VA Capitol Health Care Network Mental Illness Research, Education and Clinical Center, VA Maryland Health Care System, Baltimore, Maryland, USA.
Department of Psychiatry, School of Medicine, University of Maryland, College Park, Maryland, USA.
J Sleep Res. 2019 Aug;28(4):e12833. doi: 10.1111/jsr.12833. Epub 2019 Mar 19.
The majority of people with serious mental illness experience insomnia, and insomnia is one of the most frequent reasons for mental health referrals in the Veterans Health Administration. Insomnia also represents a critical obstacle to mental health recovery. Little is known about how military veterans with mental health problems conceptualize their sleep and sleep problems; such information may uncover new avenues for research and treatment. Therefore, the purpose of this study was to explore how veterans with serious mental illness and insomnia experience and understand their sleep, towards the aim of identifying these new avenues. Participants included 20 veterans with insomnia and serious mental illness (i.e. schizophrenia spectrum, bipolar or major depressive disorders, with serious functional impairments). Data were collected via an inductive phenomenological approach using semi-structured interviews. We identified five themes: Sleep to Recharge; Sleep as a Fight; Sleep as Safety or Escape; Sleep as Dangerous; and Military Influence. Participants' relationship with sleep was complex; many associated it with intrusive and troubling hallucinations, paranoia and military experiences, yet at the same time desired sleep for its potential to liberate them from distress. Military mindsets both helped and hindered sleep. These results extend existing models of insomnia development and maintenance, and illuminate phenomena previously unidentified in this underserved veteran population. Clinical and theoretical implications are discussed, as well as new research directions for enhancing therapeutic efficacy.
大多数患有严重精神疾病的人都经历过失眠，而失眠是退伍军人健康管理局（Veterans Health Administration）中精神健康转介最常见的原因之一。失眠也是精神健康恢复的一个关键障碍。对于有精神健康问题的退伍军人如何理解他们的睡眠和睡眠问题，人们知之甚少；这些信息可能为研究和治疗开辟新的途径。因此，本研究的目的是探讨患有严重精神疾病和失眠的退伍军人对自己睡眠的体验和理解，以确定这些新途径。参与者包括 20 名患有失眠和严重精神疾病的退伍军人（即精神分裂症谱系、双相情感障碍或重性抑郁障碍，有严重的功能障碍）。数据通过使用半结构化访谈的归纳现象学方法收集。我们确定了五个主题：睡眠以恢复精力；睡眠是一场战斗；睡眠是安全或逃避；睡眠是危险的；以及军事影响。参与者与睡眠的关系很复杂；许多人将其与侵入性和困扰性幻觉、偏执和军事经历联系在一起，但同时又希望通过睡眠来摆脱痛苦。军人心态既有帮助也有阻碍。这些结果扩展了失眠发展和维持的现有模型，并阐明了在这一服务不足的退伍军人群体中以前未被识别的现象。讨论了临床和理论意义，以及增强治疗效果的新研究方向。
