Insomnia treatment acceptability and preferences of male Iraq and Afghanistan combat Veterans and their healthcare providers

Abstract

Abstract-Sleep difficulty is a prevalent problem among returning Veterans. Although there is strong evidence for the efficacy and durability of cognitive-behavioral treatment for insomnia (CBT-I) in the general population, the interventions require motivation, attention, and adherence from patients to achieve successful outcomes. Given the unique characteristics of Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) Veterans who have experienced blast-related injuries and other trauma, CBT-I for these patients may require modification, including alternative delivery methods, to ensure effective implementation and positive outcomes. We interviewed 18 OIF/OEF Veterans who screened positive for mild traumatic brain injury and 19 healthcare providers to determine the acceptability of insomnia treatments and preferences for the interventions and treatment delivery. Veterans and providers had distinct preferences for insomnia treatment and its delivery. The treatments the Veterans found most acceptable were also the ones they preferred: relaxation treatment and pharmacotherapy. The providers identified relaxation therapy as the most acceptable treatment. Veterans preferred the individual treatment format as well as electronic methods of treatment delivery. Despite some differences between patients and providers, a compromise through modification of empirically supported behavioral treatments is feasible, and implications for preference-based insomnia intervention development and testing are discussed.

Veterans Affairs Primary Care Provider Perceptions of Insomnia Treatment

“…Epstein and colleagues 17 conducted surveys and interviews with both veterans and VA health care providers (not exclusively PCPs) regarding the acceptability of various insomnia treatments. Individual therapy and relaxation therapy were found to be acceptable by both veterans and providers, and veterans also endorsed pharmacotherapy as acceptable.…”

The Relationship Between Beliefs About Sleep and Adherence to Behavioral Treatment Combined With Meditation for Insomnia

“…Relaxation is viewed as an acceptable treatment approach for insomnia (Epstein, Babcock-Parziale, Haynes, & Herb, 2012), and there is some evidence that adherence to relaxation exercises delivered with stimulus control is related to improvement in sleep quality (Lichstein, Wilson, & Johnson, 2000). However, there has been little research on predictors of adherence to relaxation or other non-sleep-specific recommendations to reduce arousal.…”

Insomnia in the Military: Application and Effectiveness of Cognitive and Pharmacologic Therapies

“…CBTi has been shown to be an effective and acceptable treatment for both clinicians and combat veterans. Adherence to the treatment and reduction in insomnia symptoms are the key measures of success [36,37]. Training clinicians in standard application of CBTi provides the best dissemination of treatment and ensures that veterans are receiving a high standard of care [38].…”

“…Some studies discuss treatment preferences. For instance, while male veterans prefer relaxation therapy and pharmacotherapy [36], female veterans generally prefer behavioral interventions over pharmacotherapy [13]. In the future, a greater research emphasis should be placed on female veterans, as women are more likely to be diagnosed with insomnia [1, 6].…”