| Preface |
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iii | |
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ix | |
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xi | |
| Summary |
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xiii | |
| Acknowledgments |
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xxv | |
| Abbreviations |
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xxvii | |
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1 | (8) |
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1 | (2) |
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3 | (1) |
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4 | (3) |
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4 | (1) |
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Primary Data Collection and Sleep Survey Analysis |
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5 | (1) |
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6 | (1) |
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Key Informant Discussions |
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6 | (1) |
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7 | (1) |
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Organization of This Report |
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7 | (2) |
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Chapter Two Epidemiology of Sleep Problems in the Military |
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9 | (26) |
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Literature Review Approach |
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10 | (1) |
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A Conceptual Model of Post-Deployment Sleep Problems |
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11 | (2) |
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Prevalence and Types of Specific Sleep Problems in the Post-Deployment Period |
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13 | (5) |
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Diagnosed Sleep Disorders |
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13 | (2) |
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Symptoms of Sleep Problems |
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15 | (3) |
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Risk Factors for Sleep Problems in the Post-Deployment Period |
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18 | (6) |
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Stable Demographic Factors |
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19 | (1) |
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Operational and Military Support Factors |
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20 | (4) |
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Correlates and Consequences of Sleep Problems in the Post-Deployment Period |
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24 | (4) |
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24 | (2) |
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26 | (1) |
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27 | (1) |
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28 | (7) |
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Unaddressed Gaps in the Literature |
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30 | (2) |
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Future Directions for Military Sleep Studies |
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32 | (3) |
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Chapter Three Assessing Sleep Disturbances and Consequences Among Post-Deployed Servicemembers |
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35 | (32) |
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Sleep Survey Development and Administration to Servicemembers in the Deployment Life Study |
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36 | (7) |
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Deployment Life Study Overview |
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36 | (1) |
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Sleep Survey Added to the Deployment Life Study |
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37 | (1) |
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38 | (5) |
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Analytic Plan for the Sleep Survey |
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43 | (20) |
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Prevalence of Sleep Symptoms and Sleep-Related Behaviors Overall and by Subgroup |
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44 | (1) |
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Associations Between Sleep Symptoms and Sleep-Related Behaviors and Outcomes Among Previously Deployed Servicemembers |
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45 | (1) |
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46 | (1) |
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Prevalence of Sleep Problems in Full Sample |
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46 | (4) |
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Prevalence of Sleep Problems, by Subgroup |
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50 | (7) |
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Associations Between Sleep Measures and Outcomes Among Previously Deployed Servicemembers |
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57 | (6) |
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63 | (4) |
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Strengths and Limitations |
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65 | (2) |
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Chapter Four Review of Sleep Policies and Programs |
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67 | (18) |
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67 | (3) |
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Sleep-Related Prevention Policies/Programs |
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70 | (3) |
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DoD Prevention Policies/Programs |
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70 | (2) |
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Service-Specific Prevention Policies/Programs |
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72 | (1) |
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Sleep-Related Medical Policies/Programs |
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73 | (2) |
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U.S. Department of Defense Medical Policies/Programs |
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73 | (1) |
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U.S. Department of Veterans Affairs Medical Policies/Programs |
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74 | (1) |
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Department of the Air Force Medical Policies/Programs |
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74 | (1) |
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Department of the Army Medical Policies/Programs |
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75 | (1) |
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Department of the Navy/Marine Corps Medical Policies/Programs |
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75 | (1) |
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Sleep-Related Policies/Programs in Training Environments |
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75 | (2) |
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Department of the Air Force Training Policies/Programs |
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75 | (1) |
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Department of the Army Training Policies/Programs |
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76 | (1) |
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Department of the Navy/Marine Corps Training Policies/Programs |
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76 | (1) |
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Sleep-Related Policies/Programs in Operational Environments |
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77 | (4) |
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U.S. Department of Defense Operational Policies/Programs |
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77 | (1) |
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Department of the Air Force Operational Policies/Programs |
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77 | (1) |
