Cover
Title Page
Copyright
Preface
Contents
Figures
Tables
Summary
Acknowledgments
Abbreviations
Background
Research Objective
Literature Review
Primary Data Collection and Sleep Survey Analysis
Key Informant Discussions
Organization of This Report
CHAPTER TWO: Epidemiology of Sleep Problems in the Military
Literature Review Approach
A Conceptual Model of Post-Deployment Sleep Problems
Diagnosed Sleep Disorders
Symptoms of Sleep Problems
Risk Factors for Sleep Problems in the Post-Deployment Period
Stable Demographic Factors
Operational and Military Support Factors
Mental Health Problems
Physical Health Problems
Operational Readiness
Discussion
Unaddressed Gaps in the Literature
Future Directions for Military Sleep Studies
CHAPTER THREE: Assessing Sleep Disturbances and Consequences Among Post-Deployed Servicemembers
Deployment Life Study Overview
Sleep Survey Added to the Deployment Life Study
Outcomes and Covariates
Analytic Plan for the Sleep Survey
Prevalence of Sleep Symptoms and Sleep-Related Behaviors Overall and by Subgroup
Associations Between Sleep Symptoms and Sleep-Related Behaviors and Outcomes Among Previously Deployed Servicemembers
Prevalence of Sleep Problems in Full Sample
Prevalence of Sleep Problems, by Subgroup
Associations Between Sleep Measures and Outcomes Among Previously Deployed Servicemembers
Discussion
Strengths and Limitations
Approach
DoD Prevention Policies/Programs
Service-Specific Prevention Policies/Programs
U.S. Department of Defense Medical Policies/Programs
Department of the Air Force Medical Policies/Programs
Department of the Air Force Training Policies/Programs
Department of the Navy/Marine Corps Training Policies/Programs
Department of the Air Force Operational Policies/Programs
Department of the Army Operational Policies/Programs
Department of the Navy/Marine Corps Operational Policies/Programs
Discussion
CHAPTER FIVE: Evidence-Based Interventions to Treat Sleep Disturbances Among Servicemembers
Pharmacotherapy to Treat Sleep Disturbances
Pharmacologic Interventions to Treat Insomnia
Summary and Limitations of Pharmacologic Interventions
Cognitive-Behavioral Therapy for Insomnia
Imagery Rehearsal Therapy for Nightmares
Complementary and Alternative Medicine
Combined Treatment Modalities
Technological Developments in Treatment Delivery
Discussion
Participants
Qualitative Data Analysis
Cultural Barriers to Sleep Health
Sleep May Be Viewed as a Luxury Rather Than a Biological Need
Cultural Attitudes Toward Sleep Appear to Vary Across Occupational Specialties and Settings
Manpower Limitations
Balancing Sleep Policies with Operational Demands
Knowledge Barriers to Sleep Health
Lack of a Centralized Resource on Sleep Health
Lack of Knowledge About the Risks of Sleep Medication Use
Lack of Emphasis on Sleep Screening
Continuity of Care Challenges
Discussion
What Are the Correlates and Consequences of Sleep Problems Among Servicemembers in the Post-Deployment Period?
What Are the Current Policies and Programs Related to Sleep in the Military?
What Are the Barriers to Achieving Healthy Sleep for Servicemembers?
Recommendations
Recommendations to Prevent Sleep Problems
Recommendations to Increase the Identification and Diagnosis of Sleep Problems
Recommendations for Clinical Management of Sleep Disorders and Promotion of Sleep Health
Recommendations to Improve Sleep in Training and Operational Contexts
Final Words
A. Sleep Terminology
B. Methods and Review of Published Studies on Sleep in the Military.
C. Methods and Review of Published Studies on Interventions for Sleep Disorders in the Military
D. Review of Sleep Metrics
E. Description of Source Measures Included in the Sleep Survey
F. U.S. Department of Defense Policies Related to Sleep
G. Key Informant Interview Protocol
H. Sleep in the Armed Forces Working Group Proceedings
References