Back to Top Skip to main content Skip to sub-navigation

DVBIC collaboration leads to improved sleep recommendations

Airman sleeping on floor of plane A U.S. Air Force Airman sleeps inside a C-17 Globemaster III during a flight over an undisclosed location in support of Operation Freedom Sentinel, Jan. 22, 2018. (U.S. Air Force photo by Staff Sgt. Jordan Castelan)

Recommended Content:

Sleep | Traumatic Brain Injury

Newly released guidelines from the Defense and Veterans Brain Injury Center will help health care providers manage sleep disturbances among service members and veterans diagnosed with concussion, and should provide measures that could improve the health and readiness of U.S. forces.

The expanded recommendations identify additional sleep disturbances through a streamlined process of diagnosis and management; and provide medication dosing and specialty referral recommendations, when appropriate. DVBIC is a division of the Defense Health Agency Research and Development Directorate, and is the Defense Department’s center of excellence for traumatic brain injury.

“Our recommendations are developed with the primary care provider in mind,” said Gary McKinney, DVBIC’s section chief for clinical practice and clinical recommendations. “One goal is assisting with making treatment and specialty referral decisions.”

Sleep disturbances are a widely reported symptom among service members and veterans diagnosed with concussion, also known as mild traumatic brain injury. Nearly 12 percent of service members were diagnosed with at least one sleep disorder in 2018, the latest figures available from the DoD Health of the Force. The most commonly diagnosed sleep disorders were sleep apnea and insomnia.

In October 2019, the Defense Department and the Department of Veterans Affairs released a clinical practice guideline on the management of chronic insomnia disorder and obstructive sleep apnea, which noted the high prevalence of sleep disorders in active-duty service members and veterans. In addition, a study by the VA San Diego Health Care system found more than half of the veterans seeking treatment at that VA had insomnia symptoms.

At a recent TBI symposium at the National Institutes of Health, University of Maryland School of Medicine clinical psychology professor and sleep disorder specialist Emerson Wickwire explained that conditions following a TBI such as headaches, dizziness and poor balance can be affected by sleep disturbances and “if providers knew more about sleep, it would have a huge impact on TBI care.” Wickwire served as a member of DVBIC’s expert working group that developed the clinical recommendations.

Twenty four experts in sleep medicine, neurology, psychiatry, psychology, and pharmacology participated in the working group that developed the updated clinical recommendation. Experts represented the Army, Air Force and Navy, the Uniformed Service University of the Health Sciences, the Department of Veterans Affairs, and the civilian sector including the University of Maryland. The clinical recommendations align with the DoD/VA clinical practice guideline.

Practice guidelines have multiple advantages for the practitioners. “They sort of standardize the care…so everybody, if they are following the guidelines, they are generally doing the same thing for the same sort of situation,” said Army Col. (Dr.) Brian Robertson, the chief of sleep medicine service at Walter Reed National Military Medical Center. Because those who design guidelines have both clinical experience and knowledge of the scientific literature, “a lot of that work on deciding what to do has already been done for you. That makes life a lot easier for [the] clinician. That’s the goal.”

“Medical students get a one-hour lecture on sleep for their entire medical training,” said Risa Nakase-Richardson, a neuropsychologist and scientific research director at the Tampa DVBIC-VA site. Because of that, “the CR will provide an outstanding reference tool for sleep for primary care physicians to help evaluate and make clinical decisions about managing sleep for persons with TBI.”

Known as the “Management of Sleep Disturbances Following Concussion/Mild Traumatic Brain Injury: Guidance for Primary Care Management in Deployed and Non-Deployed Settings,” the recommendations are tailored to assist practitioners managing sleep and concussion in the primary care setting. To inform appropriate clinical interventions, it includes screening questions, guidance on potentially emergent symptoms, diagnostic criteria, and recommended evaluations.

Like its 2014 predecessor, the new recommendations cover insomnia, obstructive sleep apnea, and irregular sleep-wake patterns. They also address excessive daytime sleepiness, insufficient sleep syndrome, restless legs syndrome, and other unusual events during sleep, such as nightmares and sleepwalking.

