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Experts: Use behavioral therapy before meds for sleep issues

Jul. 17, 2014 - 06:00AM   |  
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Doctors and experts at the Defense and Veterans Brain Injury Center want health care providers to try treating sleep disorders caused by traumatic brain injury with some common sense such as a quiet bedroom and staying away from coffee or energy drinks at bedtime.

The recommendations mark a shift away from relying solely on medication.

In a briefing Wednesday, Dr. Therese West recommended that health care providers first offer behavioral therapy before prescribing sedatives, antihistamines or benzodiazepines to troops and veterans. West is a subject matter expert at the Defense and Veterans Brain Injury Center.

”We want to make sure that providers are implementing the first line treatments of the stimulus control and sleep hygiene prior to medication,” West said.

Stimulus control includes removing electronics from the bedroom and creating a proper sleep environment. Sleep hygiene practices include avoiding caffeine and exercising regularly.

According to the DVBIC, more than 300,000 service members have endured traumatic brain injuries since 2000. Sleep disorders are their second most frequent complaint after headaches, West said.

Recommendations made public Wednesday were the result of research conducted by military personnel, civilians, and academic experts after frequent complaints by service members about sleep disturbances.

Capt. Cynthia Spells, the DVBIC’s director of clinical affairs, works closely with service members and veterans to identify critical health issues and develop solutions.

At Fort Stewart, Georgia — Spells’ previous post before her arrival at the DVBIC — she said, troops were returning with injuries such as mild traumatic brain injury and continuing to exhibit symptoms. They were “not the same” as they were before their concussions, Spells said.

Research shows improper sleep could exacerbate TBI symptoms and prevent proper rehabilitation, she added.

The common-sense recommendations made in the DVBIC’s clinical guidelines to treat sleep disturbances are not exclusively for service members and military health providers. Spells said the guidance can be used in the medical community to treat anyone with sleep complaints.

“All of us tend to take sleep for granted and how important it really is to our day-to-day functioning and our productivity until we don’t have access to it, or not enough,” Spells said.

The DVBIC plans to collaborate with the military as well as the U.S. Surgeon General’s office to incorporate the recommendations into the broader health care system.

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