National Defence committee  That often happens with sleeping pills. Clinical practitioners are often reluctant to prescribe benzodiazepines to treat sleep problems because of the potential for abuse and dependency. Based on what we know, in any event, this type of medication is not really effective for military personnel, probably because they have a hypervigilance that the civilian population doesn't have, including those people who have chronic insomnia that isn't linked to post-traumatic stress syndrome.

National Defence committee  There's also the issue of interactions between various medications. Someone may consult a clinical practitioner who prescribes a certain medication, and then that person consults a different clinical practitioner who prescribes another medication for something else. Communication between clinical practitioners must be very open and very clear to ensure that there are no negative interactions.

National Defence committee  Yes, that's true.

National Defence committee  I was talking to Dr. Jetly recently. I liked his approach to mental health from cradle to grave, basically from the moment people sign and join the military all the way to the time they retire and after. I think sleep can reside all along the continuum of military service. The transition from research to practice is relatively straightforward in sleep, because most of us who do the research are also clinicians, or work very closely in clinical settings.

National Defence committee  Absolutely. Think about it. If you have a bad night of sleep, typically the next day your mood may be altered; you may be a little bit more irritable, and not as pleasant as usual. That's after one night. If you multiply that by thousands of nights of many years of service, you are going to have some impairments or difficulties in facing the world, in getting out of the basement.

National Defence committee  It is. This is self-reporting, so usually you have people overestimating how much sleep they get. The absolute difference does not look that dramatic, but I would suspect that in reality it's.... Well, 30 minutes of sleep is significant, so if it translates to 20 to 30 minutes and that's an underestimate of what really happens, you're thinking about a significant sleep loss during deployment.

National Defence committee  It's very low. That's the problem. The primary difficulty with natural products is that there's no control for quality. Three milligrams of melatonin from one brand can be very different from three milligrams of melatonin from another brand. That's the primary difficulty. Overall, the studies that have been done tend to be negative or to show very small effects.

National Defence committee  It's delivered over four weeks, but what really is involved is a single in-person session—and we have done it by phone or by Skype as needed—where we provide people with basic education about sleep physiology: what the mechanisms are that control sleep, and how we can change some behaviours while we're awake to facilitate alignment of these mechanisms that control sleep to improve sleep quality.

National Defence committee  Because of the fact that military people have extreme discipline, we can actually leverage that, provide them with information and basic guidance on what are healthy sleep behaviours. This includes: get up at the same time every day of the week no matter how many hours of sleep you got the night before; don't go to bed unless you're sleepy or sleeping; and don't stay in bed unless you're sleeping.

National Defence committee  In just telling people—we actually give them a pamphlet with the information—we found that 50% no longer had insomnia within four weeks. They were good sleepers. For those who spent 45 minutes with us in personalizing these sleep habits based on their own sleep patterns, 80% of the people were actually fully remitted from insomnia after four weeks.

National Defence committee  Absolutely. That work was by Colleen Carney at Ryerson University in Toronto. She's done an outstanding study. It also shows that when you focus on sleep, you show dramatic improvements in depression. The thing about sleep is it is transdiagnostic. It's not just true for post-traumatic stress or depression, it's true for anything that relates to mental health.

National Defence committee  No.

National Defence committee  There are different elements. On the CD there are actually different tracks of white noise to help people sleep or relax in a different environments. There's a self-administered treatment that is also included on this that guides people step-by-step on how to get rid of bad dreams or how to facilitate sleep onset, for example.

National Defence committee  They're so sleep deprived they can fall asleep very quickly.

National Defence committee  What we've used in the clinic is prazosin. It's an alpha-1 antagonist that has been very useful. Actually, it's the medication that had the most evidence for treating nightmares related to post-traumatic stress, sleep disturbances, and insomnia as well. There are two issues we have with pharmacological agents.