DVBIC staff have also developed a suite of patient and provider focused tools in support of these new guidelines. A fact sheet helps patients learn about healthy sleep practices and offers tips on how to limit sleep disturbances and use relaxation strategies to combat insomnia. Healthy sleep practices include limiting screen time, cutting back on caffeine and alcohol before bedtime, and making a comfortable bedroom environment where activity is limited to sleep and intimacy.

The updated recommendations are available online from the DVBIC website.

You also may be interested in...

2000-Q32021 DOD Worldwide Numbers for TBI

Publication
1/20/2022

TBICoE is the Defense Department’s office of responsibility for tracking traumatic brain injury data in the U.S. military. Here you’ll find data on the number of active-duty service members—anywhere U.S. forces are located—with a first-time TBI diagnosis from calendar year 2000 through the third quarter of 2021. The data is also broken down by each branch of the armed services.

Recommended Content:

Traumatic Brain Injury | Worldwide TBI Numbers | Traumatic Brain Injury Center of Excellence | Provider Resources | Patient and Family Resources

2021 Q3 DOD Worldwide Numbers for TBI

Publication
1/20/2022

TBICoE is the Defense Department’s office of responsibility for tracking traumatic brain injury data in the U.S. military. Here you’ll find data on the number of active-duty service members—anywhere U.S. forces are located—with a first-time TBI diagnosis in the third quarter of calendar year 2021. The data is also broken down by each branch of the armed services.

Recommended Content:

Traumatic Brain Injury | Traumatic Brain Injury Center of Excellence | Worldwide TBI Numbers | Provider Resources | Patient and Family Resources

Dream EZ App

Fact Sheet
1/19/2022

Dream EZ uses principles from Imagery Rehearsal Therapy (IRT) for nightmare reduction to help users control their nightmares by making them diminish in intensity and frequency. These techniques help users get a better night’s sleep.

Recommended Content:

Solution Delivery Division | Sleep

Six Immediate Health Benefits You Will See If You Lose a Little Weight

Article
1/14/2022
A soldier assigned to the 256th Combat Support Hospital, Twinsburg, Ohio, drinks water from a gallon-sized jug during Combat Support Training Exercise 18-03 at Fort McCoy, Wisconsin, March 26, 2018. The 256th CSH implemented a goal setting competition, dubbed Dandy Camp, to teach and encourage soldiers to monitor their total carbohydrate intake during the field exercise. The overall goal of Dandy Camp is to educate soldiers about healthy eating choices and encourage soldiers to set and meet goals for themselves.

Losing even a little weight now can have a major impact on your health and quality of life. This long list of benefits might help motivate you to adjust your habits to achieve a happier, healthier lifestyle.

Recommended Content:

Physical Fitness | Women's Health | Heart Health | Nutritional Fitness | Psychological Fitness | Sleep

Optimizing sleep as a Soldier: The science, challenges and significance

Article Around MHS
1/13/2022
Military personnel during a doctors appointment

Sustained mental health is critical to establishing and maintaining a medically ready force, and sleep can play a part in protecting that readiness. 

Recommended Content:

Sleep

Tackling Concussions: NCAA-DOD CARE Consortium Battles Brain Injuries

Article
1/6/2022
Naval Academy football team runs onto the field

Dr. Paul Pasquina and Dr. Terry Rauch recently discussed the NCAA-DOD Concussion Assessment, Research and Education (CARE) Consortium, the largest concussion and repetitive head impact study in history, on the NCAA’s “Social Series.”

Recommended Content:

Uniformed Services University of the Health Sciences | Traumatic Brain Injury | Medical Research and Development

Dizziness and Visual Problems After Concussion

Infographic
1/4/2022
Graphic containing general information on dizziness and vision  problems after a traumatic brain injury. Visit health.mil/TBIFactSheets and download related fact sheets for information.

