What Are the Evidence-Based Interventions to Treat Sleep Disorders Among Servicemembers?
The review of evidence-based interventions for sleep disturbances in servicemembers identified several promising non-pharmacologic (i.e., behavioral or cognitive-behavioral) interventions. In particular, CBT-I and IRT have been shown to be efficacious treatments for insomnia and nightmares, respectively, which are two of the most common types of sleep disturbances experienced by servicemembers in the post-deployment period. Unfortunately, there are significant gaps between guidelines from scientific studies and current practices within DoD. In particular, pharmacologic therapies (e.g., sleep medications) continue to be the front-line treatment prescribed by many providers (Schmitz, Browning, and Webb-Murphy, 2009), though there is scant evidence on the efficacy of these treatments in treating servicemember sleep disturbances and known side effects to these medications, including daytime fatigue; such side effects are particularly concerning in operational contexts and in certain occupations, which require sustained attention and cognitive vigilance. A lack of dissemination of efficacious cognitive-behavioral therapies to servicemembers—which is partly the result of a critical shortage of trained providers in behavioral sleep medicine techniques and a lack of provider awareness of the efficacy of these programs—are critical issues that should be addressed. Hiring a greater number of qualified behavioral health specialists and creating more clinical training opportunities could help decrease this shortage. However, further research using robust RCTs and participants from military populations is also greatly needed to establish best-practice guidelines for treating servicemembers and veterans specifically.