Back to Top Skip to main content

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...

DVBIC study focuses on concussion-related headaches

Article
9/17/2020
Soldier (center) standing at attention receives an award pinned to their uniform, from a soldier standing directly before her, with a soldier standing at attention to one side. A long building is seen in the background with two flagpoles, one flying the US flag.

Service members with concussion-related headaches experience more frequent and severe pain compared to those with headaches unrelated to this condition.

Recommended Content:

Traumatic Brain Injury | September Toolkit

Air Force opens Intrepid Spirit Center at Eglin AFB

Article
9/15/2020
Soldiers holding a long ribbon and cutting it

The EISC...recognizes the need for a medical facility dedicated to invisible wounds.

Recommended Content:

Posttraumatic Stress Disorder | Traumatic Brain Injury

Head Check: Know Your Helmet, Bicycle and Motorcycle

Fact Sheet
8/6/2020

A Head for the Future aims to raise awareness about TBI among service members, veterans and their families. This fact sheet provides tips for choosing the right helmet for the right ride, with information about different safety features in helmets for bicycling and riding motorcycles.

Recommended Content:

Traumatic Brain Injury | TBI Prevention | TBI Symptoms | TBI Resources

AHFTF Ride Right Fact Sheet

Fact Sheet
8/6/2020

This bicycle safety fact sheet provides tips to protect your head and help prevent TBI while riding a bike. It also includes the signs and symptoms of TBI, and how to get help if you think you sustained a brain injury.

Recommended Content:

Traumatic Brain Injury | TBI Prevention | TBI Resources

Head Check: Know Your Helmet, Football and Baseball

Fact Sheet
8/6/2020

A Head for the Future aims to raise awareness about TBI among service members, veterans and their families. This fact sheet provides tips for choosing the right helmet for the right sport, with information about different safety features in helmets for football and baseball.

Recommended Content:

Traumatic Brain Injury | TBI Prevention | TBI Resources

Cruise with Control

Fact Sheet
8/6/2020

One of the leading causes of military traumatic brain injury is motor vehicle crashes. This fact sheet provides tips on how to stay safe on motorcycles to help prevent TBI while riding. It also includes the signs and symptoms of TBI, and how to get help if you think you sustained a brain injury.

Recommended Content:

Traumatic Brain Injury | TBI Prevention | TBI Resources

Head Check: Know Your Helmet, Winter Sports

Fact Sheet
8/6/2020

A Head for the Future aims to raise awareness about TBI among service members, veterans and their families. This fact sheet provides tips for choosing the right helmet for the right sport, with information about different safety features in helmets for skiing, snowboarding and snowmobiling.

Recommended Content:

Traumatic Brain Injury | TBI Prevention | TBI Resources

Respect the Road

Fact Sheet
8/6/2020

One of the leading causes of military traumatic brain injury is motor vehicle crashes. This car safety fact sheet provides tips to help prevent TBI while driving a motor vehicle and safety measures to take to keep passengers safe. It also includes the signs and symptoms of TBI, and how to get help if you think you sustained a brain injury.

Recommended Content:

Traumatic Brain Injury | TBI Prevention | TBI Resources

TBI Hot Topics Bulletin February 2020

Publication
8/4/2020

Are you a busy health care provider? Not enough time to keep up with research? Stay informed with the TBI Hot Topics Bulletin. We track the latest TBI scientific studies, advances, and discoveries most relevant to health care providers. This issue covers the fourth quarter of calendar year 2019.

Recommended Content:

Traumatic Brain Injury | TBI Resources | Research and Innovation

TBI Hot Topics Bulletin May 2020

Publication
8/4/2020

Are you a busy health care provider? Not enough time to keep up with research? Stay informed with the TBI Hot Topics Bulletin. We track the latest TBI scientific studies, advances, and discoveries most relevant to health care providers. This issue covers the first quarter of calendar year 2020.

Recommended Content:

Traumatic Brain Injury | TBI Resources | Research and Innovation

TBI Hot Topics Bulletin September 2020

Publication
8/4/2020

Are you a busy health care provider? Not enough time to keep up with research? Stay informed with the TBI Hot Topics Bulletin. We track the latest TBI scientific studies, advances, and discoveries most relevant to health care providers. This issue covers the second quarter of calendar year 2020.

Recommended Content:

Traumatic Brain Injury | TBI Resources

Neck Pain Following Concussion/mTBI Fact Sheet

Fact Sheet
7/30/2020

Neck pain can occur together with headaches following a concussion. This fact sheet provides information to help patients manage neck pain. Various techniques are explained, including the use of heat or cold therapy, neck stretches, proper sleep positions and common activities that may contribute to neck strain.

Recommended Content:

Traumatic Brain Injury

Leader Policy Guidance for Mild TBI/Concussion in the Deployed Setting Fact Sheet

Fact Sheet
7/30/2020

This document describes the line leader responsibilities for the Department of Defense (DoD) mandated policy, DoD Instruction 6490.11, “DoD Policy Guidance for the Management of Mild Traumatic Brain Injury/Concussion in the Deployed Setting,” that applies to all service members involved in potentially concussive events in deployed settings.

Recommended Content:

Traumatic Brain Injury | TBI Prevention | TBI Screening | TBI Symptoms | TBI Resources

Healthy Sleep Following Concussion/mTBI Fact Sheet

Fact Sheet
7/30/2020

Getting restful sleep is one of the most important things you can do for your health, and it often takes thoughtful preparation during the day. This fact sheet offers service members and veterans who experience sleep disturbances with healthy sleep tips that can likely improve their sleep.

Recommended Content:

Traumatic Brain Injury | TBI Symptoms | TBI Resources | TBI Prevention

Headaches Following Concussion/mTBI Fact Sheet

Fact Sheet
7/30/2020

Although each headache is different, identifying common causes, or triggers, is important for health care providers and patients to determine appropriate treatment. This fact sheet provides non-drug options to help those diagnosed with a mild TBI and associated post-traumatic headache (PTH) manage symptoms.

Recommended Content:

Traumatic Brain Injury | TBI Symptoms | TBI Resources
<< < 1 2 3 4 5  ... > >> 
Showing results 1 - 15 Page 1 of 8

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.