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When Sleeping Becomes Difficult, VA Can Help

Senior man sleeping

March is National Sleep Awareness Month. Sleep is an important part of living a healthy, long life. Without it, serious health issue can develop.

Are you lying awake? Are your eyes wide open at night? Tossing and turning? Checking the alarm clock? If this sounds familiar, you could be struggling with insomnia. Anyone who has trouble falling asleep, staying asleep and/or waking up too early knows it is more than a nighttime problem.

Insomnia sufferers often have trouble staying awake and alert during the day. This can interfere with work, school and other daytime activities. Those who have trouble sleeping may feel irritable and depressed. They may have trouble concentrating or have low energy levels.

Did You Know?

Being sleep-deprived may increase nightmares. If you improve the quality of your sleep, you sometimes can reduce nightmares.

Insomnia is one of the biggest problems for returning Servicemembers, according to Dana Epstein, Associate Chief Nursing Service for Research at the Phoenix Veterans Affairs Health Care System. Although insomnia can have many causes, it goes hand-in-hand with posttraumatic stress disorder (PTSD).

"Research shows an estimated 20 percent of Servicemembers returning from Iraq and Afghanistan suffer from PTSD," said Epstein. "About 80 to 90 percent of combat Veterans with PTSD have sleep difficulty."

About half of the Veterans who complete PTSD treatment may continue to have insomnia, according to Christi Ulmer, a psychologist at the Durham VA Medical Center in Durham, N.C. "It takes on a life of its own."

Sleep apnea, traumatic brain injury, chronic pain, alcohol abuse and restless leg syndrome can also cause sleep problems. The U.S. Department of Veterans Affairs (VA) is training mental health providers in a treatment called Cognitive Behavioral Therapy for insomnia (CBT-I).

What is CBT-I?

CBT-I is a science-based treatment that does not involve taking medicine. The treatment focuses on thoughts, feelings and expectations about sleep that may keep you from getting a good night's rest. It also helps you adopt personal sleep habits that research has shown to be helpful.

To get results, you need to commit to the program. This includes completing a sleep diary every morning. The diary can help you and your therapist identify sleep/wake patterns and what might be affecting them. For example, if your sleep diary shows you go to bed at 9 p.m. but are not falling asleep before 1 a.m. most nights, one solution might be to switch your bedtime closer to 1 a.m., explained Ulmer.

"People with chronic insomnia extend their time in bed," she said. "The frustration of not being able to fall asleep creates a link between the bed and the insomnia." To break this link, Ulmer advises that Veterans give themselves 20 to 30 minutes to fall asleep. "If you can't, get up and do something relaxing."

CBT-I treatment typically involves meeting with a therapist, once a week or once every other week for about six weeks. Each meeting lasts about 50 minutes. Ulmer said Veterans should be evaluated for sleep apnea before beginning CBT-I. Veterans with untreated sleep apnea may be too sleepy to participate in certain parts of the treatment. About 85 percent of all cases of sleep apnea are undiagnosed. Therefore, their CBT-I provider will screen them for sleep apnea before beginning CBT-I treatment.

My HealtheVet has a "Healthy Living Center" on sleep that will direct you to a self-test for measuring insomnia. You can print out the results to discuss with your health care team. There are also suggestions for changing certain behaviors to improve sleep. Tips include avoiding caffeine later in the day, waking up at the same time each morning and avoiding naps.

Stop dreaming about getting a good night's sleep. Make it a reality with help from VA.

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