Treatment for insomnia in combat-exposed OEF/OIF/OND Military Veterans: Preliminary randomized controlled trial

Abstract

Objective Chronic insomnia is highly prevalent among military personnel returning from Iraq and Afghanistan. We evaluated the effects of a military version of a brief behavioral treatment of insomnia (BBTI-MV) compared to an information only control (IC) condition in combat-exposed Veterans of Operations Enduring/Iraqi Freedom or Operation New Dawn (OEF/OIF/OND) on insomnia, sleep quality, and daytime symptoms of anxiety and depression. Method Forty OEF/OIF/OND Veterans (Mean age = 38.4 years old, s.d. = 11.69; 85% men; 77.5% white) were randomized to one of two conditions. BBTI-MV consisted of two in-person sessions and two telephone contacts delivered over four weeks, and included personalized recommendations to reduce insomnia. The IC condition also consisted of 2 in-person sessions two telephone contacts delivered over four weeks, and Veterans were encouraged to read written information about sleep-promoting behaviors. The Insomnia Severity Index, Pittsburgh Sleep Quality Index, PTSD Checklist, and Beck Depression and Anxiety Inventories were completed at baseline, post-treatment, and at the six-month follow-up. Results Both interventions were associated with clinically significant improvements in insomnia, although the magnitude of improvements in sleep and rates of treatment response and remission were greater for BBTI-MV compared to IC from pre- to post-treatment. Conclusion Both BBTI-MV and the provision of information were associated with clinically significant improvements in insomnia among Veterans. Despite the preliminary nature of the findings and limitations inherent to small controlled trials, the findings suggest that both approaches may provide viable options in a stepped-care approach to the treatment of insomnia in retuning combat-exposed Veterans. Larger, confirmatory effectiveness trials are required.

Clinical Feasibility of a Just-in-Time Adaptive Intervention App (iREST) as a Behavioral Sleep Treatment in a Military Population: Feasibility Comparative Effectiveness Study (Preprint)

“…Consistent with previous JITAI studies [18,[32][33][34][35], we found that the implementation of personalized and time-varying JITAI approach improved the outcome of traditional evidence-based treatment. In the current study, we found that the iREST intervention was associated with slightly higher rates-although not statistically significant-of response and remission compared to our previous traditional behavioral approach [16]. Significant improvements in sleep quality and decrease in daytime sleepiness after treatment was observed.…”

“…There were no statistically significant demographic differences between participants in the current study (iREST) and the traditional BBTI study [16] that was used as a control. …”

“…We followed the intention-to-treat principle: all participants who completed the outcomes of interest for at least one of the time points were included in the analyses. The results were then compared using the Chi-squared test with previous traditional (i.e., without mobile health system) BBTI for the military population study [16].…”

“…This need might be addressed by the Just-in-Time-Adaptive-Intervention (JITAI) [14] mobile platform as well as the recently developed interactive Resilience Enhancing Sleep Tactics application (iREST) [15], a smartphone application that has the potential to increase access to these behavioral treatments as well as to improve the efficacy of treatment by tailoring and adapting sleep interventions based on each individual's dynamic moment-to-moment needs. iREST draws directly from existing behavioral sleep treatments, particularly the brief behavioral therapy for insomnia (BBTI) [16], an intervention that has been found to be effective in ADSM and Veterans.…”

Sleep and Weight among Our Veterans

“…19 In a second study of veterans, mere provision of information regarding sleep was beneficial, although, brief behavioral therapy was superior. 20 The results echo the call for a step-wise approach to insomnia from a British study in which a single session of cognitive behavioral therapy was sufficiently efficacious for a sizable proportion of those with acute insomnia. 21 Amidst the nation's ongoing epidemic of prescription drug abuse, notably, a study of 311,400 veterans from Iraq and Afghanistan demonstrated that 8.4% used more than five drugs that act on the central nervous system, and this polypharmacy was associated with overdosage and suicide-related behaviors.…”