Sleep quality problems three decades post-disaster

Mental health and sleep routines: Uttarkashi, India tunnel collapse workers' experience

Among the mental health outcomes and disaster types (determined by damage to life, property, long-term consequences, displacement, and unpredictability), floods are associated with anxiety and sleep problems, mudslides with anxiety and mood disturbance, volcanic eruptions with acute stress reactions, and earthquakes with anxiety, depression, and physical complaints. Disasters such as tunnel collapse are unique as it involves the healthy, without loss of personal property or displacement; hence, they can have very different health-related outcomes. In this study, we explore mental health and sleep-related issues in workers rescued from an under-construction collapsed tunnel trapped for 17 days. After the initial triage and stabilization and a detailed evaluation of their physical and mental health status, the participants responded to self-administered scales for assessing anxiety [Generalized Anxiety Disorder-7], depression [Patient Health Questionnaire-9], and insomnia [Insomnia Severity Index] in the local language (Hindi). A separate research team conducted open-ended interviews to explore daily routines and concerns, circadian rhythm, orientation to time and day of tunnel collapse to day of rescue events, and sleep routine (and other nuances such as sleep quality and daytime napping) during the 17 days of entrapment. Thirty-three workers consented and hailed from the northern and eastern states of India. They report a mix of hope and worry in the initial days. On the assessment of anxiety, depression, and sleep, only 2-5 scored above the cut-off value, and scales correlated with each other, though clinically it had no bearing. One-third were disoriented to the passage of time, which was related to difficulty falling asleep and more napping. Daytime napping was associated with delayed waketime. Those depressed had more difficulty in the onset, maintinance, and termination of sleep, and reduced total sleep time. Victims of tunnel collapse experience a different set of mental health and sleep problems compared to those reported in other disasters. The findings can partly be attributed to the disruption of light-dark cycles. As only a fraction develops these problems, there is a need for triaging while providing mental health and sleep-related interventions in such circumstances. Lastly, there is a need to establish a light-dark cycle to prevent disorientation among victims.

The association of polysomnographic sleep on posttraumatic stress disorder symptom clusters in trauma-exposed civilians and veterans

Study Objectives

Self-reported sleep disturbance has been established as a risk factor and predictor for posttraumatic stress disorder (PTSD); however, less is known about the relationship between objective sleep and PTSD symptom clusters, and the specific role of hyperarousal. The present study examined the relationships between sleep continuity and architecture on PTSD symptom clusters.

Methods

Participants underwent two in-laboratory sleep studies to assess sleep continuity and architecture. They also completed the Clinician-Administered PTSD-IV scale and the Structured Clinical Interview for the DSM-IV to assess for PTSD diagnosis and other psychiatric disorders.

Results

Sleep continuity (i.e. total sleep time, sleep efficiency percent, wake after sleep onset, sleep latency) was significantly related to PTSD Cluster B (reexperiencing) symptom severity (R ² = .27, p < .001). Sleep architecture, specifically Stage N1 sleep, was significantly associated with PTSD Cluster B (t = 2.98, p = .004), C (Avoidance; t = 3.11, p = .003), and D (Hyperarosual; t = 3.79, p < .001) symptom severity independently of Stages N2, N3, and REM sleep. REM sleep variables (i.e. REM latency, number of REM periods) significantly predicted Cluster D symptoms (R ² = .17, p = .002).

Conclusions

These data provide evidence for a relationship between objective sleep and PTSD clusters, showing that processes active during Stage N1 sleep may contribute to PTSD symptomatology in civilians and veterans. Further, these data suggest that arousal mechanisms active during REM sleep may also contribute to PTSD hyperarousal symptoms.This paper is part of the War, Trauma, and Sleep Across the Lifespan Collection. This collection is sponsored by the Sleep Research Society.

From a first person perspective: Soldiers' experiences three decades after an avalanche - A qualitative interview study

STUDY OBJECTIVES

The aim of this study was to explore indirectly exposed soldiers' subjective experiences following an avalanche. Three decades after the trauma, this study describes the perceived impact of the disaster by peers of those who survived or died in the avalanche.

METHOD

A qualitative, cross-sectional, study based on 17 individual interviews with persons indirectly exposed to an avalanche. Data was analysed according to qualitative content analysis.

FINDINGS

The findings revealed 'being a significant first person' as the main theme. Two categories were developed: 1) Experience of closeness to the victims 2) Experience of distance post-disaster. The categories elaborated two subcategories each: 1) Could have been me 2) Sadness, grief, shame and guilt over losing friends and 1) Unorganized military service post-disaster 2) Anger towards the system.

CONCLUSION

The soldiers indirectly exposed to the avalanche need to be seen both as a person and as a group. Both immediately following and decades after the disaster, the informants wanted the military to offer adequate follow-up.

Sleep Problems among Disaster Victims: A Long-Term Survey on the Life Changes of Disaster Victims in Korea

This study aimed to assess sleep problems and their underlying factors in victims of disasters such as typhoons, heavy rains, fires, and earthquakes. Data from the long-term survey on life changes among disaster victims in 2019 obtained by the National Disaster Management Research Institute were used. The study included 1358 victims of natural and social disasters in Korea between 2012 and 2018. Sleep problems were assessed using a survey on subjective sleep quality and the use of sleeping medication. The data were analyzed using the chi-square test, t-test, and binominal logistic regression. The results showed that the factors affecting subjective sleep quality included disaster type, time elapsed after disaster, subjective health status, depression, and posttraumatic stress disorder. The factors affecting sleep medication use included age, time elapsed after disaster, and posttraumatic stress disorder. Therefore, interventions and support systems should be provided to prevent the prolongation of sleep problems.

The experiences of dealing with consequences of an avalanche - surviving soldiers' perspectives

Purpose: The aim of the study was to explore and describe experiences of daily life after having experienced an avalanche three decades ago.Method: This paper presents a qualitative study of 12 male survivors of an avalanche during their military service, interviewed 30 years post-disaster.Findings: A comprehensive understanding of the categories led to the latent theme "Finding my own way of managing and dealing with life". Findings revealed three categories describing experiences of daily living: (i) A comfortable life; (ii) A challenging, yet accomplished life; (iii) A demanding life. The first category represents a greater degree of using adaptive coping strategies for managing everyday life compared to the other two categories. The third category represents the group having the most challenging consequences. Among the three, the latter category conveys the most maladaptive coping strategies.Conclusions:The participants had different experiences with regards to their health and how they coped with their everyday life after the avalanche disaster. Insights into coping strategies may provide a guide for appropriate interventions for survivors dealing with traumatic events.