{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T17:48:24Z","timestamp":1772560104081,"version":"3.50.1"},"reference-count":34,"publisher":"Oxford University Press (OUP)","issue":"5-6","funder":[{"name":"Joint Warfighter Medical Research Program FY21","award":["JW210372"],"award-info":[{"award-number":["JW210372"]}]},{"name":"Joint Warfighter Medical Research Program FY21","award":["JW210372"],"award-info":[{"award-number":["JW210372"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,5,18]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Insomnia affects approximately 40% of active duty service members and adversely affects health, readiness, and safety. The VA\/DoD Clinical Practice Guideline for the management of insomnia recommends cognitive-behavioral treatment of insomnia (CBTI) or its abbreviated version (brief behavioral treatment of insomnia [BBTI]) as the first-line insomnia treatment. The goal of this study was to assess CBTI\/BBTI resources at MTFs, perceived facilitators and barriers for CBTI\/BBTI, and gaps in these treatments across the Defense Health Agency.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and Methods<\/jats:title>\n                  <jats:p>Between July and October 2022, we conducted an electronic survey of CBTI\/BBTI resources across Contiguous United States and the District of Columbia (CONUS) and Outside Continental United States (OCONUS) MTFs. The survey was distributed to 154 military sleep health care providers from 32 MTFs, and a link to the survey was posted on two online military sleep medicine discussion forums. Fifteen providers from 12 MTFs volunteered to complete a 30-minute qualitative interview to explore their perception of barriers and facilitators of CBTI\/BBTI at their facility.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Fifty-two of 154 providers (33.8%) at 20 MTFs completed the survey. A majority of providers indicated that hypnotics remain the most common treatment for insomnia at their facility. Sixty-eight percent reported that CBTI\/BBTI was available at their facility and estimated that less than 50% of the patients diagnosed with insomnia receive CBTI\/BBTI. The main facilitators were dedicated, trained CBTI\/BBTI providers and leadership support. Referrals to the off-post civilian network and self-help apps were not perceived as significant facilitators for augmenting insomnia care capabilities. The primary barriers to offering CBTI\/BBTI were under-resourced clinics to meet the high volume of patients presenting with insomnia and scheduling and workflow limitations that impede repeated treatment appointments over the period prescribed by CBTI\/BBTI protocols. Four primary themes emerged from qualitative interviews: (1) CBTI\/BBTI groups can scale access to insomnia care, but patient engagement and clinical outcomes are perceived as inferior to individual treatment; (2) embedding trained providers in primary or behavioral health care could accelerate access, before escalation and referral to a sleep clinic; (3) few providers have the time to adhere to traditional CBTI protocols, and appointment scheduling often does not support weekly or bi-weekly treatment visits; and (4) the absence of quality and\/or continuity of care measures dampens providers\u2019 enthusiasm for using external referral resources or self-help apps.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Although there is a wide recognition that CBTI\/BBTI is the first-line recommended insomnia treatment, the limited scalability of treatment protocols, clinical workflow limitations, and scarcity of trained CBTI\/BBTI providers limit the implementation of the VA\/DoD clinical guideline. Educating and engaging health care providers and leadership about CBTI, augmenting CBTI-dedicated resources, and adapting clinical workflows were identified as specific strategies needed to meet the current insomnia care needs of service members. Developing protocols for scaling the availability of CBTI expertise at diverse points of care, upstream from the sleep clinics, could accelerate access to care. Establishing standardized quality measures and processes across points of care, including for external providers and self-help apps, would enhance providers\u2019 confidence in the quality of insomnia care offered to service members.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/milmed\/usad409","type":"journal-article","created":{"date-parts":[[2023,10,21]],"date-time":"2023-10-21T18:25:43Z","timestamp":1697912743000},"page":"e1089-e1097","source":"Crossref","is-referenced-by-count":4,"title":["Survey of\u00a0Resources in\u00a0Behavioral Sleep Medicine Across the Department of\u00a0Defense, Defense Health Agency"],"prefix":"10.1093","volume":"189","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6672-4800","authenticated-orcid":false,"given":"Anne","family":"Germain","sequence":"first","affiliation":[{"name":"NOCTEM, LLC , Pittsburgh, PA 15213,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Megan","family":"Wolfson","sequence":"additional","affiliation":[{"name":"NOCTEM, LLC , Pittsburgh, PA 15213,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brittany","family":"Klenczar","sequence":"additional","affiliation":[{"name":"University of Nevada, Las Vegas, Nevada, School of Public Health , Las Vegas, NV 89119,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew S","family":"Brock","sequence":"additional","affiliation":[{"name":"Department of Sleep Medicine, Wilford Hall Ambulatory Surgical Center , Joint Base San Antonio-Lackland, TX 78236,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hunter","family":"Hearn","sequence":"additional","affiliation":[{"name":"Carl R. Darnall Army Medical Center, Sleep Disorder Center , Fort Hood, TX 76544,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian","family":"O\u2019Reilly","sequence":"additional","affiliation":[{"name":"Madigan Army Medical Center , Joint Base Lewis-McChord, WA 98431,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Blue Star","sequence":"additional","affiliation":[{"name":"Hanscom Air Force Base , Bedford, MA 01730,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vincent","family":"Mysliwiec","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at San Antonio , San Antonio, TX 78229,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2023,10,20]]},"reference":[{"issue":"5","key":"2025012315141017600_R1","doi-asserted-by":"publisher","first-page":"1111","DOI":"10.5665\/sleep.5766","article-title":"Sleep and\u00a0health resilience metrics in\u00a0a large military cohort","volume":"39","author":"Seelig","year":"2016","journal-title":"Sleep"},{"issue":"10","key":"2025012315141017600_R2","doi-asserted-by":"publisher","first-page":"759","DOI":"10.7205\/MILMED-D-10-00193","article-title":"Insomnia is the most commonly reported symptom and\u00a0predicts other symptoms of\u00a0post-traumatic stress disorder in\u00a0U.S. service members returning from military deployments","volume":"175","author":"McLay","year":"2010","journal-title":"Mil Med"},{"key":"2025012315141017600_R3","article-title":"January 2000-December 2009. 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