![]() ![]() However, much less is known about how insomnia-related care processes have changed since the rollout. Evaluation data from the rollout have established that VA clinicians can be effectively trained to competently deliver CBT-I and that veterans who complete treatment tend to experience significant improvements in their insomnia severity. ![]() In 2011, the VA Office of Mental Health and Suicide Prevention (formerly Office of Mental Health Services) rolled out provider training for CBT-I as part of the evidence-based psychotherapy (EBP) training program, and there are now over 1000 trained CBT-I clinicians. Notably, VA has invested substantially in the dissemination of CBT-I. Despite these recommendations and support from numerous clinical trials, individuals with an insomnia complaint are significantly more likely to receive an insomnia medication instead of being referred for, or receiving, CBT-I. A multi-component evidence-based psychotherapy consisting of cognitive therapy, behavior change strategies, and educational components, CBT-I not only improves insomnia severity and global sleep outcomes, but also improves comorbid medical and psychiatric outcomes in adults. Per the VA/DOD Clinical Practice Guidelines, as well as recommendations from the American Academy of Sleep Medicine, the American College of Physicians, and the National Institutes of Health, the first-line treatment of insomnia for adults is cognitive behavioral therapy for insomnia (CBT-I). Though a 650% relative increase in the age-adjusted prevalence of insomnia was observed in veterans utilizing VA services between fiscal years 20 (from 0.2% to 1.5% ), there remains a notable discrepancy between reports of clinically significant insomnia symptoms and expected diagnoses of insomnia in the medical record (7.4–11.8% ).Īn additional discrepancy arises with regard to insomnia diagnosis and treatment. In contrast, administrative studies of VA electronic health records (EHR) estimate insomnia prevalence rates from 0.2% to 3.5%. Notably, a recent study of post-9/11 veterans found that 57.2% scored ≥11 (clinical cutoff) on the Insomnia Severity Index and 40.5% scored ≥15 (moderate-severe cutoff), both scores indicative of increased risk for a diagnosis of insomnia disorder. Survey studies suggest that upwards of half of US Military service members and veterans experience clinically significant insomnia symptoms (see US Department of Veterans Affairs (VA)/Department of Defense (DOD) guidelines for review ). Despite its high prevalence and known adverse health impacts, insomnia remains under-diagnosed and under-treated in clinical settings. The prevalence of insomnia is estimated to be even higher in United States (US) military service members and veterans. ![]() In the general population, about 30% of adults report at least one symptom of insomnia (e.g., difficulty falling asleep/staying asleep) and an estimated 6–10% meet diagnostic criteria for insomnia disorder (symptoms ≥3 months duration, ≥3 days per week, daytime impairment ). Insomnia-broadly defined as difficulty initiating or maintaining sleep and dissatisfaction with sleep quantity or quality-is common in adults and is associated with adverse physical and mental health outcomes. Furthermore, insomnia continues to be under-diagnosed, per VA EHR data, which may have implications for treatment consistent with clinical practice guidelines and may negatively impact veteran health. ![]() An evaluation of a large sample of veterans identified that prescription sleep medications remain the best way to identify veterans with insomnia. Significant differences were identified between the sociodemographic and clinical variables across indicators. Trends over time included increasing yearly rates for diagnoses, consults, and CBT-I, and decreasing rates for medications. The sample included 439,887 veterans, with 17% identified by one of the four indicators medications was most common (15%), followed by diagnoses (6%), consults (1.5%), and CBT-I (0.6%). Also examined were sociodemographic and clinical differences among veterans with and without an insomnia indicator, as well as differences among the four individual insomnia indicators. The annual and overall prevalence of four insomnia indicators was measured: diagnoses, medications, consultations for assessment/treatment, and participation in CBT-I. A retrospective analysis of VA electronic health records (EHR) data from 2011 to 2019 was conducted. The objective was to examine insomnia and insomnia-related care within a regional network of Department of Veterans Affairs (VA) facilities since the VA roll-out of cognitive behavioral therapy for insomnia (CBT-I) in 2011. ![]()
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