JOINT BASE LEWIS-MCCHORD, Wash. — Madigan Army Medical Center recently earned national recognition for the excellent care provided in its Sleep Service clinic when the American Academy of Sleep Medicine awarded program accreditation. 

The sleep service received the accreditation for the first time, and on its first attempt, after the AASM took a thorough look at the quality of the clinic's sleep studies and analysis, personnel training, equipment, policies, and patient care.

"It's a marker of quality," said Army Lt. Col. Herbert Kwon, chief of Madigan's Pulmonary Critical Care Sleep Service. "We do this to tell the community that we deliver high-quality care."

The sleep service cares for about five percent of all service members on Joint Base Lewis-McChord; because of the high number of patients, they only see active-duty patients, said Kwon.

While one of the most common sleep issues the clinic treats is sleep apnea, they also treat other sleep issues like hypersomnia (or excessive sleepiness), sleep walking, and circadian rhythm disturbances which can affect sleep-wake cycles.

The most common reason service members see the sleep service, however, is insomnia.

"Because there are so many things that go into insomnia, it's rarely an organic sleep issue," said Kwon. He explained that organic sleep issues are those with a direct biological cause. 

Most often, insomnia is caused by other factors to include stimulants or toxins (such as drinking caffeine or alcohol close to bedtime), other medical issues (such as chronic pain that keeps one awake), circadian rhythm issues or environmental issues (like those caused by shift work), or psychological issues (such as stress about jobs or relationships). Kwon's team assesses patients for these four areas as well as potential direct physical causes to determine which treatment may work best.

"All of these things could possibly affect sleep, but what is the main issue and how do we address that?" Kwon said.

While there are approaches the sleep service can use to help adjust patients' circadian rhythms, they often use education to encourage patients to change their habits to improve their sleep. They can offer patients sleep monitoring devices which can help record their sleep patterns.

"It's education a lot of times because human memory is very poor … it's demonstrating to people what their actual sleep patterns have been," said Kwon.

In addition, the clinic offers two behavioral health therapists who specialize in sleep medicine.

"They do cognitive behavior therapy for insomnia, which is by far the most effective treatment for chronic insomnia," he said.

When it is uncertain why a patient has daytime sleepiness, the care team may refer them to undergo a sleep study. With an eight-bed lab that offers day and night sleep studies, Madigan has one of the largest sleep labs in the Department of Defense, said Kwon. 

Obtaining the AASM accreditation makes Madigan one of just four military treatment facilities with this designation in the Army.

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