Cognitive Behavioral Therapy for Insomnia Among Active Duty Military Personnel Diagnosed With Obstructive Sleep Apnea.

INTRODUCTION: Insomnia and obstructive sleep apnea are common conditions among military service members, with high rates of comorbidity. Although cognitive behavioral therapy for insomnia (CBT-I) has been established as an effective treatment for insomnia, it is unclear whether or not CBT-I is effective among service members with comorbid insomnia and obstructive sleep apnea. MATERIALS AND METHODS: This retrospective, observational study examined insomnia outcomes among a group of service member patients (N = 73) with comorbid insomnia and obstructive sleep apnea. All patients received individual CBT-I in a specialty sleep clinic at a military treatment facility. Seven outcomes associated with insomnia were evaluated before and after treatment. RESULTS: On average, patients showed significant improvement in sleep onset latency, wake after sleep onset, sleep efficiency, number of awakenings, and symptoms reported on the Insomnia Severity Index. Twenty-six percent of patients showed clinically significant improvement in reported insomnia symptoms. CONCLUSIONS: These results suggest that CBT-I may be effective in treating military service members with comorbid insomnia and obstructive sleep apnea. Despite the limitations of data collected in a clinical setting, consistent findings across five of the seven outcome measures provide good evidence that this treatment can be implemented in military settings.

Cognitive behavioral therapy for insomnia among active duty military personnel.

Insomnia is one of the most frequent sleep complaints among veterans and military personnel. This retrospective study investigated whether cognitive-behavioral therapy for insomnia (CBT-I) improved sleep and reduced insomnia symptoms in an active duty military population. The study consisted of 98 military personnel (mean age = 31.0, SD = 7.4; 70% male) who experienced insomnia and completed CBT-I in a military sleep disorders clinic. Assessments of sleep were completed analyzing pre- and posttreatment variables from the sleep diary, Insomnia Severity Index (ISI), and Epworth Sleepiness Scale (ESS). At baseline, the mean ISI was 16.63 (SD = 4.36) with a total sleep time (TST) of approximately 5.90 hr (SD = 1.32). After CBT-I, the ISI was 14.50 (SD = 5.19) and TST was 5.62 hr (SD = 1.32). There was no significant change over time for patients who received fewer than 4 sessions, but change over time was significant for patients who received 4 or more sessions. Over the course of treatment, patients' overall sleep improved across metrics with 20% achieving clinically meaningful improvement in insomnia symptoms. CBT-I improves insomnia symptoms in some military personnel. However, everyone does not respond successfully to CBT-I treatment. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Intensive sleep deprivation and cognitive behavioral therapy for pharmacotherapy refractory insomnia in a hospitalized patient.

The case of a 59-year-old woman psychiatrically hospitalized with comorbid insomnia, suicidal ideation, and generalized anxiety disorder is presented. Pharmacologic therapies were unsuccessful for treating insomnia prior to and during hospitalization. Intensive sleep deprivation was initiated for 40 consecutive hours followed by a recovery sleep period of 8 hours. Traditional components of cognitive behavioral therapy for insomnia (CBTi), sleep restriction, and stimulus control therapies, were initiated on the ward. After two consecutive nights with improved sleep, anxiety, and absence of suicidal ideation, the patient was discharged. She was followed in the sleep clinic for two months engaging in CBTi. Treatment resulted in substantial improvement in her insomnia, daytime sleepiness, and anxiety about sleep. Sleep deprivation regimens followed by a restricted sleep recovery period have shown antidepressant effects in depressed patients. Similar treatment protocols have not been investigated in patients with pharmacotherapy refractory insomnia and generalized anxiety disorder.