Engaging Stakeholders to Optimize Sleep Disorders’ Management in the U.S. Military: A Qualitative Analysis

Abstract

Introduction Sleep disorders’ are highly prevalent among U.S. active duty service members (ADSMs) and present well-documented challenges to military health, safety, and performance. In addition to increased need for sleep medicine services, a major barrier to effective sleep management has been a lack of alignment among patients, health providers, and economic-decision-makers. To address this gap in knowledge, the purpose of the present study was to engage diverse stakeholders vested in improving sleep disorders’ management in the military. Materials and Methods We elicited feedback from ADSMs with sleep disorders (five focus group discussion, n = 26) and primary care managers (PCMs) (11 individual semi-structured interview) in two military treatment facilities (MTFs) in the National Capitol Region, in addition to national level military and civilian administrative stakeholders (11 individual semi-structured interview) about their experiences with sleep disorders’ management in U.S. MTFs, including facilitators and barriers for reaching a definitive sleep diagnosis, convenience and effectiveness of sleep treatments, and key desired outcomes from interventions designed to address effectively sleep disorders in the U.S. military health care system (MHS). Recordings from focus groups and semi-structured interviews were transcribed verbatim and analyzed using QSR International’s NVivo 12 software using inductive thematic analysis. The study was approved by Walter Reed National Military Medical Center Department of Research Programs. Results Active duty service members with sleep disorders often fail to recognize their need for professional sleep management. Whereas PCMs identified themselves as first-line providers for sleep disorders in the military, patients lacked confidence that PCMs can make accurate diagnoses and deliver effective sleep treatments. Active duty service members cited needs for expeditious treatment, educational support and care coordination, and support for obtaining sleep treatments during deployment. Challenges that PCMs identified for effective management include insufficient time during routine care visits, delays in scheduling testing procedures, and limited number of sleep specialists. Primary care managers suggested offering evidence-based telehealth tools and enhanced care coordination between PCMs and specialists; standardized medical education, materials, and tools; patient preparation before appointments; self-administered patient education; and including behavioral sleep specialists as part of the sleep management team. For administrative stakeholders, key outcomes of enhanced sleep management included (1) improved resource allocation and cost savings, and (2) improved ADSM safety, productivity, and combat effectiveness. Conclusion Current military sleep management practices are neither satisfactory nor maximally effective. Our findings suggest that solving the military sleep problem will require sustained effort and ongoing collaboration from ADSM patients, providers, and health systems leaders. Important potential roles for telehealth and technology were identified. Future research should seek to enhance implementation of sleep management best practices to improve outcomes for patients, providers, MHS, and the military as a whole.

The effect of Sleep Leadership Training on U.S. Army human performance team members

“…sleep interventions. Much of the current evidence suggests that healthcare providers receive minimal education related to sleep and are inadequately prepared by their educational programs to address sleep (Ye and Smith, 2015;Meaklim et al, 2020;Abdelwadoud et al, 2022). Some authors suggest that this lack of preparedness might even be contributing to the sleep crisis that is occurring in the United States (Meaklim et al, 2020).…”

“…One solution to reinforce education and to contribute to cultural change is to ensure that all Army healthcare providers are competent to address sleep. A study by Abdelwadoud et al (2022) which examined the perceptions of key military stakeholders including economic-decision makers, primary care managers and SMs themselves found the current state of military sleep management practices to be neither satisfactory nor maximally effective. The authors noted many barriers to managing sleep in the military population including a lack of sleep knowledge among healthcare providers, the need for more qualified providers capable of addressing sleep, the need for behavioral approaches to address sleep, and the need for standardized sleep education materials and tools for provider utilization.…”

Relationships of depression and antidepressant use with epigenetic age acceleration and all-cause mortality among postmenopausal women

“…They are distinct from clinical and molecular markers that capture more limited aspects of aging [ 28 ]. Epigenetic clocks have been developed that predict longevity [ 29 ] and are strongly correlated with chronological age across distinct cell, tissue, and organ types [ 28 , 40 , 41 ]. Epigenetic clocks show promise in elucidating biological mechanisms pertaining to aging, chronic disease, and mortality risks [ 29 ].…”

“…A higher “DNAm age” compared to chronological age suggests faster biological aging than expected [ 30 ]. Epigenetic age acceleration is linked to obesity, early menopause, Down syndrome, Werner syndrome, HIV infection, lung cancer, Alzheimer’s and Parkinson’s diseases, and is determined partly by genetic factors and partly by environmental, psychosocial, and behavioral factors [ 40 , 41 ]. Two epigenetic clocks, blood-based Hannum (71 CpGs) and pan-tissue Horvath (353 CpGs), can be used to derive extrinsic and intrinsic epigenetic age acceleration (EEAA and IEAA) by calculating the difference between DNAm and chronologic ages [ 28 , 42 ].…”

Virtual first: implementation of a novel sleep telehealth platform in the United States military

“…Consistent with this approach, our group recently engaged, for the first time, key military stakeholders including patients, primary care manages (PCMs), and economic decision-makers in qualitative focus groups and key informant interviews designed to identify barriers and facilitators to sleep telehealth in the MHS. These stakeholders identified opportunities and provided recommendations to implement sleep telehealth via a novel platform designed to improve outcomes for all stakeholders (Abdelwadoud et al, 2021;Wickwire et al, 2022). This paper presents results of implementation of this novel sleep telehealth platform in two military treatment facilities (MTFs) in the National Capital Region (NCR).…”