For veterans struggling with chronic insomnia, their nightly routine can become painful and disrupt their daily lives. Insomnia is no joke, and the idea of getting into bed tired and attempting to wake up while still tired is an awful cycle.
Prescription medications such as zolpidem, commonly sold under the brand name Ambien, can provide short-term relief. However, the Department of Veterans Affairs is encouraging veterans to consider a treatment designed to address the thoughts and behaviors contributing to insomnia instead of simply sedating them.
Cognitive behavioral therapy for insomnia, which is known as CBT-I, is available through the VA. They offer treatment in-person, online, and with telehealth. According to the VA’s Veterans Health Library, treatment averages six sessions and can help veterans reset their sleep cycles without depending on medication.
Rooting Out the Main Problem
This therapy is not your typical mill therapy. There is not a generic list of sleep hygiene or treatments to do every night. The treatment examines the habits, schedules and thought patterns that can keep insomnia going long after its original trigger has passed.
Veterans may learn to match the amount of time they spend in bed with the amount of time they are actually able to sleep, create a more supportive sleep environment and reduce anxiety about whether they will fall asleep.
The treatments attempt to retain the connection between bed and sleep. When someone regularly lies awake unable to sleep, the bedroom itself can gradually become associated with frustration and anxiety rather than rest. CBT-I attempts to reverse that association by rebuilding the connection between bed and sleep through consistent sleep patterns and changes in behaviors that reinforce wakefulness.
The VA describes its treatments as the best and most effective treatment for its patients in the way to deal with sleep disorders and insomnia. It is intended to help patients fall asleep and stay asleep instead of waking up in the middle of the night.
Why the VA Is Cautious About Sleep Medication
One thing the VA does not say is to avoid medication at all costs. Sometimes, it needs to be used. With that being said, it does warn that sedative-hypnotic medications should be used only for a short period.
That category includes medications as benzodiazepines such as temazepam and Z-drugs like zolpidem, zaleplon and eszopiclone. The VA says CBT-I is safer and more effective than taking sedative hypnotics for chronic insomnia.
Possible risks include daytime drowsiness, memory and thinking problems, dizziness, falls, broken bones, car crashes, physical dependence and rebound insomnia when the medication is discontinued.
Combining sedative hypnotics with alcohol or opioids can further increase the risk of overdose and death. Z-drugs can also induce sleep behaviors that are hard to live with, such as sleepwalking, driving, or doing stuff during sleep.
Veterans should not stop cold turkey with their medications or as a doctor prescribes. Stopping without a weaning period can produce complex situations that can be deadly to veterans.
Telehealth Removes Blockades
Offering CBT-I through telehealth may be particularly useful for veterans who live far from a VA medical center, lack reliable transportation or find frequent in-person appointments difficult because of work, school or family responsibilities.
This format does not turn the therapy into just a click-through online instruction. Veterans are encouraged to work with clinicians to analyze and improve their sleep patterns, while identifying obstacles and adjusting treatment options for their personal lives.
Veterans looking for a shorter intervention may also ask about Brief Behavioral Treatment for Insomnia. The VA says BBTI generally takes one to four visits and focuses primarily on changing behaviors that interfere with sleep. Sessions may be provided in person, virtually or through a combination of the two.
Self- Described Plans
The VA offers two options for veterans who want to learn about the treatments themselves. SleepEZ is a self-paced, veteran-focused online course that can be completed on a computer or smartphone. It does not require registration or personal information, and veterans can use it independently or alongside care from their health care team.
The VA’s Insomnia Coach mobile app provides additional strategies for improving sleep and is available for Android and Apple devices. The VA recommends discussing sleep problems with a provider before using the app to determine whether self-guided treatment is appropriate.
Insomnia can severely impair the quality of life for those who suffer from the condition. Energy, mood, performance, and other life variables can be impacted in life-ruining ways.
For veterans who want to try to avoid medicated options, CBT-I offers a different objective that slows them to not force sleep but overall rebuild their sleep schedule in a healthy way.
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