Sleep Disorders Common in Service Members, Treatment Available
Dana Crudo | Health.mil
September 20, 2013
Service members returning home from combat are increasingly reporting problems with sleep, prompting the Defense Department to take action to deal with their complaints.
According to Dr. William Brim, deputy director of the Center for Deployment Psychology at the Uniformed Services University of the Health Sciences, the most common complaints shared by service members returning from deployment are about the quantity and quality of their sleep.
In the 2011 Department of Defense Health Related Behaviors Survey of Activity Duty Military Personnel, less than half of active duty personnel reported getting the recommended seven to eight hours of sleep per night. The Army, Navy and Marine Corps reported getting the least sleep.
“Sleep is considered one of our basic psychological needs,” Brim said. “But what tends to happen within the military is that we will sacrifice sleep to get a mission done.”
He was speaking at the 2013 Warrior Resilience Conference in August.
This sacrifice has serious consequences.
“People don’t realize how sleep impacts so many areas of their lives,” said Liz Pollock, Ph.D., senior family fitness scientist at the Defense Department’s Human Performance Resource Center.
Sleep is physically and psychologically restorative. Poor sleep affects memory, attention, alertness, productivity, motivation and the ability to resolve conflicts and manage emotions. It is also associated with increased risk for accidents, relationship problems, weight gain and mental health conditions, including anxiety, depression and post-traumatic stress disorder.
“The sooner people recover from a sleep disturbance, the less likely” they will be affected, Brim said.
Army Col. (Dr.) William Frey, of Brooke Army Medical Center a sleep expert, adds that the effects of poor sleep are often “immediate and insidious,” so people may feel fine even though they are not. The sleep-deprived brain is unable to gauge its level of impairment.
“We know there is a big concern that our war fighters are not getting enough sleep,” Brim said.
The Defense Department Fights Sleep Deprivation
Military leaders recognize the importance of sleep and have launched several initiatives, including public service announcements, making sure that work schedules allow enough time for sleep and enforcing mandated sleep plans that state when a service member plans to rest and sleep. Sleep is also one of three key components that the Army is focusing on to keep soldiers healthy. The other two are physical activity and nutrition. The Army calls this new approach the Performance Triad.
“The main goal is to change … what people think of sleep,” Frey said at the Army’s Performance Triad launch ceremony in August.
In addition, unit leaders can use a special tool developed by the Air Force that predicts the levels of fatigue and impairment service members would have with a given work schedule. This helps to reduce the risk of fatigue.
The Defense Department Center for Deployment Psychology is training military and civilian medical personnel to recognize common sleep disorders among service members and how to treat them.
The number of service members receiving treatment for insomnia, obstructive sleep apnea, circadian rhythm sleep disorders and nightmares is rising, according to Brim.
Recognizing and Treating Common Sleep Disorders
Health care professionals rely on clinical interviews, questionnaires, sleep diaries and tests that measure sleepiness to diagnose sleep disorders. Other medical conditions must first be ruled out, however.
Service members are encouraged to talk to medical personnel if they are experiencing sleep problems so they can get the appropriate help.
Insomnia
Insomnia refers to difficulty falling or staying asleep. According to Brim, it is the most frequent diagnosis given in war zones.
Oftentimes, service members experience acute stress and sleep deprivation during combat that exacerbate sleepless nights, leading to insomnia.
Cognitive behavior therapy is the most effective treatment for insomnia long term. It addresses self-defeating thoughts such as, ‘I am never going to fall asleep,’ erratic sleep schedules, caffeine consumption and other things that interfere with sleep. The Defense Department National Center for Telehealth and Technology has developed CBT-I Coach, a mobile app for use during therapy Patients can use it to record their sleep patterns, do exercises to help quiet their minds as well as check their treatment plans.
Medications like eszopiclone and zolpidem, sold under the brand names Lunesta and Ambien, can help with insomnia in the short term.
Brim cautioned that these medications are never intended for long-term use and should only be used when you have time to get six to eight hours of sleep. “Behavioral changes are preferred,” Frey said.
Obstructive Sleep Apnea
According to Brim, sleep apnea is an increasingly common medical condition in the military. It is a condition where the throat briefly closes, blocking air from the lungs, causing the person to stop breathing during sleep. Those who snore loudly, are overweight or have a family history are at increased risk for sleep apnea.
Constant Positive Airway Pressure, a machine that helps people breathe more easily, is highly effective for treating sleep apnea and can be used during deployment.
Circadian Rhythm Sleep Disorders
Circadian Rhythm Sleep Disorders occur when a person’s natural wake and sleep cycle is disrupted. A number of conditions fall under this category, but the most common ones for service members are related to shift work and jet lag.
Deployed service members often work long shifts or rotate working days and nights, which can impact their bodies’ natural timing for sleep. Traveling is also disruptive. Service members should anticipate taking a day per hour difference in time zones to adjust.
To reduce the impact that shift work and jet leg has on sleep, service members should get into a regular routine as soon as possible afterward to reestablish their circadian rhythms. Other treatments that help include taking melatonin, a natural hormone found in the body, a few hours before bed, which alerts the body to start to turn off, and using a bright light to wake up in the mornings.
Nightmare Disorder
Those suffering from nightmare disorder find themselves repeatedly awakened by bad dreams that usually involve threats to survival or security and also cause significant distress during waking hours. They often wake up alert with vivid memories of their nightmares.
Feelings of anxiety can cause chronic nightmares, so it helps to find ways to handle stress during the day. The most effective therapy for nightmare disorder though is imagery rehearsal therapy, which teaches patients to rewrite their nightmares and replace the negative images with positive ones.
Promoting Healthy Sleep Habits
“Sleep is a biological necessity, good sleep is a habit,” Brim said.
Proper sleep habits make a difference and contribute to overall wellness. Brim suggests avoiding nicotine, caffeine, alcohol and naps longer than 30 minutes. Getting enough exercise and having a healthy diet also make a big difference.
“The healthier you are in [terms of] diet and exercise, the better your sleep will be,” Brim said.
Check out these tips for more healthy sleep habits from the Center for Deployment Psychology. The Harvard University Sleep Lab website also has helpful resources.
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