Date of Award

January 2022

Document Type

Open Access Thesis

Degree Name

Doctor of Nursing Practice (DNP)


Yale University School of Nursing

First Advisor

Lindsay Powell

Second Advisor

Joanne DeSanto Iennaco


Evidence-based treatments for post-traumatic stress disorder (PTSD) improve overall symptoms, but sleep disturbance often persists. Insomnia and obstructive sleep apnea (OSA) frequently co-occur with PTSD and contribute to the overall sleep disturbance. Successfully treating the sleep disturbance that occurs in the context of PTSD, including insomnia and OSA when present, will improve sleep, decrease PTSD symptoms, and enhance quality of life. This DNP project adapted an assessment and treatment protocol for veterans with PTSD and sleep disturbance for use in an outpatient veterans Affairs (VA) PTSD clinic. The protocol was implemented in a patient education and treatment-planning group for veterans with PTSD. Screening measures for insomnia and OSA were distributed to group participants. The group curriculum and patient education materials were revised to include information about insomnia, OSA and their treatments. Eight veterans attended the group during the implementation period and were sent the Insomnia Severity Index and STOP Questionnaire. Two veterans returned the questionnaires: both screened positive for insomnia and one screened positive for OSA. One referral to Cognitive Behavioral Therapy for Insomnia was submitted following the group. Results suggest that screening for insomnia and OSA in an outpatient VA PTSD clinic will uncover high rates of co-morbidity. A longer implementation period and larger sample size are needed to determine if these methods will increase referrals to evidence-based treatments recommended by the protocol. The protocol offers a strategy for treating veterans with PTSD and sleep disturbance that supports measurement-based care, evidenced-based practice, and drug safety initiatives.


This is an Open Access Thesis.

Open Access

This Article is Open Access