Assessing Insomnia in Active-Duty Service Members in a Military Primary Care Clinic

Background: Insomnia is a significant problem in the U.S. military, affecting the health, resiliency, and readiness of service members (Seelig et al., 2016). Although insomnia is a common sleep disorder among active-duty personnel (Mysliwiec et al., 2013), it often goes unrecognized and untreated because sleep disturbances are not routinely assessed during military primary care visits (U.S. Navy Medicine, 2014).

Objective: To introduce an evidence-based assessment for insomnia-the Insomnia Severity Index (ISI)-into a military primary care setting to increase the number of service members assessed for insomnia.

Methods: The ISI was integrated into the patient intake process at a military primary care clinic serving active-duty service members exclusively. Data were collected from 180 patients before implementation and 164 patients after implementation to compare the number of sleep assessments conducted. An independent samples t-test and Fisher's exact test were used to examine whether the ISI intervention led to an increase in insomnia assessment.

Results: A significant increase was found in patients who were evaluated for insomnia from pre-implementation (13.9%, n = 25/180) to post-implementation (90.3%, n = 148/164), p < .0001.

Conclusions: A sleep screening process can be effectively implemented at a military primary care facility to increase the number of active-duty service members assessed for insomnia.

Implications for nursing: Sleep assessment is critically needed to identify service members with sleep disorders that may negatively impact their physical and mental health. An evidence-based screening tool is an important preventive measure that can be integrated into primary care visits to ensure routine evaluation of sleep.