Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Aug 15;13(8):991-999.
doi: 10.5664/jcsm.6702.

Veterans Affairs Primary Care Provider Perceptions of Insomnia Treatment

Christi S Ulmer  1   2 , Hayden B Bosworth  1   3 , Jean C Beckham  2   4 , Anne Germain  5 , Amy S Jeffreys  1 , David Edelman  1   6 , Stephanie Macy  1 , Angela Kirby  4 , Corrine I Voils  7   8
Affiliations

Veterans Affairs Primary Care Provider Perceptions of Insomnia Treatment

Christi S Ulmer et al. J Clin Sleep Med. .

Abstract

Study objectives: Insomnia is a widespread issue among United States adults and rates of insomnia among veterans are even higher than the general population. Prior research examining primary care provider (PCP) perspectives on insomnia treatment found that: sleep hygiene and pharmacotherapy are the primary treatments offered; PCPs tend to focus on perceived causes of insomnia rather than the insomnia itself; and neither patients nor providers are satisfied with insomnia treatment options. Although insomnia complaints are typically first reported to primary care providers, little research has focused on perspectives regarding insomnia treatment among PCPs working in the largest integrated health care system in the United States-the Veterans Affairs (VA) health care system. This study was conducted to examine VA PCP perceptions of the availability of insomnia treatments, identify specific strategies offered by PCPs, and examine perceptions regarding the importance of treating insomnia and the role of comorbid conditions.

Methods: A survey was conducted within the VA health care system. Primary care providers completed surveys electronically.

Results: A high percentage of veterans (modal response = 20% to 39%) seen in VA primary care settings report an insomnia complaint to their provider. Almost 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 (ie, avoid stimulants before bedtime [84.3%], and keep the bedroom environment quiet and dark and comfortable [68.6%]) and many are uncertain if cognitive behavioral therapy for insomnia is available at their facility (43.1%).

Conclusions: 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.

Commentary: A commentary on this article appears in this issue on page 937.

Keywords: insomnia; primary care; provider perspectives.

PubMed Disclaimer

Comment in

References

    1. Ohayon MM. Prevalence of DSM-IV diagnostic criteria of insomnia: distinguishing insomnia related to mental disorders from sleep disorders. J Psychiatr Res. 1997;31(3):333–346. - PubMed
    1. Ohayon MM, Reynolds CF. Epidemiological and clinical relevance of insomnia diagnosis algorithms according to the DSM-IV and the International Classification of Sleep Disorders (ICSD) Sleep Med. 2009;10(9):952–960. - PMC - PubMed
    1. Roth T, Coulouvrat C, Hajak G, et al. Prevalence and perceived health associated with insomnia based on DSM-IV-TR; International Statistical Classification of Diseases and Related Health Problems, Tenth Revision; and Research Diagnostic Criteria/International Classification of Sleep Disorders, Second Edition criteria: results from the America Insomnia Survey. Biol Psychiatry. 2011;69(6):592–600. - PubMed
    1. Troxel WM, Shih RA, Pedersen ER, et al. Sleep in the Military: Promoting Healthy Sleep Among U.S. Servicemembers. Santa Monica, CA: RAND Corporation; 2015. - PMC - PubMed
    1. Jenkins MM, Colvonen PJ, Norman SB, Afari N, Allard CB, Drummond SP. Prevalence and mental health correlates of insomnia in first-encounter veterans with and without military sexual trauma. Sleep. 2015;38(10):1547–1554. - PMC - PubMed

MeSH terms

Substances