Sleep problems among active duty military members and veterans are all too common. In recent years we’ve seen a growing body of research exploring the problems associated with soldiers’ sleep—and unfortunately, much of the news
has not been good. Both activity duty personnel and veterans of the military are at significantly greater risk for sleep disorders than the public at large. Sleep problems often coincide and contribute to other health problems for active duty soldiers and veterans, complicating their return from deployment and combat and elevating their risk for a number of serious physical and mental health problems, including post-traumatic stress disorder (PTSD) and depression.
Sleep specialists at the University of Pittsburgh School of Medicine and the Department of Veterans Affairs Healthcare System conducted a review of some of the most recent research related to insomnia among active-duty soldiers and veterans. Their analysis revealed alarmingly high rates of insomnia among both active-duty personnel and veterans. Their review also details the range of factors that contribute to soldiers and veterans sleep disorders, which can develop or become exacerbated during periods of deployment as well as when soldiers return home. The findings also highlight the ways that poor and insufficient sleep put soldiers at greater risk for physical injury and mental health conditions associated with serving in combat.
As much as 54% of military personnel who have served since September 11, 2011 experience insomnia, according to the research reviewed. Estimates vary, but rates of insomnia among the general population range from 10-15% experiencing chronic insomnia, to 30-40% experiencing less severe and less frequent symptoms of insomnia. The research review cites a number of factors that contribute to the frequency and severity of insomnia among military personnel. These include:
- The stress of deployment and in many cases the exposure to combat. Rates of insomnia and disordered sleep among combat soldiers are extremely high, even compared to other military personnel.
- Irregular work shift schedules during deployment and in combat. Military personnel often work rotating shift schedules, both at home and abroad. This puts them at greater risk for sleep difficulties and related health problems, just as in other professions where shift work is common.
- The adjustment of re-entry to home and civilian life after deployment ends.
- Service-related injuries and illnesses, including mild traumatic brain injury.
Insomnia and other forms of disrupted, poor quality sleep are very common among veterans with traumatic brain injuries. Traumatic brain injury has been a leading cause of injury for U.S. combat soldiers in the wars of the past decade, and many veterans will continue to cope with this serious health problem. Soldiers diagnosed with traumatic brain injury often also have chronic pain problems, and mental health problems including PTSD. A significant percentage of military personnel with traumatic brain injury also experience disrupted, insufficient, poor quality sleep. Problems with sleep can complicate treatment and impede recovery from traumatic brain injuries.
Insomnia and other forms of disrupted sleep interfere in other ways with the health, performance and safety of both active duty military soldiers and veterans. Studies show that soldiers who suffer from insomnia and other sleep disorders are at higher risk for service-related injuries and health problems:
- Active military personnel with sleep problems are at greater risk for PTSD, depression, and anxiety. And its not just sleep problems that occur during active service or deployment that contribute to elevate risk. Sleep problems that develop before deployment put soldiers at higher risk for these mental health problems during and after they are deployed. Research indicates that insomnia is the most commonly reported symptom associated with PTSD among military service members. Disrupted sleep in the form of nightmares is also linked to elevated risk for PTSD among soldiers.
- Insomnia symptoms are a strong predictor of suicide risk among military personnel. Research has shown that the presence of insomnia is associated with an increased risk of suicide independent of other risk factors, including depression, PTSD, and anxiety, as well as alcohol and drug abuse.
- Military personnel, both active and retired, are also at risk for the broad range of health problems associated with poor sleep that affects the population at large. These include diabetes, cardiovascular diseases, and some cancers.
The frequency of sleep problems including insomnia and other forms of disordered sleep among military personnel is alarming, and strongly suggests the need for more attention directed at treatment and prevention. A 2010 study conducted at Madigan Army Medical Center examined the prevalence of sleep disorders among active-duty military personnel who had been referred for sleep testing. Most of the soldiers included in the study were male, and most had participated in combat duty. Researchers found more than 85% had a clinical sleep disorder. More than half the group was suffering from obstructive sleep apnea and nearly one quarter had insomnia. Among this group of soldiers, the average nightly sleep duration was less than 6 hours per night. What’s more, 58% of the soldiers had other service-related illnesses, including depression, PTSD, and mild traumatic brain injury. Nearly 1 in 4 was taking pain medication.
We must do better than this for our military personnel. We must make sleep an important priority when considering the health and service capabilities of our military members. We must do a better job identifying and treating sleep problems before, during, and after active service and deployment to combat zones. We need more research into the causes and the impact of sleep problems on soldiers’ health and function—and into how best to treat these sleep problems effectively.
The health of our military members is our collective responsibility and concern. Their sleep must not be overlooked as a critical component of their health and wellness, both during the time of active service and for the duration of their lives. We honor our soldiers when we care for them, and that includes caring for—and about—their sleep.
Michael J. Breus, PhD
The Sleep Doctor™
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