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NEUROLOGY &
SLEEP DISORDERS

The Problem with

Research in Military City USA

Addresses a High Priority

in Military Medicine

By Alan L. Peterson, PhD, ABPP

leep is a biological requirement that is crucial for of insomnia, most have been developed to treat acute insomnia,
S maintaining physical and psychological health and re- and their long-term efficacy is limited. An additional problem is that

siliency (Young-McCaughan et al., 2011). Sleep depri-
sleep medications can cause side effects such as grogginess, slowed
vation is a major factor related to occupational injuries cognitive processing, and slowed reaction time, which are dangerous
and transportation accidents (Uehli et al., 2014). The Sleep Re- for military personnel, particularly in deployed settings.
search Society and American Academy of Sleep Medicine task A number of studies have been conducted to evaluate the indi-
force (Zee et al., 2014) highlighted the health burden caused by vidual and combined efficacy of pharmacological and cognitive-
chronic sleep disorders and the potential for sleep-focused ther- behavioral treatment for insomnia (CBT-I). CBT-I is designed to
apy to reduce morbidity, mortality, and healthcare costs and im- treat the underlying causes of insomnia by helping individuals iden-
prove quality of life and public safety. tify thoughts and behaviors that cause or contribute to sleep prob-
When people think of sleep problems, they typically think of in- lems and replace them with practices that promote sound sleep.
somnia, which is one of the most common sleep problems seen in Results have generally shown that both medications and CBT-I
most health care settings. The prevalence of insomnia has been es- treatments are equally effective over the short term. However,
timated at about 30 percent in the general population (Roth, 2007). CBT-I has been found to result in better long-term improvements
It is even higher in certain populations such as those with chronic in sleep for those with chronic insomnia (Beaulieu-Bonneau, Ivers,
health conditions (e.g., chronic pain, obesity) and in military per- Guay, & Morin, 2017).
sonnel and veterans who have deployed in support of military op- Much of my professional career as a clinical health psychologist
erations (Peterson et al., 2008; Pruiksma & Peterson, 2018; has focused on sleep disorders. My earliest work in this area was in
Pruiksma, Taylor, & Peterson, 2015; Taylor et al., 2016). In fact, it the late 1980s while I was a resident and fellow in clinical health
is the most commonly reported problem among our troops return- psychology at Wilford Hall Medical Center in San Antonio. After
ing from deployment. several permanent-change-of-station assignments with the Air
Insomnia is generally defined as difficulty falling asleep or staying Force, I returned to Wilford Hall in 1997 to serve as the director
asleep or nonrestorative sleep. These sleep problems persist despite of the Clinical Health Psychology postdoctoral fellowship program.
having an adequate opportunity and circumstance to sleep. Insom- Because of the significant psychological factors related to sleep dis-
nia is associated with daytime impairment or distress, it occurs at orders, the Sleep Medicine and Clinical Health Psychology programs
least three times per week, and it has been a problem for at least at Wilford Hall established a close collaborative clinical, teaching,
one month. and research partnership.
Although a number of medications are effective for the treatment One of our first studies at Wilford Hall focused on delivering

12 San Antonio Medicine • August 2018