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...

Signs and symptoms of a stroke, and what to do about them

Article
5/18/2021
Infographic about the sign of a stroke

For Stroke Awareness Month, we highlight some of the most important facts about strokes in men and women.

Recommended Content:

Health Readiness | Traumatic Brain Injury

TRIP initiative bridges the gap between TBI research, clinical care

Article
5/13/2021
a statue of a broken circle

The Defense Intrepid Network launches the TRIP initiative to translate research findings into clinical practice.

Recommended Content:

Traumatic Brain Injury | Brain Injury Awareness Month | Centers of Excellence

NICoE at forefront of traumatic brain injury research and treatment

Article
5/3/2021
Picture of a mask with the American flag on one side and camo on the other side

The National Intrepid Center of Excellence is dedicated to treating and researching TBI injuries with the aim of getting patients back to maximum function.

Recommended Content:

Traumatic Brain Injury Center of Excellence | Traumatic Brain Injury | Centers of Excellence

METC NDT trainees learn about brain disorders & care

Article
4/23/2021
Military health personnel wearing face mask practicing using an EEG

NDTs help diagnose problems with the brain and nervous system, as well as sleep disorders, by use of state-of-the-art digital equipment to record electrical patterns which result in valuable data that the doctor needs to diagnose and treat their patients.

Recommended Content:

Traumatic Brain Injury | Brain Injury Awareness Month

DHA Centers of Excellence collaborate to improve TBI care

Article
3/31/2021
Medical personnel holding a model of the inner ear

The centers of excellence are divisions of the Defense Health Agency Research and Development Directorate.

Recommended Content:

Centers of Excellence | Traumatic Brain Injury | Brain Injury Awareness Toolkit | Brain Injury Awareness Toolkit

DOD warfighter brain health draft plan has six priorities

Article
3/31/2021
Military medical personnel looking at a patient's brain scan

Cognitive testing documentation throughout a service member’s career and beyond is one of six major operational concerns and priorities of service members.

Recommended Content:

Traumatic Brain Injury | Brain Injury Awareness Toolkit | Brain Injury Awareness Toolkit | Brain Injury Awareness Toolkit | Brain Injury Awareness Toolkit

Balancing rest, activity key to recovering from concussion

Article
3/17/2021
Two football teams facing off in the middle of a play

A newly revised suite of tools and resources for military health care providers will help improve the treatment of service members with concussions, and ensure their safe return to full duty.

Recommended Content:

Traumatic Brain Injury | Brain Injury Awareness Month | Brain Injury Awareness Toolkit | Brain Injury Awareness Toolkit

Military researchers gain new insights into brain injuries

Article
3/16/2021
Military personnel sitting at a table collecting data

Blast injury research helps to fill knowledge gaps about brain injury.

Recommended Content:

Brain Injury Awareness Toolkit | Brain Injury Awareness Toolkit | Brain Injury Awareness Toolkit | Traumatic Brain Injury | Brain Injury Awareness Month | Brain Injury Awareness Toolkit | Brain Injury Awareness Toolkit

Army Announces FDA Clearance of Field Deployable TBI Blood Test

Article
3/12/2021
Military personnel standing in the snow preparing to fire a missile

The US Army announced Food & Drug Administration clearance of a field-deployable traumatic brain injury blood test.

Recommended Content:

Traumatic Brain Injury | Brain Injury Awareness Month | Brain Injury Awareness Toolkit | Brain Injury Awareness Toolkit | Brain Injury Awareness Toolkit | Brain Injury Awareness Toolkit | TBI Information | Brain Injury Awareness Toolkit

Distinguishing between TBIs, psychological conditions key to treatment

Article
3/10/2021
Military personnel holding a gun

Expert says long-lasting symptoms may be a sign of another issue.

Recommended Content:

Traumatic Brain Injury Center of Excellence | A Head for the Future | Traumatic Brain Injury | Brain Injury Awareness Month | Brain Injury Awareness Toolkit | Brain Injury Awareness Toolkit | Brain Injury Awareness Toolkit | TBI and Total Force Fitness

New NICoE director sets an ambitious agenda for the future

Article
3/8/2021
Military personnel wearing face mask while talking to each other

The accomplished new leader of the NICoE and Intrepid Spirit Center network has plans for increased services and a higher profile for the unique care center.

Recommended Content:

Traumatic Brain Injury | Brain Injury Awareness Month | TBI Education and Training Events | Brain Injury Awareness Toolkit | Brain Injury Awareness Toolkit | Centers of Excellence

Updated tools and training improve TBI and concussion recovery

Article
3/3/2021
A group of military personnel wearing face mask working on laptop computers

Up-to-date clinical tools help diagnose and manage TBI on and off the battlefield.

Recommended Content:

Traumatic Brain Injury | Traumatic Brain Injury Center of Excellence | TBICoE Podcasts | Brain Injury Awareness Toolkit | Brain Injury Awareness Toolkit | Brain Injury Awareness Month | Brain Injury Awareness Toolkit | Brain Injury Awareness Toolkit

March is Brain Injury Awareness Month; TBICoE’s mission lasts all year

Article
3/2/2021
Military health personnel performing a balance test on a patient

Staying a-head of TBI

Recommended Content:

Traumatic Brain Injury Center of Excellence | Brain Injury Awareness Toolkit | A Head for the Future | Brain Injury Awareness Toolkit | Traumatic Brain Injury | Brain Injury Awareness Month | Brain Injury Awareness Toolkit | Brain Injury Awareness Toolkit | Centers of Excellence

Caregivers share their stories of support for TBI recovery

Article
11/23/2020
Group of people walking and on wheelchairs through the forest

"Recovery is possible to help lead a normal life."

Recommended Content:

Warrior Care Toolkit | Warrior Care Toolkit | Warrior Care Toolkit | Traumatic Brain Injury | Warrior Care Toolkit

NICoE & ISC Network maintain TBI care during COVID-19

Article
11/19/2020
Image of United States map with locations noted

The Network leveraged their geographic distribution to help each other quickly adapt to changing times.

Recommended Content:

Coronavirus | Traumatic Brain Injury | Centers of Excellence
<< < 1 2 3 > >> 
Showing results 1 - 15 Page 1 of 3

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.