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March 2023 | VISN 5 MIRECC Link

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Sleep Problems for People with Serious Mental Illness: How Can VA Help?

Research Publication:

Klingaman, E.A., Lucksted, A., Crosby, E. S., Hack, S. M., Peeples, A. D., Blank, Y., & Schwartz, E. (2022). How do US military veterans with serious mental illness manage insomnia? A phenomenological analysis. Journal of Sleep Research.

Klingaman, E. A., Lucksted, A., Crosby, E. S., Blank, Y., & Schwartz, E. (2019). A phenomenological inquiry into the experience of sleep: Perspectives of U.S. military veterans with insomnia and serious mental illness. Journal of Sleep Research 28(4), e12833.

People who suffer from insomnia have trouble falling and staying asleep, which can cause daytime fatigue, depression, relationship challenges, and work disruption. It is estimated that insomnia impacts 80% of Veterans with serious mental illnesses (SMI) such as schizophrenia spectrum, bipolar, and major depressive disorders. Medications for sleep often have unpleasant side e#ects or do not work long-term. Fortunately, helpful non-medication treatments are available that can improve sleep. Unfortunately, until recently, these treatments have not been tailored to meet the unique needs of Veterans with SMI. Mental health expert Dr. Elizabeth Klingaman and her team asked Veterans with SMI how they experienced and managed insomnia to determine how gold-standard insomnia treatment can be tailored to this population.

One important conclusion was that Veterans’ relationship with sleep was complex. On one hand, many associated it with intrusive and troubling hallucinations, paranoia, and stressful military experiences. On the other hand, many Veterans wanted better sleep because good sleep reduced distress. Some Veterans felt frustrated and exhausted by failed tries at better sleep. They had finally resigned to a life of drowsy days and sleepless nights. Other Veterans took a proactive role in trying to manage their insomnia by consulting with friends and providers and experimenting with new, unconventional ways to improve sleep. Of those who experimented with new and different techniques for good sleep, some found solutions that worked well. When they got better sleep, they felt more motivated, energetic, and inspired to fill their days with meaningful activities. This led to improved quality of life; and improved quality of life helped sleep continue to improve. The perspectives shared by these Veterans will be used to tailor insomnia treatment guidelines for this population. See below for specific recommendations for providers and Veterans.

“[The voices] wake me up, keeps me up…I keep on trying to fight them, trying not to listen to them…but sometimes I have to listen because there’s no way I can’t. It makes me be up all night ‘cause I’m trying to struggle with them to not do what they say…they don’t want me to go to sleep.”

“And the root of the problem is because, you know, you’re upset with yourself because you’re not able to rest properly. You’re trying everything that you possibly can…and that wears on you daily.”

“I got to take each day–I don’t look for tomorrow, I look for today. If I accomplish today, I’ll let tomorrow take care of itself. That’s with the sleep.”

What Can Providers Do?

  • Screen for insomnia with the Insomnia Severity Index (available in Mental Health Assistant) to determine whether sleep treatment may be needed.
  • Consider assessing for a fear of sleep among Veterans with SMI.
  • Talk with Veterans to understand how their psychotic symptoms impact their sleep.
  • Provide education about sleep and related conditions, such as sleep apnea, and consult with your local sleep medicine clinic to determine if the Veteran should be screened for other sleep disorders.
  • Sign up for VISN 5 MIRECC resources for updates about treatment for Veterans with insomnia and SMI.

What Can Veterans and their Families Do?

  • It’s normal for Veterans with SMI to feel anxious about sleep. You’re not alone.
  • Please tell your providers if you think that sleep di!culties are interfering with your life.
  • Let your providers know if you prefer alternatives to sleep medications; they may be able to "nd alternatives that can help.
  • VA has developed some resources to help Veterans navigate sleep problems. Please check these out!
    Sleep 101 is a short program designed to help you learn about your sleep and what can help.
    CBT-i Coach is 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.
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