr Emina Prguda, Research Fellow at GMRF.

“CBT-I is a leading treatment for insomnia, but it doesn’t specifically address nightmares, whereas IRT is a treatment option for nightmares. So, we also looked at CBT-I and IRT as a potential combined treatment option for veterans who experience nightmares as part of their sleep disturbance.”

Findings from the study are serving as a reminder to veterans that effective treatments are available, while also highlighting that more research needs to be done in this area to optimise treatment options for veterans.


Why is this research important?

Military service can involve unique experiences such as deployment and exposure to traumatic events, which have the potential to leave veterans with sleep-related health concerns, such as insomnia. For example, military service and deployments can alter regular sleep schedules, which can be challenging to reset when they return from service to civilian life.


Post-traumatic stress disorder (PTSD) is also associated with sleep disturbances, including insomnia and nightmares, because it can involve recollections about the traumatic event.


“We know from existing GMRF research that many ex-serving Defence Force members report subjective sleep disturbances. Our research was prompted by the identification that even veterans who undergo treatment for PTSD can still experience residual sleep issues, so we were interested in looking at this more closely to help find solutions.”


About our research

This study compared the use of CBT-I for sleep disturbances with CBT-I combined with IRT for nightmares to evaluate if the combined treatment led to greater reductions in trauma-related sleep disturbances in Australian veterans.

Thirty-one ex-serving Australian Defence Force personnel with a PTSD diagnosis participated in either group CBT-I treatment, or group CBT-I combined with IRT treatment.


Although this study offered the treatments in a group setting, veterans can complete the treatments individually.


Key research findings

Improvements were noted over time (from before the treatment to three-months post-treatment) across:

  • sleep quality
  • nightmare distress
  • PTSD
  • stress


While an improvement in the sleep quality of both groups of veterans was seen, there wasn’t a significantly greater improvement in the veterans who underwent the combined treatment as was expected. Additionally, all participating veterans reported that they would recommend the treatments to other veterans.

“Veterans who are experiencing sleep disturbances can consider CBT-I as a possible treatment option, in addition to considering IRT if nightmares form a part of those sleep disturbances.” said Dr Prguda.

“However, the specific findings highlight the need for further research in this area to explore how to optimise CBT-I and IRT for veterans who experience trauma-related sleep disturbances.”


The article Post Traumatic Sleep Disturbances in Veterans: A Pilot Randomized Control Trial of Cognitive Behavioural Therapy for Insomnia and Imagery Rehearsal Therapy was published in the Journal of Clinical Psychology on the 1st of July 2023.

Read the article here 

The study was funded by the Australian Government Department of Veterans’ Affairs.


Learn more about our Veteran Health research.