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Sleep in the military - Troxel Wendy M.

Year 2015

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PrefaceSummarySignificanceApproachFindingsWhat Are the Correlates and Consequences of Sleep Problems Among Servicemembers in the Post-Deployment Period?What Are the Current Programs and Policies Related to Sleep in the Military?What Are the Evidence-Based Interventions to Treat Sleep Disorders Among Servicemembers?What Are the Barriers to Achieving Healthy Sleep for Servicemembers?What Actions Can Be Taken to Promote Sleep Health Among Servicemembers?Final WordsAcknowledgmentsCHAPTER ONE. IntroductionBackgroundResearch ObjectiveMethodsLiterature ReviewPrimary Data Collection and Sleep Survey AnalysisPolicy ReviewKey Informant DiscussionsExpert Working GroupOrganization of This ReportCHAPTER TWO. Epidemiology of Sleep Problems in the MilitaryLiterature Review ApproachA Conceptual Model of Post-Deployment Sleep ProblemsPrevalence and Types of Specific Sleep Problems in the Post-Deployment PeriodDiagnosed Sleep DisordersInsomniaObstructive Sleep ApneaSymptoms of Sleep ProblemsPoor Sleep QualityNightmaresDaytime Sleepiness and FatigueRisk Factors for Sleep Problems in the Post-Deployment PeriodStable Demographic FactorsOperational and Military Support FactorsGeneral Military CharacteristicsUnit- and Deployment-Specific FactorsHealth BehaviorsCorrelates and Consequences of Sleep Problems in the Post-Deployment PeriodMental Health ProblemsDepression, Anxiety, PTSD, and Substance-Use DisordersSuicidalityPhysical Health ProblemsOperational ReadinessDiscussionUnaddressed Gaps in the LiteratureFuture Directions for Military Sleep StudiesCHAPTER THREE. Assessing Sleep Disturbances and Consequences Among Post-Deployed ServicemembersSleep Survey Development and Administration to Servicemembers in the Deployment Life StudyDeployment Life Study OverviewSleep Survey Added to the Deployment Life StudyOutcomes and CovariatesPrimary Outcome MeasuresCovariatesAnalytic Plan for the Sleep SurveyPrevalence of Sleep Symptoms and Sleep-Related Behaviors Overall and by SubgroupAssociations Between Sleep Symptoms and Sleep-Related Behaviors and Outcomes Among Previously Deployed ServicemembersSample CharacteristicsPrevalence of Sleep Problems in Full SamplePrevalence of Sleep Problems, by SubgroupAssociations Between Sleep Measures and Outcomes Among Previously Deployed ServicemembersPhysical HealthPerceived Unit ReadinessProbable DepressionProbable PTSDDiscussionStrengths and LimitationsCHAPTER FOUR. Review of Sleep Policies and ProgramsApproachSleep-Related Prevention Policies/ProgramsDoD Prevention Policies/ProgramsService-Specific Prevention Policies/ProgramsSleep-Related Medical Policies/ProgramsU.S. Department of Defense Medical Policies/ProgramsU.S. Department of Veterans Affairs Medical Policies/ProgramsDepartment of the Air Force Medical Policies/ProgramsDepartment of the Army Medical Policies/ProgramsDepartment of the Navy/Marine Corps Medical Policies/ProgramsSleep-Related Policies/Programs in Training EnvironmentsDepartment of the Air Force Training Policies/ProgramsDepartment of the Army Training Policies/ProgramsDepartment of the Navy/Marine Corps Training Policies/ProgramsSleep-Related Policies/Programs in Operational Environments U.S. Department of Defense Operational Policies/ProgramsDepartment of the Air Force Operational Policies/ProgramsDepartment of the Army Operational Policies/ProgramsDepartment of the Navy/Marine Corps Operational Policies/ProgramsDiscussionCHAPTER FIVE. Evidence-Based Interventions to Treat Sleep Disturbances Among ServicemembersApproachPharmacotherapy to Treat Sleep DisturbancesPharmacologic Interventions to Treat InsomniaPharmacologic Interventions to Treat NightmaresSummary and Limitations of Pharmacologic InterventionsEvidence-Based Behavioral Treatments for Sleep Disorders Among ServicemembersCognitive-Behavioral Therapy for InsomniaCBT-I Application to Military Populations and Evidence of EffectivenessSummary and Limitations of CBT-IImagery Rehearsal Therapy for NightmaresIRT Application to Military Populations and Evidence of EffectivenessSummary and Limitations of IRTComplementary and Alternative MedicineCAM Application to Military Populations and Evidence of EffectivenessSummary and Limitations of CAMCombined Treatment ModalitiesApplications of Combined Treatment Modalities to Military Populations and Evidence of EffectivenessSummary and Limitations of Combined Treatment ModalitiesTechnological Developments in Treatment DeliveryDiscussionCHAPTER SIX. Barriers to Achieving Healthy Sleep Among ServicemembersApproach ParticipantsQualitative Data AnalysisCultural Barriers to Sleep HealthSleep May Be Viewed as a Luxury Rather Than a Biological NeedCultural Attitudes Toward Sleep Appear to Vary Across Occupational Specialties and SettingsOperational Barriers to Sleep HealthManpower LimitationsBalancing Sleep Policies with Operational DemandsEnvironmental BarriersKnowledge Barriers to Sleep HealthLack of Servicemember and Unit Leader Knowledge About Sleep HealthLack of a Centralized Resource on Sleep HealthLack of Knowledge About the Risks of Sleep Medication UseMedical and Treatment Systems Barriers to Promoting Sleep HealthResistance to Treatment SeekingLack of Emphasis on Sleep ScreeningContinuity of Care ChallengesSleep Clinic and Provider ShortagesDiscussionCHAPTER SEVEN. Conclusions and RecommendationsConclusionsWhat 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 Evidence-Based Interventions to Treat Sleep Disorders Among Servicemembers?What Are the Barriers to Achieving Healthy Sleep for Servicemembers?RecommendationsRecommendations to Prevent Sleep ProblemsIncrease Servicemember and Line Leader Education About Healthy Sleep BehaviorsFund/Conduct Longitudinal Research on Sleep and Downstream Effects on Operational Readiness and ResilienceRecommendations to Increase the Identification and Diagnosis of Sleep ProblemsEducate Families on Signs and Symptoms of Sleep DisturbancesImprove Screening for Sleep Disturbances in Primary Care SettingsRecommendations for Clinical Management of Sleep Disorders and Promotion of Sleep HealthDevelop Provider Education Programs on Preventing, Identifying, and Treating Sleep DisordersDevelop a Clinical Practice Guideline for Sleep DisordersIncrease the Use of Technology for Assessing and Clinically Managing Sleep DisordersContinue to Research Evidenced-Based Practices for Advancing Healthy Sleep in Military SettingsEnhance Dissemination of Evidence-Based TreatmentsImprove Continuity of Care of Sleep Disorder TreatmentsRecommendations to Improve Sleep in Training and Operational ContextsRevise Existing Training and Operational Policies to Align with Current Clinical Guidelines About Optimal Sleep DurationEducate Line Leaders on Creating Sleep PlansCreate Standardized Operational and Training Policies Across DoD to Increase Sleep Duration and Quality and Reduce Fatigue-Related ImpairmentLink Sleep-Related Information to Data on MishapsPrioritize Sleep in Reintegration PoliciesDisseminate Positive Messaging About Sleep as an Operational Imperative to Increase Awareness and Reduce Cultural BarriersFinal Words
 
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