New VA/DoD Guidelines Address Sleep-Related Issues in Military Personnel, Veterans

By Joel Williams

Man struggling to sleepRecognizing and addressing the widespread problem of sleep disorders in military personnel and veterans, the U.S. Departments of Veterans Affairs and Defense (VA/DoD) have jointly issued new guidelines for assessment and treatment of insomnia and obstructive sleep apnea. Assistant professor of psychiatry and behavioral sciences Christi Ulmer, Ph.D., was among the authors of the guidelines, which were published in the Annals of Internal Medicine.

"This is a major step for these two organizations in recognizing the importance of appropriately diagnosing and treating sleep disorders in these unique populations," said Vincent Mysliwiec, M.D., a sleep medicine physician, researcher and retired U.S. Army colonel who helped author the guidelines.

Nearly half of U.S. military personnel have reported poor sleep quality, including insomnia symptoms. Insomnia is one of the most common sleep disorders and affects up to 41 percent of active-duty military personnel deployed to combat zones, 25 percent of noncombatants and 20 percent of those preparing for deployment.

For treatment of sleep apnea, notable recommendations in the CPG include:

  • Use of positive airway pressure therapy (commonly known as CPAP) for the entirety of a patient’s sleep period.
  • Continued use of CPAP even with patients who do not use it for at least the common insurance provider standard of four hours per night, while addressing barriers to CPAP adherence.
  • Interventions to improve CPAP adherence in patients with sleep apnea and co-occurring PTSD, anxiety, and/or insomnia upon initial diagnosis because these patients have higher rates of non-adherence.

For chronic insomnia, notable recommendations include:

  • Cognitive behavioral therapy for insomnia is the recommended treatment, but a shortened version called brief behavioral therapy for insomnia is also acceptable for some patients.
  • Sleep hygiene – habits that promote nighttime sleep quality, such as limiting length of daytime naps and avoiding stimulants close to bedtime – while important, should not be used as a stand-alone therapy for chronic insomnia disorder.
  • Some medications may be used as a second-line treatment for chronic insomnia, but anti-psychotic drugs and over-the-counter agents such as antihistamine and melatonin are not helpful for treating chronic insomnia.

View the full VA/DoD clinical practice guidelines.

This article was adapted from a press release published by UT Health San Antonio. Read the full press release.