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To examine these associations, a large, gender\u2010balanced cohort of veterans (<jats:italic>N =<\/jats:italic> 1,649) of the Iraq and Afghanistan conflicts participated in longitudinal assessments of PTSD and insomnia\u2010related symptoms over a period of 2.5 years following enrollment (range: 2\u20134 years). Data were obtained from multiple sources, including interviews, self\u2010report assessments, and electronic medical record data. Three\u2010fourths (74.0%) of veterans with PTSD diagnoses at Time 1 (T1) reported insomnia\u2010related sleep difficulties on at least half the nights during the past 30 days, and one\u2010third of participants had received a prescription for a sedative\u2010hypnotic drug in the past year. Veterans without PTSD had fewer sleep problems overall, although the prevalence of sleep problems was high among all study participants. In longitudinal, cross\u2010lagged panel models, the frequency of sleep problems at T1 independently predicted increases in PTSD severity at Time 2 (T2), <jats:italic>B<\/jats:italic> = 0.27, <jats:italic>p<\/jats:italic> &lt; .001, after controlling for gender and relevant comorbidities. Conversely, T1 PTSD severity was associated with increasing sleep complaints at T2 but to a lesser degree, <jats:italic>B<\/jats:italic> = 0.04, <jats:italic>p<\/jats:italic> &lt; .001. Moderately high rates of sedative\u2010hypnotic use were seen in veterans with PTSD, with more frequent use in women compared to men (40.4% vs. 35.0%). Sleep complaints were highly prevalent overall and highlight the need for increased clinical focus on this area.<\/jats:p>","DOI":"10.1002\/jts.22462","type":"journal-article","created":{"date-parts":[[2019,12,4]],"date-time":"2019-12-04T15:40:43Z","timestamp":1575474043000},"page":"936-945","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":41,"title":["Posttraumatic Stress Disorder Severity and Insomnia\u2010Related Sleep Disturbances: Longitudinal Associations in a Large, Gender\u2010Balanced Cohort of Combat\u2010Exposed Veterans"],"prefix":"10.1002","volume":"32","author":[{"given":"Raymond C.","family":"Rosen","sequence":"first","affiliation":[{"name":"HealthCore\/New England Research Institutes  Watertown Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bryanna","family":"Cikesh","sequence":"additional","affiliation":[{"name":"HealthCore\/New England Research Institutes  Watertown Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shona","family":"Fang","sequence":"additional","affiliation":[{"name":"Harvard School of Public Health  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felicia L.","family":"Trachtenberg","sequence":"additional","affiliation":[{"name":"HealthCore\/New England Research Institutes  Watertown Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen H.","family":"Seal","sequence":"additional","affiliation":[{"name":"San Francisco VA Health Care System University of California San Francisco  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashley M.","family":"Magnavita","sequence":"additional","affiliation":[{"name":"HealthCore\/New England Research Institutes  Watertown Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle J.","family":"Bovin","sequence":"additional","affiliation":[{"name":"National Center for PTSD at VA Boston Healthcare System  Boston Massachusetts USA"},{"name":"Boston University School of Medicine  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan D.","family":"Green","sequence":"additional","affiliation":[{"name":"National Center for PTSD at VA Boston Healthcare System  Boston Massachusetts USA"},{"name":"Boston University School of Medicine  Boston Massachusetts USA"},{"name":"O'Connor Professional Group  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donald L.","family":"Bliwise","sequence":"additional","affiliation":[{"name":"Department of Neurology Emory University School of Medicine  Atlanta GA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian P.","family":"Marx","sequence":"additional","affiliation":[{"name":"National Center for PTSD at VA Boston Healthcare System  Boston Massachusetts USA"},{"name":"Boston University School of Medicine  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Terence M.","family":"Keane","sequence":"additional","affiliation":[{"name":"National Center for PTSD at VA Boston Healthcare System  Boston Massachusetts USA"},{"name":"Boston University School of Medicine  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,12,4]]},"reference":[{"key":"e_1_2_5_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/00001199-199309000-00010"},{"key":"e_1_2_5_3_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.books.9780890425596"},{"key":"e_1_2_5_4_1","article-title":"Mobile app\u2010delivered cognitive behavioral therapy for insomnia: Feasibility and initial efficacy among veterans with cannabis use disorders","volume":"17","author":"Babson K. 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