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Annals of Behavioral Medicine
Published in: Annals of Behavioral Medicine 6/2017

01-12-2017 | Original Article

Observed Relationship Behaviors and Sleep in Military Veterans and Their Partners

Authors: Jennifer Fillo, PhD, Stephanie Brooks Holliday, PhD, Amy DeSantis, PhD, Anne Germain, PhD, Daniel J. Buysse, MD, Karen A. Matthews, PhD, Wendy M. Troxel, PhD

Published in: Annals of Behavioral Medicine | Issue 6/2017

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Abstract

Background

Emerging research has begun to examine associations between relationship functioning and sleep. However, these studies have largely relied on self-reported evaluations of relationships and/or of sleep, which may be vulnerable to bias.

Purpose

The purpose of the study was to examine associations between relationship functioning and sleep in military couples. This is the first research to examine associations between observed relationship behaviors and subjective and polysomnographically measured sleep in a sample at-risk for both sleep and relationship problems.

Methods

The sample included 35 military veterans and their spouses/partners. Marital functioning was coded from a videotaped conflict interaction. Analyses focused on behavioral codes of hostility and relationship-enhancing attributions. Sleep was assessed via self-report and in-home polysomnography.

Results

Greater hostility was associated with poorer sleep efficiency for oneself (b = −0.195, p = .013). In contrast, greater relationship-enhancing attributions were associated with higher percentages of stage N3 sleep (b = 0.239, p = .028). Partners’ hostility was also positively associated with higher percentages of stage N3 sleep (b = 0.272, p = .010). Neither hostility nor relationship-enhancing attributions was associated with self-reported sleep quality, percentage of REM sleep, or total sleep time.

