A Comparison of Sleep Difficulties among Iraq/Afghanistan Theater Veterans with and without Mental Health Diagnoses

Ulmer, Christi S.; Voorhees, Elizabeth E. Van; Germain, Anne; Voils, Corrine I.; Beckham, Jean C.

doi:10.5664/jcsm.5012

Cited by 29 publications

(18 citation statements)

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“…They found an annual prevalence of 3.4% for diagnosed insomnia within the VA, a rate that is lower than prevalence rates suggested for the general population despite the fact that veterans have shorter sleep durations, longer sleep onset latencies, more wake after sleep onset, and lower sleep efficiencies than non-veterans. 5,12,14,16 In fact, the failure to document insomnia in the medical record contrasts with recommendations by the American Academy of Sleep Medicine to document sleep satisfaction or quality in each visit wherein insomnia is discussed. 33 Our findings extend prior research by providing insight into possible reasons for inconsistent documentation in the VA medical record.…”

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confidence: 70%

“…First, the prevalence of insomnia among veterans is considerably higher than that of the average adult in the United States, and is often comorbid with mental health and medical conditions. [12][13][14] Thus, VA PCP perspectives could differ, reflecting a need for more intensive insomnia treatments. Second, VA PCPs may have been influenced by the presence of behavioral medicine providers embedded into the VA primary care setting pursuant to integrated primary care programs.…”

Section: Veterans Affairs Primary Care Provider Perceptions Of Insomnmentioning

confidence: 99%

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Veterans Affairs Primary Care Provider Perceptions of Insomnia Treatment

Ulmer

Bosworth

Beckham

et al. 2017

Journal of Clinical Sleep Medicine

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Study Objectives: Insomnia is a widespread issue among United States adults and rates of insomnia among veterans are even higher than the general population. Prior research examining primary care provider (PCP) perspectives on insomnia treatment found that: sleep hygiene and pharmacotherapy are the primary treatments offered; PCPs tend to focus on perceived causes of insomnia rather than the insomnia itself; and neither patients nor providers are satisfied with insomnia treatment options. Although insomnia complaints are typically first reported to primary care providers, little research has focused on perspectives regarding insomnia treatment among PCPs working in the largest integrated health care system in the United States-the Veterans Affairs (VA) health care system. This study was conducted to examine VA PCP perceptions of the availability of insomnia treatments, identify specific strategies offered by PCPs, and examine perceptions regarding the importance of treating insomnia and the role of comorbid conditions. Methods: A survey was conducted within the VA health care system. Primary care providers completed surveys electronically. Results: A high percentage of veterans (modal response = 20% to 39%) seen in VA primary care settings report an insomnia complaint to their provider. Almost half of respondents do not consistently document insomnia in the medical record (46% endorsed "sometimes," "rarely," or "never"). PCPs routinely advise sleep hygiene recommendations for insomnia (ie, avoid stimulants before bedtime [84.3%], and keep the bedroom environment quiet and dark and comfortable [68.6%]) and many are uncertain if cognitive behavioral therapy for insomnia is available at their facility (43.1%). Conclusions: Findings point to the need for systems-level changes within health care systems, including the adoption of evidence-based clinical practice standards for insomnia and PCP education about the processes that maintain insomnia. Commentary: A commentary on this article appears in this issue on page 937.

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confidence: 70%

Section: Veterans Affairs Primary Care Provider Perceptions Of Insomnmentioning

confidence: 99%

Veterans Affairs Primary Care Provider Perceptions of Insomnia Treatment

Ulmer

Bosworth

Beckham

et al. 2017

Journal of Clinical Sleep Medicine

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“…52 In a recent study, Ulmer et al evaluated veterans of Iraq/Afghanistan and reported findings similar to ours. 53 In their cohort of veterans, 10.1% had TRN, which increased to 54.1% in veterans with comorbid mental health diagnoses. Although TRN are frequently present in PTSD, these findings suggest that TRN occur in a number of behavioral medicine disorders and not exclusively PTSD.…”

