Sleep disturbances are thought to affect as many as nine out of 10 veterans and a similar number have been classified as poor sleepers according to the Pittsburgh Sleep Quality Index.

A 2017 review published in Military Medicine set out to determine the best interventions for sleep problems in veterans. Here are its findings.

Treating sleep problems in veterans with cognitive behavioral therapy for insomnia (CBTI)

A total of 10 studies involving 1,051 veterans investigated the effectiveness of CBTI. The studies showed significant improvements on a number of measures of sleep quality and insomnia severity including:

• Time taken to fall asleep
• Waking during the night
• Overall sleep duration
• Sleep efficiency

These findings led researchers to rank the evidence for using CBTI to treat sleep disturbances in veterans as “promising.”

Treating sleep problems in veterans with CBTI and psychotherapy

Five studies investigated the effectiveness of CBTI combined with psychotherapy to target post-traumatic nightmares. A total of 133 veterans were involved in these studies.

The review found the strength of evidence for this treatment option to be high. All five studies demonstrated improvements in sleep quality and insomnia severity such as:

• Fewer nightmares
• Increased sleep duration
• Falling asleep faster
• Better sleep efficiency
• Fewer nighttime awakenings

These findings led researchers to rank the evidence for using CBTI with psychotherapies to treat sleep disturbances related to post-traumatic stress disorder (PTSD) as “supported.”

Treating sleep problems in veterans with sleep hygiene education and prazosin (Minipress)

One study explored the effectiveness of sleep hygiene education with pharmacotherapy. It included 74 veterans.

It found that when sleep hygiene counseling was combined with prazosin, the number of veterans reporting restful sleep increased from two percent prior to treatment to 100 percent at the end of a six-month follow-up. However, the small sample size and weakness of the evidence base led the authors of the review to rank the effectiveness of this treatment option as “unknown.”

Treating sleep problems in veterans with mind-body bridging

Mind-body bridging is a mindfulness intervention that teaches awareness skills to help calm the mind and relax the body. The technique also teaches how to recognize (and be aware of) dysfunctional thoughts and feelings.

Compared to sleep education, two sessions of mind-body bridging were found to be more effective at improving patient-reported sleep on measures such as time taken to fall asleep and adequacy of sleep.

The authors of the review found the strength of the evidence demonstrated by the study to be moderate. However, because this result has only been reported in one study so far, and because certified instructors are rare outside the United States and Canada, the evidence for this treatment option was ranked as “unknown.”

Treating sleep problems in veterans with hypnotherapy

One study involving 42 veterans evaluated the effects of four sessions of hypnotherapy over a two-week period compared with two weeks of taking zolpidem (Ambien) nightly. All patients were also educated on various aspects of sleep hygiene.

Both groups saw improved total sleep duration, but those in the hypnotherapy group saw greater improvements in sleep quality, fewer nighttime awakenings, and less morning sleepiness.

This was a single study limited to the specific case of Israeli veterans with PTSD, who had moderate susceptibility to hypnosis. The authors of the review therefore ranked the effectiveness of this treatment option as “unknown.” With that being said, the strength of the evidence for hypnotherapy with sleep hygiene education was found to be moderate.

Conclusion

The high prevalence of sleep problems among veterans highlights the need for effective treatment. As pointed out by the authors of the review, sleep issues affect veterans regardless of their mental health condition.

Although treatments for sleep problems now include CBTI as a first-line intervention, it would be helpful for future research to identify which specific components of CBTI are most beneficial, to help make treatments more effective.

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Martin is the creator of Insomnia Land’s free insomnia sleep training. His online course uses CBT techniques to teach participants how to fall asleep without relying on sleeping pills. More than 5,000 insomniacs have completed his course and 97 percent of graduates say they would recommend it to a friend.