Special Considerations in the Adaptation of Cognitive Behavioral Therapy for Insomnia With Active-Duty U.S. Army Personnel

Chronotype and self-reported sleep, alertness, and mental health in U.S. sailors

“…Items included questions on demographics and the reduced morningness-eveningness questionnaire (rMEQ) [5], which yields both continuous and categorical measures of chronotype (definitely morning, moderately morning, neither type, moderately evening, or definitely evening; this can be further binned into morning, evening and neither types). Average sleep Open Access *Correspondence: emharrison@ucsd.edu 1 Center for Circadian Biology, University of California San Diego, San Diego, USA Full list of author information is available at the end of the article duration (Pittsburgh sleep quality index, PSQI) and recent symptoms of depression, anxiety, posttraumatic stress, and sleep disturbances were assessed using validated scales [Generalized anxiety disorder scale (GAD-7), 8-item version of the patient health questionnaire (PHQ-8), Posttraumatic stress disorder checklist version 5 (PCL-5), and PSQI, respectively; higher scores = greater symptomatology on all scales]. An additional four items measured readiness over the past month, and two asked about perceived importance of sleep for performance.…”

“…Sleep is regulated in part by internal, self-sustaining daily (“circadian”) rhythms. While sleep and circadian rhythms play a critical role in service member readiness, disturbances of these important physiological processes are unfortunately common in military populations, which face unique challenges [ 1 ]. “Chronotype” is a circadian phenotype, with both biological and environmental underpinnings, that describes one’s alignment with the solar cycle and either a relatively early (morningness) or late (eveningness) schedule preference.…”

“…Early types also woke about 30 min earlier than intermediate types (Additional file 1 : Table S2). Early start times are among several military-specific issues that affect alertness and sleep [ 1 ]. Modest shifts in schedules, where possible, may better align with peak performance in evening types.…”

“…Chronotype is an understudied facet of circadian rhythm research in military populations that could provide a mechanism for performance optimization. Service members are at increased risk for mental health and sleep issues, [ 1 , 4 ] both of which were related to chronotype in these unadjusted analyses. Future studies should consider examining chronotype as a risk factor for mental health and sleep outcomes.…”

Insomnia.

“…For example, only recently has CBT-I been applied along a trajectory of women's health, ranging from pregnancy (Tomfohr-Madsen et al, 2017) and postpartum (Seeman et al, 2018) to menopausal and postmenopausal insomnia (Drake et al, 2018;Nowakowski et al, 2017). Another population whereby insomnia is known to be highly prevalent and where CBT-I has been recently deployed is in military personnel (Amin & Wirtz, 2017;Pruiksma et al, 2018;Taylor et al, 2018). That said, comparative studies examining CBT-I among different ethnic and socioeconomic populations, including specific challenges and barriers to treatment outcome, are missing.…”