War Vets With Insomnia Prefer A Combination Of Pharmacological And Nonpharmacological Treatments

Main Category: Sleep / Sleep Disorders / Insomnia
Also Included In: Public Health;  Conferences
Article Date: 11 Jun 2008 - 1:00 PDT

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A combination of pharmacological and non-pharmacological treatment for insomnia may be preferred among Operation Enduring Freedom / Operation Iraqi Freedom war veterans, according to a research abstract presented on Monday at SLEEP 2008 (9-12 June, 2008), the 22nd Annual Meeting of the Associated Professional Sleep Societies (APSS).

The study, authored by Dana R. Epstein, PhD, of the Phoenix Veterans Affairs Health Care System, focused on five male veterans ranging in age from 25 to 37 years with an insomnia duration of one to five years. All veterans served in Iraq from 15 to 23 months involving one to three deployments. Tests revealed a moderate to severe insomnia problem.

According to the results, the veterans found non-pharmacological and pharmacological treatment acceptable. They preferred relaxation therapy and pharmacological treatment followed by stimulus control instructions, sleep restriction therapy, mindfulness-based intervention, and sleep education and hygiene. Electronic approaches such as MP3 files and the Internet were the preferred non-pharmacological treatment delivery methods using four weeks of 30- to 60-minute treatment in the evening or with 24-hour access. Three veterans took daily sleep diaries home and two completed them using a daily voicemail service. Four veterans took an actigraph watch home, but only one wore it and completed 14 days.

"These preferences may reflect the technology savvy of this new era of veterans," said Dr. Epstein. "An Internet-based, non-medication intervention option could supplement the pharmacological treatment available in routine care."

Insomnia is a classification of sleep disorders in which a person has trouble falling asleep, staying asleep or waking up too early. It is the most commonly reported sleep disorder. About 30 percent of adults have symptoms of insomnia.

Behavioral therapies and medications have been shown to be effective therapies for insomnia. Behavioral therapies use non-pharmacologic methods to improve sleep and are effective and long lasting. Sleep medications are effective and safe treatments for insomnia when used properly and judiciously by a patient who is under the supervision of a sleep medicine or primary care physician.

The American Academy of Sleep Medicine (AASM) offers the following recommendations for individuals who use sleep medications:

• Read carefully the package insert and all information provided by your physician and pharmacist for your sleep medication. This information will help guide you in the safe use of the medication.
  
  
• Especially read the package insert and all information to learn the side effects of the medication.
  
  
• Adhere strictly to the indicated use of your sleep medication. Do not take it for purposes other than to sleep.
  
  
• Follow the prescription carefully and do not take more than the dosage your doctor prescribes.
  
  
• Allow time for a full night of sleep when using sleep medication to avoid morning or daytime drowsiness.
  
  
• Avoid combining sleep medication with alcohol.
  
  
• Ask your doctor any questions you have about the intended use, dosage and side effects. Communication with your physician will help ensure safe use of the medication.
  
  
• Inform your doctor right away of any problems you have while taking a sleep medication.
  
  
• Make your doctor aware of any other medications, prescriptions or over-the-counter, that you use. Mixing medications may cause adverse effects.
  
  
• Make your doctor aware of other medical conditions, including other sleep disorders, you may have. Sleep medications can be dangerous when treating sleep disruption that may arise from another disorder.

It is recommended that adults get between seven and eight hours of nightly sleep.

The AASM offers the following tips on how to get a good night's sleep:

• Follow a consistent bedtime routine.
  
  
• Establish a relaxing setting at bedtime.
  
  
• Get a full night's sleep every night.
  
  
• Avoid foods or drinks that contain caffeine, as well as any medicine that has a stimulant, prior to bedtime.
  
  
• Do not bring your worries to bed with you.
  
  
• Do not go to bed hungry, but don't eat a big meal before bedtime either.
  
  
• Avoid any rigorous exercise within six hours of your bedtime.
  
  
• Make your bedroom quiet, dark and a little bit cool.
  
  
• Get up at the same time every morning.

Those who suspect that they might be suffering from insomnia, or another sleep disorder, are encouraged to consult with their primary care physician or a sleep specialist.

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The annual SLEEP meeting brings together an international body of 5,000 leading researchers and clinicians in the field of sleep medicine to present and discuss new findings and medical developments related to sleep and sleep disorders.

More than 1,000 research abstracts will be presented at the SLEEP meeting, a joint venture of the AASM and the Sleep Research Society. The three-and-a-half-day scientific meeting will bring to light new findings that enhance the understanding of the processes of sleep and aid the diagnosis and treatment of sleep disorders such as insomnia, narcolepsy and sleep apnea.

SleepEducation.com, a patient education Web site created by the AASM, provides information about various sleep disorders, the forms of treatment available, recent news on the topic of sleep, sleep studies that have been conducted and a listing of sleep facilities.

Source: Kathleen McCann
American Academy of Sleep Medicine

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