Sleep disturbances are some of the most commonly reported psychiatric complaints by combat veterans. Hundreds of thousands struggle regularly with insomnia, both falling and staying asleep, and nightmares.
A variety of treatments are available to address these problems. Cognitive-behavioral therapy for insomnia (CBT-I) is effective for those who have a difficult time falling asleep. The high blood pressure medication prazosin has been shown in numerous research studies that it can eliminate nightmares. And different versions of a talk therapy that teaches the person to change the content of their nightmares in order to make them less distressing are effective for many.
Unfortunately, the treatment of insomnia and nightmares has historically required multiple treatments, often from multiple providers. The treatments effective for insomnia were not necessarily effective for nightmares. And the treatments effective for nightmares were not necessarily effective for insomnia. That is, until now.
A relatively new therapy called Exposure, Relaxation, and Rescription Therapy (ERRT) is proving to be effective for these sleep problems.
ERRT has almost exclusively been studied in civilian groups. The results have been strong. Recognizing the need for effective treatments in veterans, researchers modified the treatment specifically for this group. Results from this modified version of ERRT with veterans are promising.
For four weeks, 19 veterans were provided once weekly sessions for four weeks. The sessions included a mix of education about insomnia and nightmares, techniques for learning to sleep better, intentional exposure to content of the nightmare, and "rewriting" and rehearsing the new dream.
After only one week, some veterans saw a reduction in the number of nightmares they experienced as well as the intensity of their dreams. They also saw an increase in overall sleep quality and a drop in the severity of their insomnia. Surprisingly, those who were depressed saw improvement in mood. This may be related to the fact that poor sleep and nightmares are directly tied to depression. The good news is that the results were not temporary. Improvements continued up to two months after treatment ended.
There are some limitations of this initial study, and it's too early to declare victory against nightmares and insomnia. Approximately half of the veterans continued to have significant sleep difficulties. Plus, the study only looked at 19 veterans over a short period of time. It also didn't include a control group. Without comparing a group that got the treatment versus one that didn't, it's impossible to know if the actual treatment led to the improvements or was due to some other unknown factors.
Regardless of the limitations, this study is a great first step in the battle against sleep problems in combat veterans. Hopefully other researchers will pick up where this group left off.
Bret A. Moore, Psy.D., is a board-certified clinical psychologist who served two tours in Iraq. Email him at kevlarforthemind@militarytimes.com. This column is for informational purposes only and is not intended to convey specific psychological or medical guidance.
