23.08.2015
When I tell people that I’m a sleep psychologist, their first response is usually to tell me how they sleep. And even though sleep occurs during a finite period of time, it has an impact across the entire 24 hours of a person’s day. Events in peoples’ lives can predispose them to disrupted sleep, and often people know exactly what the problem is.
The American Board of Sleep Medicine has certified 213 providers nationally in behavioral sleep medicine (BSM).
One of these non-medication treatments for insomnia is called cognitive behavioral therapy for insomnia (CBT-i). CBT-i has been tested in many studies and found to improve sleep across a range of populations.
Many of the veterans participating in the treatment reported significant satisfaction in the outcome.
Treatment providers also reported high satisfaction with learning and implementing the treatment for their patients. I had the great privilege of working on this VA initiative from the beginning, as one of the original eight sleep experts assigned to the project. Working with the VA at a national level on this training initiative enhanced my interest in working with the VA as a frontline provider to help veterans with sleep issues. We will be starting a comprehensive behavioral sleep medicine program that provides CBT-i for disrupted sleep. This program is uniquely integrated with other facets of our sleep assessment and treatment planning efforts.
Positive results from our own and other studies indicate that CBT-i is a very effective treatment for insomnia across numerous populations with a range of complicating comorbidities. Allison Siebern, PhD, CBSM, is a licensed clinical psychologist who is board-certified in behavioral sleep medicine. In all sleep disorders treatment can only be successful if the condition and causes are diagnosed accurately.
In the sleep disorders list above the conditions are mainly long-term health complications of a traumatic brain injury. Sleeping disorders can trigger a wide spectrum of behavioral, emotional, cognitive and communication problems.


It is estimated that veterans are four times more likely to be affected by sleep issues than the general population. This is not a well-known treatment at present, primarily because there are a limited number of individuals trained to provide it. In fact, when compared to sleep medications, effectiveness of both interventions is quite similar in the short term. It’s been shown to be a good treatment fit even if a person is experiencing comorbidities such as medical or psychiatric disorders.
It was common for individuals who hadn’t slept well in years to describe improvement in the quality of their sleep in a short period of time. Veterans using CBT-i revealed significant improvement in sleep, improved quality of life and decrease in symptoms of depression and suicidal thoughts. I encourage other healthcare systems to take note—and then take steps to increase patient access to evidence-based treatments. I recently left a fulltime career at Stanford Sleep Center, the birthplace of sleep medicine, to join one of the fastest-growing VA’s in the country, the Veterans Affairs Medical Center in Fayetteville, North Carolina. These include our sleep laboratory, the Sleep Medicine Clinic, and Continuous Positive Airway Pressure treatment, where respiratory therapists work with patients diagnosed with sleep apnea. This means addressing not only sleep time, but waking hours which can be impaired or distressing as a result of not sleeping well. It is important that more people experiencing troubled sleep have an opportunity to consider this very effective treatment. We also need to grow comprehensive behavioral sleep medicine and sleep health programs that address additional sleep issues in a non-pharmacological way, both for veterans and for the general public.
Psychiatrists, psychologists, neurologists, pulmonary specialists, pediatricians, otorhinolaryngologists, dental specialists are some of the specialists who can diagnose and carry out sleep disorders treatment.
The field applies psychological theory, behavioral change strategies and the science of sleep medicine to improve people’s ability to sleep well.
More important, as a person continues to practice and improve the cognitive behavioral skills that improve sleep, CBT-i actually has more durable long-term effectiveness. Veterans noted a decrease in fear about going to sleep and satisfaction with the tools they learned to help quiet the mind when they wanted to be sleeping. This heightened my own passion to continue to help increase access to sleep services within the VA system.


I’m particularly committed to improving access to CBT-i, given that insomnia is the most prevalent sleep disorder in the nation.
Additionally, we’ll support veterans as they work with their prescribing providers to gradually discontinue use of sleep medications.
The team approach allows us to look at the bigger picture of influences on a person’s sleep. There is increasing recognition of the bidirectional relationship between waking and sleep. Sleep is such an essential component for health, and such a vital indicator of quality of life, it should be one of our nation’s highest healthcare priorities. Siebern’s current research focuses on special considerations for sleep treatment implementation in various population. People can experience troubled sleep at times of difficult life transitions such as losing a spouse or losing a job.
This is the exact opposite of drug interventions for sleep, which typically can become less effective over time. Erin Cassidy-Eagle, PhD, Director of Research at ETR, conducted a study using CBT-i and found improved cognitive functioning in a geriatric population by improving sleep. Poor sleep in older individuals is also a risk factor for a range of other concerns, including declining cognition, depression and greater functional impairment. Poor sleep has been associated with chronic conditions such as diabetes, heart disease and high blood pressure, as well as depression and weight gain. She just joined the Veterans Affairs Medical Center in Fayetteville, NC, to build the Sleep Health Integrative Program. She is also a consulting assistant professor at Stanford Center for Sleep Sciences and Medicine where she remains involved in training sleep medicine postdoctoral fellows and research.



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