Still awake at 0300, nothing seems to help you fall asleep or stay asleep. What steps can you take? The Internal Behavioral Health Consultant or IBHC, team member in your Army Medial Home, can assist you with sleep disturbances, anxiety, hypertension, depression, diabetes and much more.

Captain (Dr.) Aditya Bhagwat, Program Manager for Primary Care Behavioral Health (PCBH), explains that integrating behavioral health providers into the Army Medical Home has resulted in substantial changes in the way Army Medicine delivers healthcare. By integrating Internal Behavioral Health Consultants (IBHC) directly into primary care clinics, a team based approach can be used to address sleep disturbances, anxiety, depression, chronic pain, obesity, tobacco use and many other problems with which patients struggle.

Bhagwat, a United States Public Health Service officer and Board Certified Clinical Neuropsychologist explained IBHCs have recently received training on Brief Behavioral Treatment of Insomnia (BBTI) in Primary Care. Insomnia is a prevalent disorder among older adults and a frequent complaint encountered in primary care clinics. Insomnia is defined by difficulty falling asleep, difficulty staying asleep, nonrestorative sleep, and waking symptoms such as fatigue, impaired concentration, and mood disturbance. According to a study published in the Journal of Clinical Sleep Medicine more than 75 percent of patients with insomnia receive treatment in primary care settings, thus integrating providers in the Army Medical Home with specialized skills to treat insomnia was an important goal.

In a study published in Military Medicine, increased sleep latency, increased duration of wakefulness after sleep onset, short sleep duration, and increased sleep fragmentation are some of the common forms of sleep disturbances experienced by military personnel during military deployment. However, chronic sleep problems are very common not just because of deployments but in the general population as well. Poor sleep is a major factor in interpersonal problems and contributes significantly to the risk of many chronic diseases such as hypertension, heart disease, cancer, diabetes, and various psychiatric problems such as depression.

Many patients only know about medication interventions for sleep problems, but medications should only be used in the short term, and are not as effective at treating long standing sleep difficulties. The American College of Physicians recommends cognitive behavioral interventions as the first line treatment for insomnia. BBTI is an evidence based cognitive behavioral treatment for insomnia available in primary care clinics that allows active duty, family members and retirees to take control of their sleep, and to learn skills that they can put into practice for the rest of their lives.

BBTI is a five, 30 minute appointment model to assess and treat sleep difficulties. Two of the appointments can be telephonic, for patient convenience. The initial appointment consists of a focused sleep assessment and explanation of the BBTI process. Patients will then have approximately four additional appointments over the course of the next couple of months. BBTI has a behavioral focus and is linked to a physiological model of sleep regulation. It utilizes a sleep diary, workbook, and behavioral interventions to provide patients with an individualized plan to correct their sleep difficulties. BBTI focuses on four principles for good sleep: Reduce your time in bed; don't go to bed unless sleepy; don't stay in bed unless you are asleep; and get up at the same time every day. IBHCs will work closely with patients to address any barriers to implementing their plans and with their PCMs to consider all treatment possibilities.

Currently, over 90 IBHCs are trained in BBTI. Positioning IBHCs as a routine element of primary medical care allows patients easy access to a specially trained provider that can assist with the prevention and treatment of numerous medical diagnoses. Bhagwat also stated an even larger percentage of the population could benefit from treatment by IBHCs, and primary care providers are strongly encouraged to incorporate IBHCs into their standard treatment plans.

Sleep impacts medical readiness and is vital for health, performance, and well-being. The better the sleep the greater its benefits.