Up all night: How a new therapy helps military members get the sleep they need
Members of the military, whose jobs put them in situations where proper sleep is sometimes difficult, can be especially hard hit with insomnia. According to the National Institutes of Health, about 10 percent of the general population has insomnia, but that number jumps to close to 25 percent in the military. (U.S. Marine Corps photo)
INsomnia is more than just the occasional restless night; it can disrupt lives and harm overall health. Members of the military, whose jobs put them in situations where proper sleep is sometimes difficult, can be especially hard hit. According to the National Institutes of Health, about 10 percent of the general population has insomnia, but that number jumps to close to 25 percent in the military. Now service members suffering from chronic insomnia have a better chance at relief.
“People sometimes do things in an effort to get more sleep that actually backfire and sabotage their sleep,” said Diana Dolan, a clinical psychologist with the Department of Defense’s Center for Deployment Psychology. “Cognitive behavioral therapy for insomnia (CBTI) counters all of those unintentional and unhelpful things people do to try and get the proper sleep.”
She said people suffering from insomnia need to realize the condition cannot be easily fixed.
“It’s like the difference between having a cold and a serious sinus infection,” said Dolan. “People need to recognize chronic insomnia is a problem that needs professional help. It’s not a situation that will resolve on its own.”
Part of a larger set of tools caregivers have to fix sleep issues, CBTI involves working with a provider to modify behaviors. One of the techniques is to actually reduce the amount of time in bed.
“It might seem counterintuitive, but if you get out of bed when you are awake, then when you are in bed, that becomes a better quality sleep,” said Dolan. “By cutting back the time you’re spending in bed, you prime your sleep pump and make yourself sleep.”
Getting in bed earlier to get more sleep stretches your sleep time over a longer period and makes it not as deep and strong, what Dolan calls “chasing sleep.” “In CBTI, we take someone’s sleep and consolidate it into better sleep quality by cutting out all that time lying in bed awake. Then, once the time they’re spending in bed is solid sleep, we can gradually adjust their sleep window to what works best for them.”
Besides changing behaviors and consolidating sleep, a relaxation component introduced through CBTI helps people get into the right frame of mind so they can sleep better.
Certain habits help people maintain good sleep hygiene. These include using relaxation breathing techniques, avoiding coffee and nicotine near bedtime, and finding a quiet, comfortable place to sleep free of distractions, such as TVs and video games. But these are short-term solutions. CBTI is a longer-term fix, customized for each patient with a chronic problem, not one-size-fits-all. One of the tools clinicians use is a sleep diary.
“Every day, they describe what happened the night before,” said Army Maj. Jimmie Butcher, a clinical psychologist at Tripler Army Medical Center in Hawaii. Patients track when they went to bed, when they fell asleep, if they woke up in the middle of sleep and how long they stayed awake. They also note caffeine use, medications and exercise, he said. “You get a really good picture of what their sleep actually looks like.”
Some devices can help measure sleep, but both Butcher and Dolan emphasized a diary includes the quality of sleep as evaluated by the patient, an important factor for clinicians.
“If you’re using those devices in addition to a sleep diary, they can be helpful, but you really need to have a form that a clinician can look at to determine what’s really going on,” said Butcher.
More behavioral health providers are now available in primary care hospitals and clinics to evaluate those sleep diaries.
“Having these caregivers available helps us make the right diagnosis before we proceed with treatment,” said Dolan. “It’s a great way for people to get the care they need.”