Sleep Suffers in Wartime Deployment

Despite months or even years of preparation, many troops will struggle to sleep for some time after they arrive in Iraq or Afghanistan. Insomnia affects about 28 percent of deployed American troops, a study in the December issue of the journal SLEEP suggests.

The symptoms may not improve when the tour of duty is over. 21 percent of troops reported difficulty sleeping after returning home to the United States. Troops may have twice the risk of insomnia if they had poor health or mental health problems such as depression or posttraumatic stress disorder prior to deployment.

The study involved 41,225 troops from all service branches and components of the U.S. military, including active duty and Reserve/National Guide personnel. The participants completed a baseline survey with questions about sleep and overall health prior to deployment. About a quarter of the troops responded to a follow-up survey three years later, either in Iraq or Afghanistan, or after returning from either warzone.

Sleep duration was limited even for the troops who did not have insomnia. The average sleep time during wartime was 6.5 hours - slightly less than the recommended amount of sleep for adults. The AASM reports adults require 7 to 8 hours to be fully alert during the daytime.
Insomnia or not, lost sleep may have dire consequences. While military personnel are trained to function on little to no sleep, a single mistake may be fatal.

For us in the civilian world, the findings should come as no surprise. It’s hard to image trying to sleep to the sound of gunfire and explosions or even the prospect of an attack.

As a side note, the study also looked at mothers of young children and pregnant women who served in the military. On average, the women slept less than six hours. The authors speculate that the possibility of future deployment and separation from their families may multiply the normal stress of pregnancy and motherhood.

Photo courtesy United States Marine Corps

Most U.S. soldiers come home with sleep disturbance

The numbers are staggering for soldiers in the weeks after returning home from war. Researchers say 86 percent of them have some kind of sleep disturbance.

An abstract being presented at SLEEP 2010 shows the toll deployment takes American servicemen and women’s sleep.

Participants in the study were assessed the moment they stepped foot back on U.S. soil. The follow-up was 45 days later. Authors used a variety of tests to screen for sleep disturbances and physical and mental health problems.

Most of the soldiers in the study didn’t have post-traumatic stress or depression. Researchers found those with a history of sleep problems, physical illness or brain injury were more likely to report sleep disturbances.

Hear a presentation on this research Tuesday at 4:30 p.m. at SLEEP 2010. You can also read a summary included in this year’s abstract supplement available on the website of the journal SLEEP.

Sleepless Nights for Army Wives

A new study examined how deployment affects the mental health of the wives of U.S. Army soldiers. The results were published yesterday in the New England Journal of Medicine.

The study involved 250,626 wives of active-duty U.S. Army soldiers. Their electronic medical records from 2003 to 2006 were analyzed.

Results were compared according to the deployment status of their husbands. Length of deployment also was considered. Deployments included both Operation Iraqi Freedom and Operation Enduring Freedom in Afghanistan.

Adjusted results show that the wives of deployed soldiers had more sleep problems than the wives of soldiers who were not deployed. They also had more cases of depression and anxiety.

They had 11.6 excess cases of sleep disorders per 1,000 wives when the deployment lasted up to 11 months. This rate increased to 23.5 excess cases when their husband was deployed for more than 11 months.

“This study confirms what many people have long suspected,” lead author Alyssa Mansfield, PhD, said in a news release. “It provides compelling evidence that Army spouses are feeling the impact of recent deployments to Iraq and Afghanistan. The result is more depression, more stress, more sleepless nights.”

The authors noted that current warfare in Iraq and Afghanistan differs greatly from other recent conflicts involving the U.S. Both operations have involved sustained ground combat. They also have been met by strong insurgent attacks.

As a result the wives of deployed soldiers may fear for the safety of their loved ones. At the same time they face the stress of maintaining a household and caring for children alone.

The authors also suggested that the results may underestimate the severity of the problem. In the military seeking care for mental health concerns may involve a stigma. So some spouses may avoid seeking care.

“The majority of active-duty soldiers are married, so we need to pay attention to the needs of their families,” said Mansfield.

Get help for a sleep problem at an AASM-accredited sleep center near you.

