
If you think your sleep could be better, you can use this healthy sleeping tool to review your sleep behaviours. It will offer you tailored advice and tips for improving your sleep.
Short-term sleep difficulties could be caused by:
Some people will have more long-lasting difficulty in initiating or maintaining sleep. Chronic non-restorative sleep indicates they may have insomnia. People with insomnia may also show:
Scant evidence exists about the prevalence of insomnia. Australian studies have reported a prevalence of:
Females are more likely to suffer from insomnia than males (Zhang & Wing, 2006). Given the increasing proportion of women in younger veteran cohorts, it is worth keeping this in mind.
Sleep problems are often related to other mental health conditions. Such as:
Therefore, it is important to screen for these disorders if chronic sleep problems are detected.
For veterans, sleep problems may also stem from military experiences. There may be a lingering impact of disturbed sleep routines resulting from:
Veterans may have frequent nightmares related to military experiences. Hypervigilance may also have a negative impact on the sleep process.
Insomnia is both a common and complex condition. Medical treatment should be based on a thorough assessment that includes:
The assessment should also clarify the consequences of insomnia for a veteran’s functioning and quality of life. Useful questions to ask the veteran include:
Screening questions should include investigations of early, middle and late-onset insomnia. For early-onset insomnia:
For middle-onset insomnia:
For late-onset insomnia:
Asking the veteran to keep a sleep diary for about a week can assist with the assessment process. Useful things to include in the sleep diary include:
Further physical investigations of sleep problems such as suspected sleep apnoea can be conducted by sleep centres or clinics.
Self-management strategies encouraged by a GP are the recommended first-line intervention for insomnia. However, if the insomnia persists after the veteran has implemented self-management strategies, it may be necessary to consider more formal interventions.
Practitioners can advise veterans on a number of sleep hygiene strategies. These may allow them to manage their sleep difficulties common to many disorders. Practitioners should:
These strategies are based on the premise that sleep problems can be developed and/or maintained by a series of problems or habits inherently disruptive to sleep. Sleep hygiene techniques seek to re-establish sleep promoting behaviours. Key features of sleep hygiene include:
An important component of sleep hygiene is stimulus control; encourage the veteran to:
In the event self-management strategies are noneffective, more formal intervention is required. Cognitive behavioural therapy for insomnia (CBT-I) is the recommended approach (e.g., Ree et al., 2017)
CBT-I is designed to assist clients in developing healthy sleep habits through a range of behavioural interventions and in challenging the negative thoughts or cognitions that can play a role in maintaining and perpetuating sleep disturbance. CBT-I may include the following components:
CBT-i Coach is an app for people who are engaged in Cognitive Behavioral Therapy for Insomnia with a health provider, or who have experienced symptoms of insomnia and would like to improve their sleep habits. The app will guide users through the process of learning about sleep, developing positive sleep routines, and improving their sleep environments. It provides a structured program that teaches strategies proven to improve sleep and help alleviate symptoms of insomnia.
Insomnia can usually be treated in an outpatient setting. There is currently insufficient evidence to recommend an optimal duration of psychological treatment.
Pharmacotherapy for insomnia should be limited to the:
Pharmacotherapy should not be used in isolation from CBT-I or other evidence-based psychological interventions. If medication is considered necessary, non-benzodiazepine hypnotic agents such as zolpidem (e.g. Stilnox) and zopiclone (e.g. Imovane) are the preferred first-line agents. These are preferred as they:
Benzodiazepine hypnotics are problematic because of the potential for:
Longer-acting more potent agents such as nitrazepam (e.g. Alodorm) and flunitrazepam (e.g. Hypnodorm) should be avoided for these reasons.
When other agents such as antihistamines and sedating antidepressants are used for their hypnotic effects, the broader array of potential side effects must be considered and balanced against the desired benefits. As a general principle, short-term use (less than four weeks) is preferable when using hypnotic medication. This helps to prevent many potential complications.
Longer-term use of hypnotic medication may be required if:
In the longer-term situations, intermittent use is preferable to continuous use. Withdrawal from long-term use should always be tapered slowly.
If you think your sleep could be better, you can use this healthy sleeping tool to review your sleep behaviours. It will offer you tailored advice and tips for improving your sleep.