Conclusions

Both partners’ positive and negative behaviors during conflict interactions were related to sleep quality. These findings highlight the role that effective communication and conflict resolution skills may play in shaping not only the marital health of veterans and their spouses but also the physical health of both partners as well. Understanding the links between relationship functioning and sleep may be important targets of intervention in the aftermath of war.
Literature
1.
Kiecolt-Glaser JK, Newton TL. Marriage and health: His and hers. Psychological Bulletin. 2001;127(4):472–503.PubMedCrossRef
2.
3.
Robles TF, Slatcher RB, Trombello JM, McGinn MM. Marital quality and health: A meta-analytic review. Psychological bulletin. 2014;140(1): doi: 10.​1037/​a0031859.
4.
Robles TF, Kiecolt-Glaser JK. The physiology of marriage: Pathways to health. Physiology & Behavior. 2003;79(3):409–416.CrossRef
5.
National Sleep Foundation. 2005 Sleep in America Poll. Washington, DC: National Sleep Foundation;2005.
6.
7.
Gangwisch JE, Heymsfield SB, Boden-Albala B, et al. Short sleep duration as a risk factor for hypertension: Analyses of the first National Health and Nutrition Examination Survey. Hypertension. 2006;47(5):833–839.PubMedCrossRef
8.
Chaput J-P, Després J-P, Bouchard C, Astrup A, Tremblay A. Sleep duration as a risk factor for the development of type 2 diabetes or impaired glucose tolerance: Analyses of the Quebec Family Study. Sleep Medicine. 2009;10(8):919–924.PubMedCrossRef
9.
Cappuccio FP, D'Elia L, Strazzullo P, Miller MA. Quantity and quality of sleep and incidence of type 2 diabetes: A systematic review and meta-analysis. Diabetes Care. 2010;33(2):414–420.PubMedCrossRef
10.
Chandola T, Ferrie JE, Perski A, Akbaraly T, Marmot MG. The effect of short sleep duration on coronary heart disease risk is greatest among those with sleep disturbance: A prospective study from the Whitehall II Cohort. Sleep. 2010;33(6):739–744.PubMedPubMedCentralCrossRef
11.
Dahl RE. The regulation of sleep and arousal: Development and psychopathology. Development and Psychopathology. 1996;8(1):3–27.CrossRef
12.
Troxel WM, Robles TF, Hall M, Buysse DJ. Marital quality and the marital bed: Examining the covariation between relationship quality and sleep. Sleep medicine reviews. 2007;11(5):389–404.PubMedPubMedCentralCrossRef
13.
Dahl RE, El-Sheikh M. Considering sleep in a family context: Introduction to the special issue. Journal of Family Psychology. 2007;21(1):1.PubMedCrossRef
14.
15.
16.
Mikulincer M, Shaver PR, Pereg D. Attachment theory and affect regulation: The dynamics, development, and cognitive consequences of attachment-related strategies. Motivation and Emotion. 27: 2003:77–102, Springer Netherlands.CrossRef
17.
Prigerson HG, Maciejewski PK, Rosenheck RA. The effects of marital dissolution and marital quality on health and health service use among women. Medical Care. 1999;37(9):858–873.PubMedCrossRef
18.
Troxel WM, Buysse DJ, Hall M, Matthews KA. Marital happiness and sleep disturbances in a multi-ethnic sample of middle-aged women. Behavioral Sleep Medicine. 2009;7(1):2–19.PubMedPubMedCentralCrossRef
19.
Hasler BP, Troxel WM. Couples' nighttime sleep efficiency and concordance: Evidence for bidirectional associations with daytime relationship functioning. Psychosomatic Medicine. 2010;72(8):794–801.PubMedPubMedCentralCrossRef
20.
El-Sheikh M, Kelly R, Rauer A. Quick to berate, slow to sleep: Interpartner psychological conflict, mental health, and sleep. Health Psychology. 2013;32(10):1057–1066.PubMedPubMedCentralCrossRef
21.
El-Sheikh M, Kelly RJ, Koss KJ, Rauer AJ. Longitudinal relations between constructive and destructive conflict and couples’ sleep. J Fam Psychol. 2015;29(3):349–359.PubMedPubMedCentralCrossRef
22.
Yang HC, Suh S, Kim H, Cho ER, Lee SK, Shin C. Testing bidirectional relationships between marital quality and sleep disturbances: A 4-year follow-up study in a Korean cohort. J Psychosom Res. 2013;74(5):401–406.PubMedCrossRef
23.
Lai AY, Ip MS, Lam JC, Weaver TE, Fong DY. A pathway underlying the impact of CPAP adherence on intimate relationship with bed partner in men with obstructive sleep apnea. Sleep and Breathing. 2016;20(2):543–551.PubMedCrossRef
24.
Gordon AM, Chen S. The role of sleep in interpersonal conflict: Do sleepless nights mean worse fights? Social Psychological and Personality Science. 2014;5(2):168–175.CrossRef
25.
Heyman RE. Observation of couple conflicts: Clinical assessment applications, stubborn truths, and shaky foundations. Psychological assessment. 2001;13(1):5–35.PubMedPubMedCentralCrossRef
