This chapter reviewed gaps in the literature on the effects of childhood trauma exposure on long-term sleep outcomes. PTS symptoms may be one potential mechanism linking trauma exposure to long-term sleep difficulties. However, the direction of this relationship is unclear. To address these issues, this chapter included a data-driven example that examined the long-term relationship between war exposure in childhood and sleep problems in young adulthood, among a sample of Kuwaiti youth exposed to the Gulf War of 1990. Overall, findings highlight that war exposure in childhood contributed to poor sleep quality in young adulthood. Importantly, this longitudinal relationship was not mediated by PTS symptoms in preadolescence. These findings are elaborated below.

Exposure to war trauma predicted sleep problems among young adults 10 years after youth’s initial exposure. Sleep problems among adults are concerning because they are associated with numerous maladaptive outcomes, including hypertension [36], cardiovascular disease [37], and depression [37, 38]. In this example, exposure to war trauma significantly predicted sleep quality but not sleep duration . In fact, youth were homogenous in reporting an adequate amount of sleep, as indicated by the limited variability in sleep duration. This finding is important, because among adults receiving an adequate amount of sleep, as indicated by sleep duration, it has been found that poor sleep quality is related to a variety of problems, including tension, depression, anger, fatigue, and confusion [29]. Given the unfortunate increase in children’s exposure to war trauma, our results indicate that we may expect more children and young adults to be at risk for sleep problems and, by extension, the health and psychological consequences of poor sleep.

Second, results were not consistent with the hypothesis that PTS symptoms are a mediator of the effects of war on sleep. While numerous studies implicate PTS symptoms in the development of health problems [39, 40], PTS symptoms did not link war exposure to sleep problems. Thus, it appears that other consequences of war exposure lead to sleep problems. This is a surprising finding, given that sleep difficulties are a potential feature of the PTSD diagnosis (i.e., intrusion cluster and the alterations in arousal and reactivity cluster) [17], and two sleep systems are impacted by PTSD: (a) the ability to modulate arousal (resulting in hyperarousal) and (b) memory consolidation in dreams [27]. It is possible that we did not observe that PTS symptoms mediated exposure and sleep problems because PTS symptoms were assessed 10 years before sleep problems. This protracted time difference may have been too long for observing relationships between PTS symptoms and sleep. Future studies assessing sleep problems closer in time to PTS symptoms may be needed in order to clarify the relationship between PTS symptoms and sleep after war exposure. Further, depressive symptoms may need to be considered when examining PTS symptoms, given that these symptoms are often comorbid after traumatic events [6]. This question was explored in the larger study from this dataset [1], which examined psychological distress (i.e., PTS symptoms as well as depressive symptoms) as a potential mechanism linking war exposure and sleep. When depressive symptoms were included in the model, the relationship between psychological distress and sleep quality trended toward significance (p < 0.10), but psychological distress did not mediate the relationship between war exposure and sleep quality.