Fear of sleep in first responders: Associations with trauma types, psychopathology, and sleep disturbances

Fear of sleep contributes to insomnia in some individuals with posttraumatic stress disorder (PTSD) but remains uncharacterized in first responders, a population with high rates of insomnia and PTSD. We evaluated the clinical relevance of fear of sleep in first responders by (1) examining its relationship with trauma types and clinical symptoms and (2) assessing differences in fear of sleep severity between those reporting provisional PTSD, insomnia, or both. A cross-sectional study of 242 first responders across the US (59.2% male, 86.4% White, 56.2% law enforcement officers, 98.7% active duty, Myears of service = 17). Participants completed the Fear of Sleep Inventory – Short Form and measures of trauma history, psychopathology (e.g., PTSD), and sleep disturbances (insomnia and trauma-related nightmares). Fear of sleep was associated with trauma types characterized by interpersonal violence and victimization, as well as symptoms of PTSD, depression, anxiety, stress, alcohol use problems, insomnia, and trauma-related nightmares. Fear of sleep was most pronounced among first responders reporting provisional PTSD comorbid with insomnia compared to those with PTSD or insomnia only. Post hoc analyses revealed PTSD hyperarousal symptoms and trauma-related nightmares were independently associated with fear of sleep, even after adjusting for the remaining PTSD clusters, insomnia, sex, and years of service. Fear of sleep is a clinically relevant construct in first responders that is associated with a broad range of psychopathology symptoms and is most severe among those with co-occurring PTSD and insomnia. Fear of sleep may merit targeted treatment in first responders.