By the Numbers - 28 August 2017

By the Numbers - 28 August 2017

By the Numbers Graphic


The percentage of Veterans who meet "the criteria for an insomnia disorder," according to a new commentary article in the Journal of Clinical Sleep Medicine -- Insomnia in Primary Care: Misreported, Mishandled, and Just Plain Missed. Approximately 10% meet those criteria in the general U.S. population (although a related article gives a range of 4% to 22%).

Insomnia is a major risk factor for neuropsychiatric disorders, suicide, cardiometabolic disease risk, and all-cause mortality. It is frequently comorbid with psychiatric, chronic medical and addictive disorders, conditions commonly reported in the Veteran population. Fortunately, efficacious and effective treatments exist, most notably cognitive behavioral therapy for insomnia (CBT-I), which is the recommended first-line treatment for the disorder, even in the context of comorbidities.

The article says that insomnia complaints generally surface in the primary care environment which can be problematic, as primary care physicians (PCP) "often lack training regarding importance, screening, assessment, and management of insomnia." The Veterans Health Administration (VA), however, "has made efforts and allocated resources to recognize the importance of mental health in the context of primary care, including those for insomnia. In addition, the VA has engaged a nationwide training and education program focused on insomnia diagnosis and treatment."

This commentary references a study in the same issue of the journal -- Veterans Affairs Primary Care Provider Perceptions of Insomnia Treatment -- which says that although the VA has made progress in treating insomnia in the primary care setting, more needs to be done.

A high percentage of veterans (modal response = 20% to 39%) seen in VA primary care settings report an insomnia complaint to their provider. Almost half of respondents do not consistently document insomnia in the medical record (46% endorsed “sometimes,” “rarely,” or “never”). PCPs routinely advise sleep hygiene recommendations for insomnia (ie, avoid stimulants before bedtime [84.3%], and keep the bedroom environment quiet and dark and comfortable [68.6%]) and many are uncertain if cognitive behavioral therapy for insomnia is available at their facility (43.1%).