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Post-Traumatic Stress Disorder (PTSD), traumatic brain injury (TBI), and sleep problems significantly affect recovery and functional status in military personnel and Veterans returning from combat. Despite recent attention, sleep is understudied in the Veteran population. Few treatments and rehabilitation protocols target sleep, although poor sleep remains at clinical levels and continues to adversely impact functioning even after the resolution of PTSD or mild TBI symptoms. Recent developments in non-pharmacologic sleep treatments have proven efficacious as stand-alone interventions and have potential to improve treatment outcomes by augmenting traditional behavioral and cognitive therapies. This review discusses the extensive scope of work in the area of sleep as it relates to TBI and PTSD, including pathophysiology and neurobiology of sleep; existing and emerging treatment options; as well as methodological issues in sleep measurements for TBI and PTSD. Understanding sleep problems and their role in the development and maintenance of PTSD and TBI symptoms may lead to improvement in overall treatment outcomes while offering a non-stigmatizing entry in mental health services and make current treatments more comprehensive by helping to address a broader spectrum of difficulties., Competing Interests: All authors declare that they have no conflicts of interest., (Published by Elsevier Ltd.)

Objective: We evaluated the effectiveness of Strength at Home Friends and Families (SAH-F), a dyadic group intervention to prevent relational aggression and its negative consequences, in a community-based sample of service members/veterans and significant others who reported relational difficulties., Method: Participants included 70 veterans and their loved ones. Recruitment was conducted from October 2010 through March 2012. Participants completed an initial assessment that included measures of relational aggression and functioning, depressive symptoms, and posttraumatic stress disorder (PTSD) symptoms. Participants were enrolled in the 10-week SAH-F targeting social information-processing mechanisms hypothesized to underlie the relationship between trauma and aggression and were reassessed at program completion and 3 months after intervention., Results: Significant reductions in psychological aggression were seen both at program completion and at 3-month follow-up for both veterans (standardized mean gain effect size [ESsg] = -0.45, P < .05) and significant others (ESsg = -0.30, P < .05). Perpetration of physical aggression remained low after pretreatment and did not increase. Relationship adjustment reported by significant others, but not veterans, indicated a significant improvement from pretreatment to program completion (ESsg = 0.33, P < .05). Significant (P < .05) decreases in depressive symptoms were observed from pretreatment to program completion for veterans (ESsg = -0.30, P < .05) and significant others (ESsg = -0.55, P < .05), and significant decreases in PTSD symptoms were observed from pretreatment to follow-up for veterans and significant others (ESsg = -0.52, P < .05)., Conclusions: Results provide support for the effectiveness of SAH-F in reducing relational aggression in military member/significant other dyads and enhancing relationship quality and mental health., (© Copyright 2015 Physicians Postgraduate Press, Inc.)

Objectives: Research finds significant sleep deprivation among adolescents with early school start times. This study surveyed sleep patterns in elementary school students before and after a district-wide change to earlier start times., Design: Students in grades 3-5 completed a self-administered sleep survey in the spring of 2009 (third grade, n = 216; fourth grade, n = 214; fifth grade, n = 259; total, n = 689) and again in 2010 (third grade, n = 168; fourth grade, n = 194; fifth grade, n = 263; total, n = 625), after the school start time switched from 8:20 am to 7:45 am in the Fall of 2009. Students entering grade 3 experienced a larger shift from 9:10 am to 7:45 am, due to moving from the kindergarten-second-grade building to the third-to-fifth-grade building. Descriptive statistics quantified responses by grade., Results: Prechange, wake time across all grades was similar; postchange, fourth and fifth graders woke on average 30-40 minutes earlier than children in those grades the year before, and third graders woke on average 8 minutes later. Compared to prechange, third graders reported longer average total sleep times (24 minutes); fourth and fifth graders reported average sleep times 4 and 9 minutes shorter, respectively, than students in those grades the previous year. The percentage of students in each grade reporting later weekend wake and bed times decreased postchange. Reports of sleepiness somewhat increased for fifth graders postchange., Conclusions: School start time change did not decrease total amount of sleep. This is the first study of its kind to report on the effects of a start time change in elementary school students., (Copyright © 2015 Elsevier Inc. All rights reserved.)