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Department of the Army Operational Policies/Programs |
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78 | (1) |
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Department of the Navy/Marine Corps Operational Policies/Programs |
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79 | (2) |
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81 | (4) |
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Chapter Five Evidence-Based Interventions to Treat Sleep Disturbances Among Servicemembers |
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85 | (16) |
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86 | (1) |
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Pharmacotherapy to Treat Sleep Disturbances |
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86 | (3) |
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Pharmacologic Interventions to Treat Insomnia |
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87 | (1) |
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Pharmacologic Interventions to Treat Nightmares |
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88 | (1) |
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Summary and Limitations of Pharmacologic Interventions |
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88 | (1) |
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Evidence-Based Behavioral Treatments for Sleep Disorders Among Servicemembers |
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89 | (7) |
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Cognitive-Behavioral Therapy for Insomnia |
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89 | (3) |
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Imagery Rehearsal Therapy for Nightmares |
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92 | (1) |
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Complementary and Alternative Medicine |
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93 | (2) |
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Combined Treatment Modalities |
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95 | (1) |
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Technological Developments in Treatment Delivery |
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96 | (3) |
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99 | (2) |
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Chapter Six Barriers to Achieving Healthy Sleep Among Servicemembers |
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101 | (16) |
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101 | (2) |
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101 | (1) |
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Qualitative Data Analysis |
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102 | (1) |
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Cultural Barriers to Sleep Health |
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103 | (3) |
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Sleep May Be Viewed as a Luxury Rather Than a Biological Need |
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104 | (1) |
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Cultural Attitudes Toward Sleep Appear to Vary Across Occupational Specialties and Settings |
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105 | (1) |
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Operational Barriers to Sleep Health |
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106 | (2) |
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106 | (1) |
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Balancing Sleep Policies with Operational Demands |
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107 | (1) |
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108 | (1) |
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Knowledge Barriers to Sleep Health |
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108 | (3) |
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Lack of Servicemember and Unit Leader Knowledge About Sleep Health |
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109 | (1) |
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Lack of a Centralized Resource on Sleep Health |
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109 | (1) |
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Lack of Knowledge About the Risks of Sleep Medication Use |
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110 | (1) |
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Medical and Treatment Systems Barriers to Promoting Sleep Health |
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111 | (2) |
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Resistance to Treatment Seeking |
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111 | (1) |
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Lack of Emphasis on Sleep Screening |
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111 | (1) |
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Continuity of Care Challenges |
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112 | (1) |
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Sleep Clinic and Provider Shortages |
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113 | (1) |
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113 | (4) |
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Chapter Seven Conclusions and Recommendations |
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117 | (18) |
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117 | (4) |
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What Are the Correlates and Consequences of Sleep Problems Among Servicemembers in the Post-Deployment Period? |
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117 | (2) |
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What Are the Current Policies and Programs Related to Sleep in the Military? |
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119 | (1) |
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What Are the Evidence-Based Interventions to Treat Sleep Disorders Among Servicemembers? |
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120 | (1) |
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What Are the Barriers to Achieving Healthy Sleep for Servicemembers? |
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120 | (1) |
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121 | (12) |
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Recommendations to Prevent Sleep Problems |
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123 | (2) |
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Recommendations to Increase the Identification and Diagnosis of Sleep Problems |
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125 | (2) |
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Recommendations for Clinical Management of Sleep Disorders and Promotion of Sleep Health |
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127 | (3) |
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Recommendations to Improve Sleep in Training and Operational Contexts |
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130 | (3) |
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133 | (2) |
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135 | (6) |
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B Methods and Review of Published Studies on Sleep in the Military |
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141 | (30) |
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C Methods and Review of Published Studies on Interventions for Sleep Disorders in the Military |
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171 | (10) |
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D Review of Sleep Metrics |
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181 | (12) |
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E Description of Source Measures Included in the Sleep Survey |
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193 | (4) |
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F U.S. Department of Defense Policies Related to Sleep |
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197 | (8) |
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G Key Informant Interview Protocol |
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205 | (4) |
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H Sleep in the Armed Forces Working Group Proceedings |
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209 | (18) |
| References |
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227 | |
