Taking stock of research on sleepless soldiers

Various behavioral treatment options are helping to treat the sleeplessness experienced by one in every two American soldiers who have been deployed in recent military operations. So says Dr. Adam Bramoweth of the Department of Veterans Affairs (VA) Pittsburgh Healthcare System, and Dr. Anne Germain of the University of Pittsburgh School of Medicine in the US. This review of research on deployment-related insomnia among military personnel and veterans, conducted since 2010, is published in Springer's journal Current Psychiatry Reports.

Insomnia is reported by up to 54 percent of the two million men and women who have served in various American combat efforts since 11 September 2001, compared to up to 22 percent of civilian adults. Although it is possible that a person's insomnia may develop prior to joining the military, it can also occur during the service period, or post-deployment when the soldier returns to civilian life. Studies have found that deployment-related stressors like combat exposure, mild traumatic brain injury, irregular sleep/wake schedules and the adjustment of returning home, all contribute to sleeplessness. Soldiers who suffer from insomnia while being deployed have a bigger chance of developing traumatic stress reactions such as depression and posttraumatic stress disorders, and even committing suicide. Also, it contributes to physical war-related injuries.

The research duo highlighted the need for additional research to better understand the underlying psychological, socio-environmental, physiological and neural reasons that cause among . All of this is recommended in an effort to help further develop effective treatment options in the process.

If researchers are able to identify individual characteristics and biomarkers of people who are more vulnerable to chronic insomnia, this information could help inform strategies for prevention and early detection, as well as interventions to enhance sleep resilience within the military context. Early identification and timely interventions are important in order to reduce the impact of deployment on sleep, to improve recovery from insomnia and to ultimately help prevent the onset of related psychiatric conditions.

Behavioral interventions such as cognitive-behavioral therapy and imagery rehearsal therapy often yield positive results in trying to reduce the effects of insomnia and nightmares, respectively. These treatments can be delivered during in-person sessions with clinicians, brief follow up sessions via telephone, or online and mobile resources. Training was recently rolled out to prepare providers in the Veterans Health Administration to use cognitive of insomnia. The goal is to eventually educate 1,000 clinicians in an effort to bridge the gap between veterans who need treatment, and available providers. Training of clinicians in military settings and other non-VA clinics is equally important to meet the needs of our service members and veterans.

"Training providers to be knowledgeable about insomnia and behavioral is a vital component to the treatment of chronic and managing its impact on other disorders," say the authors, who believe more research is needed on methods to increase access to care. "In addition to research and clinical efforts specifically for service members and , research and clinical efforts directed at military family members are also important components in providing the care needed and promoting health and recovery among service members and their families."

More information: Bramoweth, A.D & Germain, A. (2013). Deployment-Related Insomnia in Military Personnel and Veterans. Current Psychiatry Reports. DOI: 10.1007/s11920-013-0401-4

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