Insomnia and Insomnia-Related Care in the Department of Veterans Affairs: An Electronic Health Record Analysis

• Published in: International journal of environmental research and public health Vol. 18; no. 16; p. 8573
• Main Authors: Bramoweth, Adam D, Tighe, Caitlan A, Berlin, Gregory S
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 13.08.2021; MDPI
• Subjects: Clinical medicine; Codes; Cognitive Behavioral Therapy; Comorbidity; Drug use; Electronic Health Records; Electronic medical records; Humans; Indicators; Insomnia; Mental disorders; Mental health; Military service; Psychotherapy; Retrospective Studies; Sleep; Sleep disorders; Sleep Initiation and Maintenance Disorders - epidemiology; Sleep Initiation and Maintenance Disorders - therapy; Sociodemographics; Substance abuse treatment; United States - epidemiology; Variables; Veterans; United States; United States > US; sedatives and hypnotics; veterans; cognitive behavioral therapy for insomnia; veterans affairs; insomnia
• ISSN: 1660-4601; 1661-7827; 1660-4601
• DOI: 10.3390/ijerph18168573

The objective was to examine insomnia and insomnia-related care within a regional network of Department of Veterans Affairs (VA) facilities since the VA roll-out of cognitive behavioral therapy for insomnia (CBT-I) in 2011. A retrospective analysis of VA electronic health records (EHR) data from 2011 to 2019 was conducted. The annual and overall prevalence of four insomnia indicators was measured: diagnoses, medications, consultations for assessment/treatment, and participation in CBT-I. Also examined were sociodemographic and clinical differences among veterans with and without an insomnia indicator, as well as differences among the four individual insomnia indicators. The sample included 439,887 veterans, with 17% identified by one of the four indicators; medications was most common (15%), followed by diagnoses (6%), consults (1.5%), and CBT-I (0.6%). Trends over time included increasing yearly rates for diagnoses, consults, and CBT-I, and decreasing rates for medications. Significant differences were identified between the sociodemographic and clinical variables across indicators. An evaluation of a large sample of veterans identified that prescription sleep medications remain the best way to identify veterans with insomnia. Furthermore, insomnia continues to be under-diagnosed, per VA EHR data, which may have implications for treatment consistent with clinical practice guidelines and may negatively impact veteran health.