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Sleep problems are an ongoing issue for many people working in the military, especially veterans. Recent research shows that more than 75% of veterans have some symptoms that can be related to different sleep disorders. Among those who have been diagnosed with post-traumatic stress disorder, this percentage is even higher.
Many Americans are dealing with sleep disorders which occur as a consequence of their lifestyle or career choices, for example, working in shifts is particularly bad for our sleep, but some professions are more stressful and come with higher risks and responsibility. Military-related jobs are recognized as professions that have a profoundly negative impact on sleep since those consequences on sleep usually remain or get even worse when people retire from the military.
By the term veteran federal law and military service consider any person who served for any length of time in any branch of military service (“Any, any, any”), for example, navy, army, marines or air force.
In 2015. the Department of Defense performed a study which showed that around 33% of active service members feel severe fatigue at least three times per week due to the lack of sleep, while 51% of them reported that they feel how sleep loss is hindering their daily functioning and responsibilities. Service members normally sleep for six or fewer hours per night, which is below the optimal recommendation of eight hours, they are also often deployed, exposed to traumatic events and injuries. This specific lifestyle is hard to keep up with, and there is not much time for rest, so people would expect that once they retire they should be able to be carefree and get enough sleep, but then as the aftermath, they have to deal with sleep difficulties.
What Keeps Veterans Up At Night?
Military service corps are highly valued for their sacrifices since they often find themselves in difficult and dangerous situations far away from home in foreign countries that are in a war. Those who go through these war-torn countries are often facing many psychological and emotional struggles since the things that they have seen and survived haunts them afterward. Being exposed to such things for months or years, impacts each person in a different way, but sleep-related problems are common for almost all of them. Getting insufficient sleep due to the unique nature of their job in combination with stress and life-or-death decision making keeps our veterans up for many nights. We have all spent a few nights up overthinking some minor things that happened to us, so it is not hard to imagine how challenging can it be to fall asleep after spending a part of your life as a military service member. Here are some of the most common causes of why our veterans are having troubles with sleep.
- Post-traumatic stress disorder (PTSD) – many veterans that have been through some traumatic events experience mental health problem called PTSD. Upsetting memories, combats, emotional and physical stress, injuries, anxiety, etc. all provide veterans with the feeling of fear or life treating danger that they cannot control. It is normal to have some symptoms of it right after the event, but if they continue to last over a month it is considered as PTSD, also, sometimes the symptoms can show off later on. Trauma-focused psychotherapy is very beneficial as it has been proved that 53 out of 100 people successfully got rid of PTSD symptoms thanks to it, another way of successful treatment includes medications.
- Pain – those who have been physically injured or go home with them have problems with pain management. Sometimes even after the injury has been treated neurological pain in ghost limbs occurs or severe headaches start. Other, long-term painful conditions such as arthritis are also common among veterans and hinder their sleep, and the term painsomnia refers to those painful chronic conditions that are impacting sleep negatively.
- Traumatic brain injury (TBI) – bumps, jolts or any other head injuries may cause disruption of the brain’s normal function. Types of these injuries can vary from smaller contusions to severe ones which can leave long-term consequences on mental health, memory, and many other aspects, depending on the brain damage. Chronic pain often remains a problem for months or even years, after the primary injury is healed.
- Tinnitus – this is a perception of ringing, hissing or buzzing noise in the ear and head. Many soldiers that have been exposed to gunfire, mine explosions or missiles noise, are struggling with a chronic problem of so-called ringing ears. The loudness and intensity can vary, but it is usually the worst when there is little or no background noise because then we can be fully aware of it, for example, during the night when we are trying to fall asleep. Besides sleep, it affects concentration, work, and normal daily functioning, it can cause stress, but it is not a cause of hearing loss.
- Substance abuse – since military-related jobs are so stressful many try to cope their daily issues with some legal and illegal substances. Legal ones such as cigarettes, alcohol, energy drinks have a negative impact on their life quality, prescribed drugs for alertness, pain management or sleeping can also have side effects, particularly when they are abused. Then there are many illegal ones that we all hope service members are not using, but in reality that happens too, a lot of them struggles when dealing with pressure and seeks their way out through drugs such as marijuana, heroin or other psychoactive substances.
- Substance withdrawal – some of them continue with their addictive habits once they return home, while others try getting into rehab and treating their addiction properly. This process is never an easy one, and it can be a temporary cause of many sleepless nights.
