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Poisson regression analysis was used to examine the bidirectional associations between sleep problems and PTSS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Individuals reporting sleep problems before the disaster were more likely to develop PTSS after exposure to disaster trauma, while there was no effect modification, i.e. prevalence ratio for sleep problems did not differ by the magnitude of disaster damages. Individuals reporting sleep problems after the disaster were less likely to recover from PTSS, and more likely to develop the delayed onset of PTSS 5 years after the disaster. While individuals who recovered from PTSS 9 years after the disaster were still at slightly higher risk of having sleep problems compared to those who never had PTSS, none of the sleeping problems were found to be significantly prevalent after the Bonferroni correction.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Pre-disaster sleep problems predicted PTSS onset independently of experiences of disaster trauma. The association between PTSS and sleep problems was bidirectional. Intervening to mitigate lingering sleep problems may benefit the recovery of disaster survivors from post-traumatic symptoms.<\/jats:p><\/jats:sec>","DOI":"10.1093\/sleep\/zsad106","type":"journal-article","created":{"date-parts":[[2023,4,8]],"date-time":"2023-04-08T15:16:38Z","timestamp":1680966998000},"source":"Crossref","is-referenced-by-count":9,"title":["Bidirectional associations between post-traumatic stress symptoms and sleep quality among older survivors of the 2011 Great East Japan Earthquake and Tsunami"],"prefix":"10.1093","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4335-3880","authenticated-orcid":false,"given":"Aki","family":"Yazawa","sequence":"first","affiliation":[{"name":"Department of Social and Behavioral Sciences, Harvard T.H. 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