By Kristian Krslovic   

Most people have experienced a poor night's sleep at some point in their lives, but experiences of insomnia go beyond the occasional restless night. It involves frequently waking up, having trouble falling back asleep, and feeling unrested after a night’s sleep, which in turn can leave a person feeling tired, fatigued, and irritable during the day. 

While insomnia affects millions of people, it is especially common among veterans and active-duty service members, with as many as a quarter of service members and veterans reporting insomnia symptoms 1. Military-specific factors, including frequent deployments, irregular sleep schedules, and prolonged exposure to high-stress situations, can make healthy sleep difficult to maintain 1.

The most supported frontline treatment for insomnia is Cognitive Behavioral Therapy for Insomnia (CBT-I).2 CBT-I restores healthy sleep by shaping unhelpful thoughts surrounding sleeplessness, coupled with behavioral interventions such as stimulus control (e.g., reassociating one’s bed with sleep) to collectively improve sleep efficiency. 3 For many service members and veterans, however, insomnia does not occur on its own: it often overlaps with conditions like post-traumatic stress disorder (PTSD), depression, anxiety or nightmares. 2 Living with multiple conditions at once can be challenging for service members or veterans as they might not have the time, resources, or support to pursue separate treatments for each disorder. This raises an important question: Could CBT-I support symptoms of these co-morbid conditions in addition to improving insomnia symptoms?

A growing body of research does suggest that CBT-I may help common psychological comorbidities. In one study of veterans experiencing both insomnia and PTSD, participants who received a CBT-I intervention showed improvements in PTSD symptoms, with effect sizes ranging from medium to large. 4 The same study found that nightmare frequency decreased in participants who received a sleep-focused intervention. In another study with veterans deployed during Operation Enduring Freedom and Operation Iraqi Freedom, participants who received CBT-I treatment had reduced PTSD symptom severity compared to veteran participants who did
not receive CBT-I. 5 Lastly, CBT-I also showed significant improvements in depression and anxiety scores in a sample of U.S. Army Soldiers diagnosed with insomnia. 6

Taken together, this research suggests that CBT-I may offer benefits beyond improving sleep. It is not a replacement for treatments for PTSD, depression, or anxiety, but it may be a helpful place to start, particularly for veterans who are managing several concerns at once. Learning CBT-I skills could also give service members practical tools to use throughout their careers and after leaving the military.

Leveraging technology to increase access to CBT-I

As mentioned earlier, interventions like CBT-I can be difficult for individuals to access. Modern technology can help increase access to and engagement in insomnia-focused care. Right now there are sleep apps that create a tailored user experience by tracking sleep habits and designing customized sleep plans aimed at improving sleep and combating insomnia symptoms, such as Insomnia Coach. 7 Although Insomnia Coach is not meant to replace professional care, it is one example of how an app can provide service members and veterans with important tools, such as psychoeducation and self-care strategies, as a first step towards addressing insomnia.

Additionally, researchers at CDP led by Dr. Tim Rogers, and collaborating institutions nationwide are evaluating the effectiveness of Insomnia Coach with brief check-ins versus group CBT-I, delivered by either clinicians or behavioral health technicians, on insomnia symptoms, alongside secondary outcomes of depression, anxiety, and PTSD. By bridging the gap between innovative technology and evidence-based sleep care, service members can be equipped with tools and support to restore their sleep, build resilience, and strengthen overall mission readiness.

The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.

Kristian Krslovic joined the Consortium for Defense Psychology (CDP) as a Research Assistant in October 2025. He received a Bachelor of Arts degree in Psychology from Bard College in 2023. At Bard, Kristian was an undergraduate research assistant in the Affective Science Lab identifying factors that contribute to mood disorders.

References:
1. Hughes, J. M., Ulmer, C. S., Gierisch, J. M., Nicole Hastings, S., & Howard, M. O.
(2018a). Insomnia in United States military veterans: An integrated theoretical model.
Clinical Psychology Review, 59, 118-125. https://doi.org/10.1016/j.cpr.2017.11.005

2. Bramoweth, A. D., & Germain, A. (2013). Deployment-related insomnia in military
personnel and Veterans. Current Psychiatry Reports, 15(10).
https://doi.org/10.1007/s11920-013-0401-4

3. Walker, J., Muench, A., Perlis, M. L., & Vargas, I. (2022). Cognitive behavioral therapy
for insomnia (CBT-I): A Primer. Clinical Psychology and Special Education, 11(2),
123–137. https://doi.org/10.17759/cpse.2022110208

4. Ulmer, C. S., Edinger, J. D., & Calhoun, P. S. (2011). A multi-component
cognitive-behavioral intervention for Sleep disturbance in veterans with PTSD: A pilot
study. Journal of Clinical Sleep Medicine, 7(1), 57–68.
https://doi.org/10.5664/jcsm.28042

5. Margolies, S. O., Rybarczyk, B., Vrana, S. R., Leszczyszyn, D. J., & Lynch, J. (2013).
Efficacy of a cognitive‐behavioral treatment for insomnia and nightmares in Afghanistan
and Iraq veterans with PTSD. Journal of Clinical Psychology, 69(10), 1026–1042.
https://doi.org/10.1002/jclp.21970

6. Taylor, D. J., Peterson, A. L., Pruiksma, K. E., Hale, W. J., Young-McCaughan, S.,
Wilkerson, A., Nicholson, K., Litz, B. T., Dondanville, K. A., Roache, J. D., Borah, E. V.,
Brundige, A., & Mintz, J. (2018). Impact of cognitive behavioral therapy for insomnia
disorder on sleep and comorbid symptoms in military personnel: A randomized clinical
trial. Sleep, 41(6). https://doi.org/10.1093/sleep/zsy069

7. Insomnia coach - PTSD: National Center for PTSD. (n.d.).
https://www.ptsd.va.gov/appvid/mobile/insomnia_coach.asp