Veterans Sleep Disorders
As we mentioned before, while they are working as active service members on duty, many are unable to maintain a healthy sleep routine, they are chronically sleep deprived, fatigued, which impacts their performance and overall health. They develop sleep disorders even before they retire, but since they can be so hard to treat, many get used to living with them. But, due to the many stressful and traumatic things that they have survived, it is essential that sleep disorders among veterans are not taken for granted, they need to be treated properly because they can often lead to depression and suicide. Unfortunately, the suicide rate is high among the veterans, according to the data collected between 1979. and 2016. when the Department of the US Veterans Affairs analyzed the records of 55 millions of veterans, it shows off that on average 20 veterans die each day due to suicide. Sleep disorders are, of course, not the main and only cause of it, but they can contribute significantly.
- Insomnia – this is the most common sleep problem among the members of the military. Many things that are specific to military lifestyle can be the cause of it, for example, deployment, stress, sleeping on the ground or in the crowded rooms, sleeping with a bright light on, traumas, loud surroundings including gunfire and missile noise, combats, and so on. Returning home and trying to re-adjust to civilian life can also be a potential cause of insomnia. Deployment-related insomnia is a unique type of sleeplessness, common among new troops after the deployment. They are in fear of fire and combats, with little or no time to get used to new surroundings and their sleep-wake schedules are usually irregular since day one. When this type of insomnia is not treated on time, and properly, it can be the cause of depression, PTSD, and suicide.
- Nightmares and night terrors – more than a half of combat veterans have nightmares several times during the week, and they come to their sleep as flashbacks of unpleasant and traumatic things that they have experienced while they were serving abroad. Night terrors are also common, those terrifying and anxious moments in the middle of the night are scary not only for the person who is going through it but also for their partners, families or roommates. The difference between night terrors and nightmares is that we usually remember our nightmares on the day after, but although during an episode of a night terror a people can seem fully awake and inconsolable, they will hardly have any memory about it on the next day. Althouhg military branches are trying to reduce the stigma for seeking adequate help for mental health care, many veterans and service members still deny their underlying problems, they would rather seek help for insomnia only without trying to cope with underlying trauma first.
- Sleep apnea – veterans with sleep apnea are dealing with snoring, and occasional breathing stops during the night. Usual causes of sleep apnea can be age, obesity, or any health-related problem, but veterans experience it mainly because of some neurological or physical damage that happened to them during their service, or as a result of substance abuse.
- Restless leg syndrome – many veterans have reported having restless leg syndrome, but for them, it is usually diagnosed as a neurological dysfunction which falls off under the spectrum of PTSD. In some severe cases, this can be a contributor to disability. RLS disrupts sleep because one leg develops those uncomfortable sensations, followed by an uncontrolled urge to move. The leg gets itchy or jumpy, and it easily awakes the person or prevents him/her from falling asleep. The best way to calm down the muscles is a massage or a warm shower, but there are also medications that can help with keeping these unpleasant sensations under control.
- Sleep paralysis – this is a somewhat strange condition which usually occurs either when we are falling asleep or when we are waking up. People who are experiencing sleep paralysis are being fully awake, but at the same time, they are unable to move their arms or legs, which causes panic. Researches show that around 85% of people with PTSD have experienced sleep paralysis.
- REM behavior disorder – also known as RBD, refers to the changes that happen while we are at the REM stage of sleep in which dreams usually occur. During the REM phase, our brain shuts down all muscle functions, those groups of muscles are in a mode of temporary paralysis, all except the diaphragm which continues to work and support breathing. People who experience RBD start acting out the things they are dreaming about because their muscles fail to stay temporarily paralyzed. It can be potentially dangerous for people with this disorder but also for everyone sleeping around them. Small studies in veterans have shown that more than 50% of those with PTSD will probably experience RBD sooner or later. For veterans, these vivid nightmares are mainly physical manifestations of inner traumas or flashbacks of some events.
- Enuresis – also known as urinary incontinence or bedwetting, among adults it is mostly connected to diabetes, untreated sleep apnea, or other medical conditions, but veterans usually have it for other reasons. It has been related to the long-lasting psychiatric and physiological stress that many encounter during the service, and it is more common among the female population of personnel.
- Circadian rhythm disorders – hectic work schedules in the military can either exacerbate or stem our natural sleep-wake cycle. Normal sleep-wake cycle is usually aligned with the shift of daytime and nighttime, but some jobs have such work schedules that neglect these things. For example, the notorious Panama schedule, which is still used in some units, requires from workers that every 2-3 days they go on and off duty, switching their shifts from daily to night ones every four weeks. Shift working is more present during deployments, and those who have been working night shifts have problems with establishing a normal sleep pattern once they return home.