1. Sleep 2009
23 rd AnnuAl Meeting Of the
ASSOciAted
prOfeSSiOnAl Sleep
SOcietieS, llc.
June 6 - 11, 2009
WAShingtOn StAte cOnventiOn And trAde center • SeAttle, WAShingtOn

2. Conflict of Interest Disclosures
Authors: to disclose, OR
X 1. The authors do not have any potential conflicts of interest
2. The authors wish to disclose the following potential conflicts of interest:
Type of Potential Conflict Details of Potential Conflict
Grant/Research Support
Consultant
Speakers’ Bureaus
Financial support
Other
3. The material presented in this lecture has no relationship with any of these potential conflicts, OR
4. This talk presents material that is related to one or more of these potential conflicts, and the
following objective references are provided as support for this lecture:
1.
2.
3.

3. Waking qEEG in Veterans with PTSD
Compared with Subjects with Insomnia and
Good Sleepers.
Jennifer Alman1, David Cashmere2, Robert Seres2, Jean
Miewald2, Daniel J. Buysse2, MD., and Anne Germain2,
Ph.D.
1
Washington & Jefferson University
2
Department of Psychiatry, University of Pittsburgh School of
Medicine

4. Background
• Veterans with Post-Traumatic Stress Disorder
(PTSD) have many sleep disturbances.
» e.g., Neylan et al., 1998
• Sleep disturbances in PTSD relate to central
arousal during wakefulness and sleep.
» e.g., Woodward et al., 2000
• Primary Insomnia (PI) is also associated with
heightened central arousal during sleep.
» e.g., Buysse et al., 2008

5. Study Aim
1. To explore markers of central arousal
during pre-sleep wakefulness in participants
with PTSD, PI, and good sleepers (GS).
– Primary focus on beta activity derived from
qEEG
– Other activity bands were also explored.
2. To explore correlations between pre-sleep
markers of central arousal and PTSD
severity, depression, and anxiety.

6. Participants
• 10 Military Veterans with PTSD
– All combat exposed except for 1
– M age = 37.57 + 11.72 years old
– 5 PTSD subjects were free of medication: 3 antidepressants, 1
hypnotic, 1 benzodiazepine.
• 10 PI subjects
– M age = 35.344 + 9.67 years old
– Free of medication, medical conditions, psychiatric and other sleep
disorders.
• 9 GSC
– M age = 40.12 + 22.78 years old
– Free of medication, medical conditions, psychiatric and other sleep
disorders

7. Procedures
• Participants had one night of acclimation
in the lab.
• The second night a five-minute pre-sleep
waking EEG was recorded.
• Questionnaires to assess PTSD severity (PCL),
depression (BDI), and anxiety (BAI).
• Editing software was used to clear
artifacts from records.

8. Artifact Rejection
(Not Rejected and Rejected)
C4
EOG
4 seconds
C4
EOG
4 seconds

9. Data Analysis
• Data were processed using an FFT model for
power spectral analysis.
• Kruskal-Wallis tests used for group differences
on spectral data.
– Distribution normalized when necessary for analysis
• Spearman’s rho used for relationships between
qEEG activity bands and self-reported symptom
measures.

10. Results: Number of Epochs
Rejected per Group
• The number of epochs
rejected in each group does
not differ.
Mean of Epochs Rejected
• p > .05.
4
3.5
3
• Mean Record Length 2.5
(good)
2
1.5
1
– PTSD: 2.72 minutes 0.5
0
– Insomnia: 2.44 PTSD Insomnia GSC
minutes
– GS: 2.15 minutes

11. Results: Beta 2 Power (16-32 Hz) and
Beta 1 Power (12-16 Hz) Across Groups
Mean Beta 2 Power Mean Beta 1 Power
9
20
18 8
16 7
14 6
12
5
10
4
8 Frequency
Frequency
3
6
4 2
2 1
0 0
PTSD Insomnia GSC PTSD Insomnia GSC

12. Results: Correlations
• Beta 2 (16-32 Hz) positively correlated to:
– PTSD severity: rho: 0.78 p < 0.01
– Depression: rho: 0.72 p < 0.05
– Anxiety: rho: 0.84 p < 0.01
• Beta 1 (12-16 Hz) positively correlated to:
– Depression: rho: 0.72, p < 0.05
• Theta power (4-8 Hz) positively correlated
to:
– PTSD severity: rho: 0.87, p < 0.01

13. Conclusions
1. There was no significant group
differences in beta activity during pre-
sleep wakefulness.
– Trend for PTSD > PI, GSC in Beta 2
– Trend for PI > PTSD, GSC in Beta 1
2. The neurobiological underpinnings of
central arousal may differ pre- and
post- sleep onset across diagnostic
groups.

14. Conclusions
1. Fast-frequency (Beta 2) activity during
pre-sleep wakefulness is positively
associated with clinical symptom
severity in the subjects with PTSD.
2. Increased theta power indicates
sleepiness but patient cannot sleep
because clinical symptoms prevent
sleep onset.

15. Conclusions
1. Larger samples are required to
evaluate the robustness of these
preliminary findings.
2. Combining qEEG with neuroimaging
techniques will clarify the source of
heightened arousal in PTSD and PI.

16. Acknowledgements
• Gina Pietrone
• Research participants
• N-CTRC staff
US Department of Defense (PR054093: Germain)
National Institute of Health (RR 0052, RR 024153, MH24652)