More than 80% of all concussions—also known as a mild traumatic brain injury— in the military are considered mild. Dizziness and visual problems are among the most common symptoms after concussion and often resolve within days or weeks. This infographic reviews common signs and symptoms to look out for.

Recommended Content:

Traumatic Brain Injury Center of Excellence | Traumatic Brain Injury | Patient and Family Resources

Eight Tips to Get Better, More Restful Sleep

Article
1/3/2022
Being deployed may not always make it possible for service members to get proper sleep, but experts recommend they try to adopt healthy sleep practices as much as possible, such as using their bed or cot only for sleeping.

Insomnia is a common sleep disorder characterized by difficulty falling asleep, staying asleep, or sleeping continuously through the night. It can result in lack of energy and result in disease, injury, or disability if not treated. Behavioral therapies are designed to help adopt proper sleep behaviors.

Recommended Content:

Sleep

TBI Hot Topics Bulletin, December 2021 Edition

Publication
12/8/2021

The TBI Hot Topics Bulletin is a product of the TBICoE research branch and provides a quarterly summary of TBI research relevant to health care providers. This issue covers research published July through September 2021.

Recommended Content:

Traumatic Brain Injury Center of Excellence | Traumatic Brain Injury

2021 Q2 DOD Worldwide Numbers for TBI

Publication
10/14/2021

TBICoE is the Defense Department’s office of responsibility for tracking traumatic brain injury data in the U.S. military. Here you’ll find data on the number of active-duty service members—anywhere U.S. forces are located—with a first-time TBI diagnosis in the second quarter of calendar year 2021. The data is also broken down by each branch of the armed services.

Recommended Content:

Traumatic Brain Injury Center of Excellence | DOD TBI Worldwide Numbers | Traumatic Brain Injury

2000-Q2 2021 DOD Worldwide Numbers for TBI

Publication
10/14/2021

TBICoE is the Defense Department’s office of responsibility for tracking traumatic brain injury data in the U.S. military. Here you’ll find data on the number of active-duty service members—anywhere U.S. forces are located—with a first-time TBI diagnosis from calendar year 2000 through the second quarter of 2021. The data is also broken down by each branch of the armed services.

Recommended Content:

Traumatic Brain Injury Center of Excellence | DOD TBI Worldwide Numbers | Centers of Excellence | Traumatic Brain Injury

USU Co-leads Largest NCAA-DOD Concussion Study in History

Article
10/8/2021
A doctor looks at a patient's prosthetic arm.

The Uniformed Service University will co-lead the next phase of the largest concussion and repetitive head impact study.

Recommended Content:

Traumatic Brain Injury

Back from the Brink: One Marine's Recovery from Suicidal Thoughts

Article
9/29/2021
Portrait photo of John Peck

After suffering a TBI in Iraq and losing all four limbs in Afghanistan, Marine Sgt. John Peck talks about his own experience and the differences in the ways in which individuals deal with traumatic life events.

Recommended Content:

Traumatic Brain Injury | Suicide Prevention | Talking About Afghanistan

Concussion Linked to Depression, Anxiety and PTSD, Studies Show

Article
9/28/2021
Picture of blast waves during an explosion

A clear link between blast-related concussions and mental health symptoms like depression, anxiety, and PTSD, is shown in a series of recent studies.

Recommended Content:

Traumatic Brain Injury

NICoE, NHRC Team Up To Make CAREN Technology Portable

Article
8/12/2021
A person walks in front of a large virtual reality screen.

Head-mounted display technology has become more affordable and accessible

Recommended Content:

Traumatic Brain Injury | Traumatic Brain Injury Center of Excellence
<< < 1 2 3 4 5  ... > >> 
Showing results 1 - 15 Page 1 of 16

DHA Address: 7700 Arlington Boulevard | Suite 5101 | Falls Church, VA | 22042-5101

Some documents are presented in Portable Document Format (PDF). A PDF reader is required for viewing. Download a PDF Reader or learn more about PDFs.