SAN DIEGO — Sleep researchers at the VA have sent out a distress signal about the high rates of insomnia disorder in younger veterans.
An article in the journal Sleep called those rates “alarmingly high” and advised that the issue “requires increased attention and direct treatment, especially in the context of co-occurring disorders.”1
VA San Diego Healthcare System led researchers pointed out that post-9/11 veterans are particularly vulnerable to insomnia disorder, adding, “Having accurate prevalence rates of insomnia disorder in this relatively young, diverse population, is vital to determine the resources needed to identify and treat insomnia disorder. However, there are no accurate prevalence rates for insomnia disorder in post-9/11 veterans enrolling in the VA Healthcare System (VHA).”
Veterans in general are especially vulnerable to insomnia, with rates double and even triple those of civilian populations, according to background information in the article. Reasons include irregularity of their sleep/wake schedules during active duty, harsh living conditions, combat stress, higher rates of physical and psychological injury and issues associated with post-deployment reintegration.
Furthermore, the authors predict that insomnia disorder among VHA beneficiaries is only expected to continue rising as post-9/11 troops leave military service and begin accessing VHA healthcare. “Having accurate prevalence rates of insomnia disorder in this relatively young, diverse set of veterans, along with a better understanding of the demographic and clinical correlates, is vital for VHA to determine the resources needed to identify and treat insomnia disorder using evidence-based care. Unfortunately, there are no accurate prevalence rates of insomnia disorder in post-9/11 veterans seeking services,” they add.
To remedy that, the group sought to present accurate prevalence of insomnia disorder, and correlates in a large sample of post-9/11 veterans enrolling in VHA care.
An observational study was conducted of 5,552 post-9/11 veterans newly enrolling for VHA care. Data were collected using VA eScreening, with insomnia diagnosis determined using a clinical cutoff score of ≥ 11 on the Insomnia Severity Index. Other measures undertaken were sociodemographic, service history, posttraumatic stress disorder (PTSD), depression, suicidal ideation, alcohol misuse, military sexual trauma, traumatic brain injury (TBI) and pain intensity.
Results indicated that about 57.2% of the sample population had insomnia disorder. Chronic insomnia disorder is a behavioral sleep disorder characterized as dissatisfaction with sleep quantity or quality, marked by complaints of difficulty falling or staying asleep, waking up earlier than desired and significant sleep-related daytime impairment. Complicating the problem, according to the study, is that insomnia is linked to reduced quality of life, increased risk for morbidity, premature mortality and higher rates of healthcare utilization. It also causes impaired functioning and has a societal cost of $100 billion a year, according to the study team.
“Our sample was nationally representative for age, sex, ethnicity, branch of the military, and race,” researchers emphasized. “The sample also was at high-risk for a host of clinical disorders, including PTSD, TBI, and pain; all of which showed higher rates of insomnia disorder (93.3%, 77.7%, and 69.6%, respectively).”
Calling their findings the most accurate available, the authors added, “Examining and treating insomnia disorder, especially in the context of co-occurring disorders (e.g. PTSD), will be a necessity in the future.”
- Colvonen PJ, Almklov E, Tripp JC, Ulmer CS, Pittman JOE, Afari N. Prevalence rates and correlates of insomnia disorder in post-9/11 veterans enrolling in VA healthcare. Sleep. 2020 Dec 14;43(12):zsaa119. doi: 10.1093/sleep/zsaa119. PMID: 32529231.