Insomnia Treatment Acceptability and Preferences of Male Iraq and Afghanistan Combat Veterans and Their Healthcare Providers

By Epstein, Dana R.; Babcock-Parziale, Judith L. et al. | Journal of Rehabilitation Research & Development, June 2012 | Go to article overview

Insomnia Treatment Acceptability and Preferences of Male Iraq and Afghanistan Combat Veterans and Their Healthcare Providers


Epstein, Dana R., Babcock-Parziale, Judith L., Haynes, Patricia L., Herb, Christine A., Journal of Rehabilitation Research & Development


INTRODUCTION

Sleep disturbance is one of the most frequently cited symptoms among soldiers returning from the Iraq war [1]. Physiological, psychological, military, and civilian readjustment stressors can initiate insomnia in Operations Iraqi Freedom/Operation Enduring Freedom (OIF/ OEF) Veterans. In response to acute sleep problems, patients may develop ineffective strategies to obtain sleep, poor sleep habits, and sleep-related dysfunctional cognitions. These responses perpetuate sleep difficulty and lead to chronic insomnia [2].

Insomnia is highly prevalent in patients with traumatic brain injury (TBI) [3], the leading injury in the current combat theaters of operation, and may be more common in mild than moderate or severe injuries [4]. Insomnia symptoms are reported by 50 percent of TBI patients, and 29 percent meet diagnostic criteria for an insomnia syndrome [3]. TBI patients report that insomnia interferes with daily functioning and exacerbates symptoms such as cognitive deficits, irritability, pain, and fatigue [3]. Difficulty with sleep onset and maintenance was reported by 93.5 percent of OIF/OEF Veterans seen at a Department of Veterans Affairs (VA) Polytrauma Network Site [5]. Sleep impairment is common in disorders associated with polytrauma such as posttraumatic stress disorder (PTSD) [6], depression [7], and pain [8]. These disorders are highly comorbid with TBI and may be better predictors of sleep disturbance than mild TBI [5,9]. In an analysis of the "polytrauma triad" (PTSD, pain, and TBI), PTSD was the major contributor to sleep difficulty in Veterans, and when it occurred with TBI, sleep disturbance increased [5]. Given the prevalence and effect of insomnia in mild TBI and polytrauma patients, tailored insomnia interventions are needed for this unique Veteran population.

In 2005, a National Institutes of Health State-of-the-Science panel recognized cognitive-behavioral treatment (CBT) as a first-line therapy for insomnia [10]. Two single-case design studies used CBT for insomnia (CBT-I) for mild-to-severe TBI patients in the non-Veteran population [11-12]. Cognitive deficits did not limit the subjects' ability to understand the treatment rationale, to self-monitor sleep, to demonstrate insight, or to benefit from CBT-I. Significant statistical and clinical reductions in insomnia, night-to-night variability, and fatigue were found and intervention effects were maintained at 1 and 3 months posttreatment. CBT-I improved sleep in conditions associated with traumatic injuries such as depression [13] and pain [14] in the non-Veteran population and PTSD in Veterans, including the OIF/OEF cohort [15]. These findings suggest that OIF/OEF Veterans who have experienced traumatic injuries may benefit from CBT-I. Unfortunately, nothing is known about this Veteran cohort's views on the acceptability of and preference for insomnia treatments.

Acceptability represents a favorable attitude toward a treatment option based on careful consideration of the treatment attributes (e.g., appropriateness, suitability, effectiveness, risks, and convenience). Patients' perceptions of treatment attributes influence their preferences for treatment. Treatment preferences denote patients' choices of treatment, that is, the treatment option patients want to receive to manage the presenting clinical problem [16]. Eliciting patient preferences is a key element of patient-centered care [17]. An increasing number of studies involve assessing participants' perception of treatment preferences, yet there is limited knowledge of patients' views regarding acceptability of and preferences for insomnia treatments [16].

Two studies found that behavioral interventions for insomnia were more acceptable and suitable than pharmacological treatment [18-19]. Morin et al. found the short-term effects of behavioral and medication treatments were rated equivalently by participants, but participants thought nonpharmacological treatment would be more effective in the long term, have fewer side effects, and have a more beneficial effect on daytime functioning than pharmacotherapy [18]. …

The rest of this article is only available to active members of Questia

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Buy instant access to cite pages or passages in MLA 8, MLA 7, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

(Einhorn 25)

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Note: primary sources have slightly different requirements for citation. Please see these guidelines for more information.

Cited article

Insomnia Treatment Acceptability and Preferences of Male Iraq and Afghanistan Combat Veterans and Their Healthcare Providers
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Help
Full screen
Items saved from this article
  • Highlights & Notes
  • Citations
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

matching results for page

    Questia reader help

    How to highlight and cite specific passages

    1. Click or tap the first word you want to select.
    2. Click or tap the last word you want to select, and you’ll see everything in between get selected.
    3. You’ll then get a menu of options like creating a highlight or a citation from that passage of text.

    OK, got it!

    Cited passage

    Style
    Citations are available only to our active members.
    Buy instant access to cite pages or passages in MLA 8, MLA 7, APA and Chicago citation styles.

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

    1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

    Cited passage

    Thanks for trying Questia!

    Please continue trying out our research tools, but please note, full functionality is available only to our active members.

    Your work will be lost once you leave this Web page.

    Buy instant access to save your work.

    Already a member? Log in now.

    Search by... Author
    Show... All Results Primary Sources Peer-reviewed

    Oops!

    An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.