HomeMy WebLinkAbout032026 - Brief Cognitive-Behavioral Insomnia Treatment for Primary Care Veterans at Elevated Risk for Suicide_ A Randomized Clinical TrialALERT: BE CAUTIOUS This email originated outside the organization. Do not open attachments or click on links if you are not expecting them.
The guideline describes the critical decision points in the Management of Chronic Insomnia Disorder and Obstructive Sleep Apnea (Insomnia/OS
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NewsFlash
Brief Cognitive-Behavioral Insomnia Treatment for Primary Care Veterans at Elevated Risk for Suicide: A Randomized Clinical Trial <https://links-1.govdelivery.com/CL0/https:%2F%2Fkarger.com%2Fpps%2Fa
rticle-abstract%2Fdoi%2F10.1159%2F000550973%2F944751%2FBrief-Cognitive-Behavioral-Insomnia-Treatment-for/1/0100019d0c31e2f9-5494d220-d6d0-4fb6-870c-978a23372312-000000/0WYeXJIbBXKZyLZHaTust0KPjqi8lR6
Dhpnr0-sA_5Q=449>
Wilfred R Pigeon, Jennifer S Funderburk, Todd M Bishop, Wendi Cross, Hugh F Crean
PMID: 41678426 DOI: 10.1159/000550973
Abstract
Introduction: Many patients at risk for suicide present in primary care where insomnia and other suicide risk factors are prevalent. Addressing insomnia in this milieu may augment suicide
prevention strategies.
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Methods: A randomized clinical trial was conducted to test the effectiveness of brief cognitive behavioral therapy for insomnia (bCBTi) for primary care patients at risk for suicide
recruited from three U.S. Veterans Health Administration practices. The 194 participants (77% male; mean age 51.5+/-13.6 years) with insomnia, co-occurring depression and/or posttraumatic
stress disorder (PTSD) and recent death or suicide ideation were randomized to receive four 30-minute sessions of bCBTi or Sleep Hygiene over six weeks. Blinded assessments occurred
every 6 weeks from baseline to 30 weeks. Change in Insomnia Severity Index (ISI) across 30 weeks was the primary outcome with co-secondary outcomes measured by the Scale for Suicidal
Ideation (SSI), Patient Health Questionnaire-9 (PHQ-9) and PTSD Checklist (PCL).
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FORWARD MARCH: Almost everyone who has PTSD also has trouble sleeping. Both insomnia and nightmares are PTSD symptoms <https://links-1.govdelivery.com/CL0/https:%2F%2Fwww.ptsd.va.gov%2Funderstand%2Fr
elated%2Fsleep_problems.asp/1/0100019d0c31e2f9-5494d220-d6d0-4fb6-870c-978a23372312-000000/ukpaNzZKFFrDshPJDXglJulREYrk2nBhhWZwZlfV67U=449> . Learn about treatments that can help if
you have PTSD and sleep problems. Also, sleep problems that last a long time are related to medical problems such as heart disease, depression, kidney disease, high blood pressure,
diabetes, obesity and stroke. Both nightmares and insomnia are symptoms of PTSD. Nightmares are often a replay of the traumatic event; and, if the dreams cause kicking and screaming,
bed partners can be affected too.
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Help enhance Veteran care by forwarding this article and VA/DoD clinical practice guidelines to your colleagues.
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Results: Mixed level modeling showed a significant condition effect at posttreatment (6-weeks) for ISI favoring bCBTi (t(df) = -4.58(153); p < .0001) which was maintained through 30-weeks
(t(df) = 0.35(141); p >.05). PHQ-9 was lower at 6 weeks in the bCBTi condition (t(df) = -2.07(155); p = .04) maintained through 30 weeks (t(df) = -0.47(137); p > .05). No PCL differences
and no difference in SSI at posttreatment. However, a significant timexcondition effect from 6 to 30 weeks existed for SSI favoring bCBTi (t(df) = -2.60(118); p = 0.01).
Conclusion: The bCBTi intervention designed for primary care settings effectively reduces insomnia severity with modest effects for depression and suicidal thoughts, offering an adjuvant
to suicide prevention strategies.
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VA/DoD Clinical Practice Guidelines
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EpUJaUAEJjy91kM_X_rC8a0=449>
The Management of Chronic Insomnia Disorder and Obstructive Sleep Apnea (Insomnia/OSA) (2025) <https://links-1.govdelivery.com/CL0/https:%2F%2Fwww.healthquality.va.gov%2Fguidelines%2FCD%2Finsomnia%2F
index.asp/2/0100019d0c31e2f9-5494d220-d6d0-4fb6-870c-978a23372312-000000/aEOy6PZ6JmfavlcHl0UcDK1vmtbl1RGeHDwrYC3RLiI=449>
The guideline describes the critical decision points in the Management of Chronic Insomnia Disorder and Obstructive Sleep Apnea (Insomnia/OSA) <https://links-1.govdelivery.com/CL0/https:%2F%2Fwww.hea
lthquality.va.gov%2Fguidelines%2FCD%2Finsomnia%2Findex.asp/3/0100019d0c31e2f9-5494d220-d6d0-4fb6-870c-978a23372312-000000/2e_jpOYLM9AiRD9xza2ZaNZCC0JC8xSNvmxcxPteJPU=449> and provides
clear and comprehensive evidence based recommendations incorporating current information and practices for practitioners throughout the DOD and VA Health Care systems. The guideline
is intended to improve patient outcomes and local management of patients with Insomnia/OSA.
The guideline is formatted as three clinical algorithms and 29 evidence-based recommendations.
Module A - Screening for Sleep Disorder
Module B - Management of Chronic Insomnia Disorder
Module C - Management of Obstructive Sleep Apnea
Disclaimer: This Clinical Practice Guideline is intended for use only as a tool to assist a clinician/healthcare professional and should not be used to replace clinical judgment.
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About VISN 20 and NW MIRECC
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