26.
Gottman JM. The roles of conflict engagement, escalation, and avoidance in marital interaction: A longitudinal view of five types of couples. Journal of Consulting & Clinical Psychology. 1993;61(1):6–15.CrossRef
27.
Lauderdale DS, Knutson KL, Yan LL, Liu K, Rathouz PJ. Sleep duration: How well do self-reports reflect objective measures? The CARDIA Sleep Study. Epidemiology. 2008;19(6):838.PubMedPubMedCentralCrossRef
28.
Troxel WM, Cyranowski JM, Hall M, Frank E, Buysse DJ. Attachment anxiety, relationship context, and sleep in women with recurrent major depression. Psychosomatic Medicine. 2007;69(7):692–699.PubMedPubMedCentralCrossRef
29.
Benington JH, Heller HC. Restoration of brain energy metabolism as the function of sleep. Progress in neurobiology. 1995;45(4):347–360.PubMedCrossRef
30.
Troxel WM, Shih R, Pedersen ER, et al. Sleep in the Military: Promoting Healthy Sleep Among U.S. Servicemembers. Santa Monica, CA: RAND Corporation;2015.
31.
32.
Allen ES, Rhoades GK, Stanley SM, Markman HJ. Hitting home: Relationships between recent deployment, posttraumatic stress symptoms, and marital functioning for Army couples. Journal of Family Psychology. 2010;24(3):280.PubMedPubMedCentralCrossRef
33.
Institute of Medicine. Gulf War and Health: Physiologic, Psychologic, and Psychosocial Effects of Deployment-Related Stress. Washington, DC: National Academies Press.; 2008.
34.
Goff BSN, Crow JR, Reisbig AM, Hamilton S. The impact of individual trauma symptoms of deployed soldiers on relationship satisfaction. Journal of Family Psychology. 2007;21(3):344.PubMedCrossRef
35.
36.
Mansfield AJ, Kaufman JS, Marshall SW, Gaynes BN, Morrissey JP, Engel CC. Deployment and the use of mental health services among US Army wives. New England Journal of Medicine. 2010;362(2):101–109.PubMedCrossRef
37.
Kiecolt-Glaser JK, Loving TJ, Stowell JR, et al. Hostile marital interactions, proinflammatory cytokine production, and wound healing. Archives of General Psychiatry. 2005;62(12):1377–1384.PubMedCrossRef
38.
Kiecolt-Glaser JK, Malarkey WB, Chee M, et al. Negative behavior during marital conflict is associated with immunological down-regulation. Psychosomatic Medicine. 1993;55(5):395–409.PubMedCrossRef
39.
Kiecolt-Glaser JK, McGuire L, Robles TF, Glaser R. Psychoneuroimmunology: Psychological influences on immune function and health. Journal of Consulting and Clinical Psychology. 2002;70(3):537–547.PubMedCrossRef
40.
Robles TF, Shaffer VA, Malarkey WB, Kiecolt-Glaser JK. Positive behaviors during marital conflict: Influences on stress hormones. Journal of Social and Personal Relationships. 2006;23(2):305–325.CrossRef
41.
Gordon AM, Chen S. The Role of Sleep in Interpersonal Conflict: Do Sleepless Nights Mean Worse Fights? Social Psychological and Personality Science. 2013.
42.
Douglass FM, Douglass R. The Marital Problems Questionnaire (MPQ): A short screening instrument for marital therapy. Family Relations. 1995;44(3):238–244.CrossRef
43.
Heyman RE, Chaudhry BR, Treboux D, et al. How much observational data is enough? An empirical test using marital interaction coding. Behavior therapy. 2001;32(1):107–122.PubMedPubMedCentralCrossRef
44.
45.
Heyman RE. Observation of couple conflicts: Clinical assessment applications, stubborn truths, and shaky foundations. Psychological Assessment 13(1), 5–35, 2001.PubMedPubMedCentralCrossRef
46.
Bradbury TN, Fincham FD. Attributions and behavior in marital interaction. Journal of Personality and Social Psychology. 1992;63(4):613–628.PubMedCrossRef
47.
Gottman JM, Levenson RW. Marital processes predictive of later dissolution: Behavior, physiology, and health. Journal of Personality & Social Psychology. 1992;63(2):221–233.CrossRef
48.
Iber C, Ancoli-Israel S, Chesson A, Quan SF. The AASM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications (Vol. 1). Westchester, IL: American Academy of Sleep Medicine. 2007.
49.
Cartwright RD, Wood E. Adjustment disorders of sleep: The sleep effects of a major stressful event and its resolution. Psychiatry Research 1991;39(3):199–209.PubMedCrossRef
50.
Dew MA, Hoch CC, Buysse DJ, et al. Healthy older adults’ sleep predicts all-cause mortality at 4 to 19 years of follow-up. Psychosomatic Medicine. 2003;65(1):63–73.PubMedCrossRef
51.
Matthews KA, Kamarck TW, Hall MH, et al. Blood pressure dipping and sleep disturbance in African-American and Caucasian men and women. American Journal of Hypertension. 2008;21(7):826–831.PubMedPubMedCentralCrossRef
52.
