SAN ANTONIO (June 14, 2017) ― Insomnia is a widespread problem in the U.S. military and the most commonly reported symptom following deployment. A new study published online in the journal Sleep found that cognitive-behavioral therapy for insomnia , a form of talk therapy, was highly effective with an active duty population.
Conducted by researchers at the University of North Texas and other institutions affiliated with the STRONG STAR Consortium, based at UT Health San Antonio, the study was funded by the Department of Defense. It is the largest randomized clinical trial in the DOD’s history to evaluate a non-medication treatment for the sleep disorder in active duty military personnel. STRONG STAR is a federally funded network of national experts seeking the best ways to treat behavioral health problems impacting post-9/11 service members and veterans.
While the study showed that cognitive-behavioral therapy for insomnia led in person by a therapist is superior, it also validated an Internet-based version of the therapy, which was about half as effective, as a possible option.
One hundred soldiers at Fort Hood, Texas, with chronic insomnia participated in the study led by Daniel Taylor, Ph.D., professor of psychology and director of the Sleep Health Research Laboratory at the University of North Texas. One-third of the participants met with clinicians for the talk therapy once a week for six weeks, while another third received the therapy via the Internet once a week for six weeks. Both the in-person and Internet therapy had the exact same content, with the Internet lessons presented as audio recordings accompanied by visual graphics and animations. A third control group of participants was contacted by the researchers every other week during the six weeks but did not receive cognitive-behavioral therapy.
All participants completed one week of sleep monitoring by keeping sleep diaries and wearing activity monitors.
Dr. Taylor and his colleagues discovered that the study participants who received in-person cognitive-behavioral treatment for their insomnia reported significantly greater improvements in sleep quality — as determined by the sleep diaries and activity monitors — than those who received the Internet therapy. But both groups had greater improvements in sleep quality than those who did not receive cognitive-behavioral therapy.
Cognitive-behavioral therapy, which traditionally includes regular, and often weekly, visits to a clinician, is recommended by the American College of Physicians and other organizations for treatment of chronic insomnia.
But military personnel, who often develop chronic insomnia because of rapidly changing schedules and deployments that keep them constantly on alert, may not be able to regularly meet with clinicians, who provide clients with sleep assessments, ask them to track each night’s sleep by keeping sleep diaries, and work with them to help change the way they sleep.
Chronic insomnia is defined by the Diagnostic and Statistical Manual of Mental Disorders as sleeping poorly at least three nights a week for a month or longer, despite adequate opportunity for a full night’s sleep. It is “a significant problem in the military,” and a strong risk factor for post-traumatic stress disorder, depression and substance abuse, absenteeism and occupational accidents, Dr. Taylor said. Treatment of insomnia may not only improve sleep in these soldiers, but also improve these other conditions, he said.
“About 10 percent of deployed military personnel take sleep medications, which are effective for short-term treatment of insomnia in civilian populations. For deployed military personnel, the side effects such as grogginess slowed cognitive processing and slowed reaction time can be dangerous,” Dr. Taylor said.
Alan Peterson, Ph.D., professor of psychiatry at UT Health San Antonio, director of STRONG STAR and a co-author on the Sleep paper, added that, in addition to the danger that medications create for active-duty military personnel, drugs are not effective for treating chronic insomnia.
“So, an effective, non-medication therapy for insomnia is very much needed in the military,” Dr. Peterson said. “And the finding that an Internet version of the treatment can be effective is important, since this option could be used to make the therapy more accessible.
“Results of this study will be considered by the Department of Defense as it sets treatment guidelines for insomnia among military service members,” Dr. Peterson added.
Kristi Pruiksma, Ph.D., an assistant professor of psychiatry at UT Health San Antonio and a STRONG STAR collaborating investigator who served as a clinical psychologist for the study, said that the in-person and Internet treatment options have unique benefits.
“A benefit of the in-person treatment is that therapists can be creative with patients and brainstorm ideas to help them follow the sleep recommendations and better engage in treatment,” Dr. Pruiksma said. “That is hard to accomplish with an online program.”
However, she said that the online program is valuable because it allows patients with work and family demands to complete sessions on their own time, serves as a treatment option for service members who want to avoid the perceived stigma of going to a military behavioral health clinic, and provides easy access to a valuable treatment for which there are not enough trained providers to meet the high demand for help with insomnia.
The investigators believe that an important next step will be to figure out who can achieve good benefits from the online program and who may need additional assistance from a therapist.
Because insomnia is commonly also diagnosed in military members with post-traumatic stress disorder, and each makes the other more difficult to treat, another next step is to find the best way to treat these two conditions when they occur together. That already is the subject of another, ongoing research study at Fort Hood led by Dr. Taylor and other STRONG STAR-affiliated investigators through the federally funded Consortium to Alleviate PTSD. For more information, visit www.strongstar.org/ptsd-sleep.
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STRONG STAR , or the South Texas Research Organizational Network Guiding Studies on Trauma and Resilience, is a multidisciplinary, multi-institutional research consortium funded by the U.S. Departments of Defense and Veterans Affairs and led by UT Health San Antonio. STRONG STAR aims to develop and evaluate the most effective early interventions possible for the detection, prevention, diagnosis, and treatment of combat post-traumatic stress disorder and related conditions in active duty military personnel and recently discharged veterans so they can maintain or resume full, productive lives. To learn more visit www.strongstar.org.