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How Do VA PCPs Respond to Insomnia Complaints?

by U.S. Medicine

October 16, 2017

DURHAM, NC — Veterans have even higher rates of insomnia than other adults in the United States, and many seek treatment from their primary care physicians.

A new study in the Journal of Clinical Sleep Medicine looked at how those complaints are perceived by PCPs. A high percentage of veterans, 20% to 39%, seen in VA primary care settings report an insomnia complaint to their healthcare provider, according to the report.1

Durham, NC, VA Health Services Research and Development researchers and colleagues noted that prior research found that sleep hygiene and pharmacotherapy are the primary treatments offered by PCPs, who tend to focus on perceived causes of insomnia rather than the insomnia itself. Those studies also suggested that neither patients nor providers are satisfied with insomnia treatment options.

To better understand the perspectives, a survey was conducted within the VA healthcare system, with PCPs completing the questionnaires electronically.

Results indicated:

  • Nearly half of respondents do not consistently document insomnia in the medical record—46% endorsed “sometimes,” “rarely” or “never.”
  • PCPs routinely advise sleep hygiene recommendations for insomnia, such as avoiding stimulants before bedtime (84.3%) and keeping the bedroom environment quiet and dark and comfortable (68.6%);
  • Many said they are uncertain if cognitive behavioral therapy for insomnia is available at their facility (43.1%).

“Findings point to the need for systems-level changes within health care systems, including the adoption of evidence-based clinical practice standards for insomnia and PCP education about the processes that maintain insomnia,” study authors concluded.

1. Ulmer CS, Bosworth HB, Beckham JC, Germain A, Jeffreys AS, Edelman D, Macy S,
Kirby A, Voils CI. Veterans Affairs Primary Care Provider Perceptions of Insomnia
Treatment. J Clin Sleep Med. 2017 Aug 15;13(8):991-999. doi: 10.5664/jcsm.6702.
PubMed PMID: 28728623; PubMed Central PMCID: PMC5529136.

 


4 Comments

  • Pamela Detrick says:

    AT our VA, for some reason, most of the veterans are referred to mental health to be treated. Never made any sense to me..

  • Pamela Detrick says:

    AT our VA, for some reason, most of the veterans are referred to mental health to be treated. Never made any sense to me..

  • Frederic Will MD FAPA says:

    The use of Antihistaminic drugs especially in people over 70 tends toward cognitive blunting.

    The use of Ambien like drugs in PTSD is like playing with matches in a magazine. In non PTSD populations we have sleep walking/ eating/ driving, in a VA population we also see serious assaults on the bed partner.

    The off label use of Trazodone for sleep is questionable as is the use of Queitiapine.

    Insomnia is a symptom not a disease. Sleep Hygiene , Melatonin, and CBT-I are treatments of choice.

    Sometimes it is hard to tell patients that they must work at treatment which may take 3 months.

    When patients self D/c Melatonin after a few days or weeks , that is not an adequate trial; as to sleep hygiene , avoiding 3 am video games is a problem. Having an anchor time of 7 or 8 AM is essential and only the patient can self regulate. A sleep diary is a useful tool as are the reports of bed mates.

    The courage to just say no to bad/addictive meds should be encouraged.

  • Frederic Will MD FAPA says:

    The use of Antihistaminic drugs especially in people over 70 tends toward cognitive blunting.

    The use of Ambien like drugs in PTSD is like playing with matches in a magazine. In non PTSD populations we have sleep walking/ eating/ driving, in a VA population we also see serious assaults on the bed partner.

    The off label use of Trazodone for sleep is questionable as is the use of Queitiapine.

    Insomnia is a symptom not a disease. Sleep Hygiene , Melatonin, and CBT-I are treatments of choice.

    Sometimes it is hard to tell patients that they must work at treatment which may take 3 months.

    When patients self D/c Melatonin after a few days or weeks , that is not an adequate trial; as to sleep hygiene , avoiding 3 am video games is a problem. Having an anchor time of 7 or 8 AM is essential and only the patient can self regulate. A sleep diary is a useful tool as are the reports of bed mates.

    The courage to just say no to bad/addictive meds should be encouraged.


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