Troxel WM, Germain A. Insecure attachment is an independent correlate of objective sleep disturbances in military veterans. Sleep Medicine. 2011;12(9):860–865.PubMedPubMedCentralCrossRef
53.
Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research. Psychiatry research. 1989;28(2):193–213.PubMedCrossRef
54.
Bixler E. Sleep and society: An epidemiological perspective. Sleep medicine. 2009;10 Suppl 1:S3–6.PubMedCrossRef
55.
Hoge CW, Auchterlonie JL, Milliken CS. Mental health problems, use of mental health services, and attrition from military service after returning from deployment to Iraq or Afghanistan. Journal of the American Medical Association. 2006;295(9):1023–1032.PubMedCrossRef
56.
SteelFisher GK, Zaslavsky AM, Blendon RJ. Health-related impact of deployment extensions on spouses of active duty army personnel. Military medicine. 2008;173(3):221–229.PubMedCrossRef
57.
Blake DD, Weathers FW, Nagy LM, et al. The development of a Clinician-Administered PTSD Scale. Journal of Traumatic Stress. 1995;8(1):75–90.PubMedCrossRef
58.
Mueser KT, Salyers MP, Rosenberg SD, Ford JD, Fox L, Carty P. Psychometric evaluation of trauma and posttraumatic stress disorder assessments in persons with severe mental illness. Psychol Assess. 2001;13(1):110–117.PubMedCrossRef
59.
Weathers FW, Keane TM, Davidson JR. Clinician-administered PTSD scale: A review of the first ten years of research. Depression and anxiety. 2001;13(3):132–156.PubMedCrossRef
60.
Kenny DA, Kashy DA, Cook WL. Dyadic Data Analysis. Guilford Press; 2006.
61.
Tononi G, Cirelli C. Sleep function and synaptic homeostasis. Sleep medicine reviews. 2006;10(1):49–62.PubMedCrossRef
62.
Horne J. Human slow wave sleep: A review and appraisal of recent findings, with implications for sleep functions, and psychiatric illness. Experientia. 1992;48(10):941–954.PubMedCrossRef
63.
Halász P, Bódizs R, Parrino L, Terzano M. Two features of sleep slow waves: Homeostatic and reactive aspects—from long term to instant sleep homeostasis. Sleep medicine. 2014;15(10):1184–1195.PubMedCrossRef
64.
Ochsner KN, Gross JJ. The cognitive control of emotion. Trends in cognitive sciences. 2005;9(5):242–249.PubMedCrossRef
65.
Ochsner KN, Silvers JA, Buhle JT. Functional imaging studies of emotion regulation: A synthetic review and evolving model of the cognitive control of emotion. Annals of the New York Academy of Sciences. 2012;1251(1):E1-E24.PubMedPubMedCentralCrossRef
66.
Dang-Vu TT, Schabus M, Desseilles M, et al. Spontaneous neural activity during human slow wave sleep. Proceedings of the National Academy of Sciences. 2008;105(39):15160–15165.CrossRef
67.
Hobson JA, Pace-Schott EF. The cognitive neuroscience of sleep: Neuronal systems, consciousness and learning. Nature Reviews Neuroscience. 2002;3(9):679–693.PubMedCrossRef
68.
Holt-Lunstad J, Jones BQ, Birmingham W. The influence of close relationships on nocturnal blood pressure dipping. International journal of psychophysiology: official journal of the International Organization of Psychophysiology. 2009;71(3):211–217.CrossRef
69.
Smith TW, Gallo LC, Goble L, Ngu LQ, Stark KA. Agency, communion, and cardiovascular reactivity during marital interaction. Health Psychology. 1998;17(6):537–545.PubMedCrossRef
70.
71.
Troxel WM, Braithwaite SR, Sandberg JG, Holt-Lunstad J. Does improving marital quality improve sleep? Results from a marital therapy trial. Behav Sleep Med. 2016:1–14.
72.
Rogojanski J, Carney CE, Monson CM. Interpersonal factors in insomnia: A model for integrating bed partners into cognitive behavioral therapy for insomnia. Sleep Medicine Reviews. 2013;17(1):55–64.PubMedCrossRef
73.
Ellis JG, Deary V, Troxel WM. The role of perceived partner alliance on the efficacy of CBT-I: Preliminary findings from the partner alliance in insomnia research study (PAIRS). Behavioral Sleep Medicine. 2015;13(1):64–72.PubMedCrossRef
74.
Blow AJ, Gorman L, Ganoczy D, et al. Hazardous drinking and family functioning in National Guard veterans and spouses postdeployment. Journal of Family Psychology. 2013;27(2):303–313.PubMedCrossRef
Metadata
Title
Observed Relationship Behaviors and Sleep in Military Veterans and Their Partners
Authors
Jennifer Fillo, PhD
Stephanie Brooks Holliday, PhD
Amy DeSantis, PhD
Anne Germain, PhD
Daniel J. Buysse, MD
Karen A. Matthews, PhD
Wendy M. Troxel, PhD
Publication date
01-12-2017
Publisher
Springer US
Published in
Annals of Behavioral Medicine / Issue 6/2017
Print ISSN: 0883-6612
Electronic ISSN: 1532-4796
DOI
https://doi.org/10.1007/s12160-017-9911-3

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