Section: Discussionmentioning

confidence: 95%

Nightmares in United States Military Personnel With Sleep Disturbances

Creamer

Brock

Matsangas

et al. 2018

Journal of Clinical Sleep Medicine

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Study Objectives: Sleep disturbances are common in United States military personnel. Despite their exposure to combat and trauma, little is known about nightmares in this population. The purpose of this study was to describe the prevalence and associated clinical and polysomnographic characteristics of nightmares in United States military personnel with sleep disturbances. Methods: Retrospective review of 500 active duty United States military personnel who underwent a sleep medicine evaluation and polysomnography at our sleep center. The Pittsburgh Sleep Quality Index and the Pittsburgh Sleep Quality Index-Addendum were used to characterize clinically significant nightmares. Subjective and objective sleep attributes were compared between groups. Results: At least weekly nightmares were present in 31.2%; yet, only 3.9% reported nightmares as a reason for evaluation. Trauma-related nightmares occurred in 60% of those patients with nightmares. Patients with nightmares had increased sleep onset latency (SOL) and rapid eye movement (REM) sleep latency (mean SOL/REM sleep latency 16.6/145 minutes, P = .02 and P = .01 respectively) compared to those without (mean SOL/REM sleep latency 12.5/126 minutes I NTRO DUCTI O NNightmares are defined by repeated occurrences of extended, extremely dysphoric, and well-remembered dreams that cause clinically significant distress or impairment in social, occupational, or other areas of functioning. 1 Occasional nightmares are part of a normal adaptive response to life stressors and are not pathologic, with 85% of adults reporting at least one nightmare per year. 2 The prevalence of clinically significant nightmares, which occur at least once per week, is estimated between 0.9% and 6.8%. [3][4][5][6][7][8][9] In the largest study to date (69,813 adults), the prevalence of nightmares was 3.5% in men and 4.8% in women. 10 Participants from the World War II generation had a significantly higher prevalence of 7.2% in men and 7% in women. Nightmares are more common among patients with sleep disturbances, sleep disorders, depression, anxiety, and posttraumatic stress disorder However, most research evaluating sleep disorders in active duty military personnel has focused on insomnia, obstructive sleep apnea (OSA), and PTSD, noting that a recent study focusing on OSA and PTSD did not evaluate nightmares. [18][19][20] Following traumatic experiences, sleep disturbances are frequently reported, including trauma-related nightmares (TRN). 21 The nightmares of trauma survivors tend to be more severe and distressing than idiopathic nightmares. 1,3 Though not exclusive to PTSD, TRN have been referred to as the "hallmark" of this disorder, with rates as high as 90%. 22,23 Addressing nightmares as a distinct sleep disorder following a BRIEF SUMMARY Current Knowledge/Study Rationale: The spectrum of sleep disorders in military personnel is varied and complicated by the presence of comorbidities and psychological disorders. Currently, little is known regarding nightmares, especially trauma-related nig...

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“…Epidemiological studies conducted among American soldiers (Strelau, 2009) have shown that PTSD and depression were more frequent among those taking part in the mission in Iraq (19%) and Afghanistan (11.3%). Studies Ulmer et al (2015) involving 1,238 participants; veterans and active duty military soldiers show a higher prevalence of various symptoms of sleep disorders among war veterans, compared with the general population. Epidemiological data from employees of military service on these disorders presented by the Mysliwiec et al (2013) demonstrate the occurrence of mild obstructive sleep apnea (called.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the Quality of Sleep of the Professional Soldiers Population

Stępień–Słodkowska

Ustianowski

Starkowska

et al. 2017

Central European Journal of Sport Sciences and Medicine

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The aim of this study was to identify sleep problems in a select group of professional soldiers. For the study used a questionnaire containing the Athens Insomnia Scale by Soldatos, allowing klinimetric evaluation of sleep disorders reflecting mainly insomnia. Material Data were obtained from 200 professional soldiers. The results showed no pathological abnormalities of sleep study population, however, the results show some reduction in the prevalence of symptoms of sleep quality based on the selected factors. The health status of all the soldiers experiencing combat stress requires periodic and thorough control since the diagnosis of disorders is difficult and they can appear even after a long period of lived events. This may lead to look for other ways to deal with problems; the use of psychoactive substances or drug abuse. Therefore it is extremely important to use therapeutic activities.

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A Comparison of Sleep Difficulties among Iraq/Afghanistan Theater Veterans with and without Mental Health Diagnoses

Cited by 29 publications

References 50 publications

Veterans Affairs Primary Care Provider Perceptions of Insomnia Treatment

Veterans Affairs Primary Care Provider Perceptions of Insomnia Treatment

Nightmares in United States Military Personnel With Sleep Disturbances

Evaluation of the Quality of Sleep of the Professional Soldiers Population

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