Image courtesy of the U.S. Army

U.S. Navy Paying Attention to Sleep Cycles & Sleep Deprivation

The dramatic rescue of Capt. Richard Phillips from Somali pirates has focused the world’s attention on the U.S. Navy and the Navy SEALs. The mission exemplified the Navy ethos of being “disciplined and well-prepared.”

Does sleep play a role in this preparation of Navy sailors and pilots?

An article in the Virginian-Pilot takes a look. It finds that within the Naval ranks awareness of the importance of sleep is growing.

One major issue of concern is the effect that rotating work shifts and missions can have on performance and alertness. The article reports that a squadron in Iraq is experimenting to find the best way to rotate its pilots' flight schedules.

But it’s not just the pilots who need sleep. Crew members often get by on short naps during carrier operations.

There also is concern that sleep deprivation and fatigue can increase mistakes and accidents. In response the Navy is taking a high-tech approach.

It is testing the Fatigue Avoidance Scheduling Tool software, or FAST. This system helps predict performance over time based on sleep and work schedules.

Is this leading to a sea change in how the Navy operates? Not yet.

The article points out that the Navy has been doing things a certain way for a long time. Changes will come in ripples rather than waves.

U.S. Navy photo by Mass Communication Specialist 2nd Class Elliott Fabrizio

Sleepy Soldiers: Proposal Recommends More Sleep for U.S. Combat Troops

Stars and Stripes reports that the U.S. Army Medical Command is proposing changes to current Army sleep guidelines.

The draft proposal recommends that U.S. soldiers in combat zones get seven to eight hours of sleep each night. Current guidelines suggest that soldiers get at least four hours of sleep each day when deployed.

The change would help prevent “performance degradation” on the battlefield. The guidelines state that sleep loss can have a critical effect on problem solving and decision making. It can result in delayed reaction times, lapses of attention and confused thinking.

The article cites two recent studies conducted at the Walter Reed Army Institute of Research. The first study was published in the journal Sleep in 2007. It shows that 53 hours of sleep deprivation can impair the ability to make some moral judgments.

The second study is in the current issue of Sleep. It shows that “banking sleep” before a period of sleep deprivation can reduce the effects of sleep loss on performance and alertness.

The study restricted the sleep of two groups to three hours in bed for seven nights. Prior to the sleep restriction, one group extended their nightly sleep to 10 hours in bed for one week. The other group maintained a typical nightly sleep time of about seven hours in bed during the week before sleep restriction.

The “extended sleep” group performed better during sleep restriction. They were better able to remain awake during the day. Their performance also rebounded faster after the period of restricted sleep.

Image courtesy of the U.S. Army.

No Purple Hearts for PTSD

Does a U.S. soldier who has post-traumatic stress disorder (PTSD) deserve a Purple Heart? The question has sparked a heated debate in the military community.

Stars and Stripes, the American Forces Press Service and the New York Times report that the Defense Department recently rejected the idea.

A Purple Heart is only awarded when a soldier with one of the U.S. Armed Services is wounded or killed by enemy action. Army Regulation 600-8-22 defines a wound as “an injury to any part of the body from an outside force or agent.” The wound “must have required treatment by a medical officer.”

The regulation lists PTSD as an injury that clearly does not meet these requirements. The Purple Heart has never been awarded for mental or psychological problems.

In a May article in Stars and Stripes a military psychologist argued for a change in the policy. He said that PTSD is in part a physical disorder because it damages the brain.

The idea got the attention of U.S. Secretary of Defense Robert Gates. This prompted a review of the policy and stoked the debate.

Common signs of PTSD include feelings of intense fear and horror after a terrifying event. Sometimes this response is delayed. Symptoms may not appear until a few days or even weeks after the event.

Recurring nightmares tend to be most disturbing aspect of PTSD. In these dreams the event may be relived in a way that seems shockingly real.

Most people with PTSD also report having disturbed sleep. It can be very hard to fall asleep or stay asleep. This is known as “adjustment insomnia.”

About half of people with PTSD get better within three months. For others it can be a lifelong problem.

What do you think? Are veterans with PTSD being overlooked?