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

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  • Adam D. Bramoweth

    (VISN 4 Mental Illness Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Research Office Building (151RU/MIRECC), University Drive, Pittsburgh, PA 15240, USA
    Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Research Office Building (151C), University Drive, Pittsburgh, PA 15240, USA
    Current Address: Research Office Building (151RU/MIRECC), University Drive C, Pittsburgh, PA 15240, USA.)

  • Caitlan A. Tighe

    (VISN 4 Mental Illness Research, Education and Clinical Center, VA Pittsburgh Healthcare System, Research Office Building (151RU/MIRECC), University Drive, Pittsburgh, PA 15240, USA)

  • Gregory S. Berlin

    (VA Connecticut Healthcare System, 950 Campbell Avenue (116B), West Haven, CT 06516, USA
    Department of Psychiatry, Yale University School of Medicine, 300 George Street, New Haven, CT 06511, USA)

Abstract

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.

Suggested Citation

  • Adam D. Bramoweth & Caitlan A. Tighe & Gregory S. Berlin, 2021. "Insomnia and Insomnia-Related Care in the Department of Veterans Affairs: An Electronic Health Record Analysis," IJERPH, MDPI, vol. 18(16), pages 1-11, August.
    • Handle: RePEc:gam:jijerp:v:18:y:2021:i:16:p:8573-:d:614077
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    References listed on IDEAS

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    1. Adam D. Bramoweth & James Luther & Barbara H. Hanusa & Jon D. Walker & Charles W. Atwood & Anne Germain, 2018. "Clinical Characterization of Insomnia among Veterans with PTSD: Identifying Risk Factors for Diagnosis and Treatment with Sedative-Hypnotics," Defence and Peace Economics, Taylor & Francis Journals, vol. 29(1), pages 78-90, January.
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