Soldiers try to regain sleep patterns after return from combat zones

By ADAM ASHTON | The News Tribune (Tacoma, Wash.) | Published: February 1, 2013

TACOMA, Wash. — Army Capt. David Raines is home in Lacey, Wash., with his family, but he sleeps like he’s still deployed in Afghanistan. The 35-year-old officer manages only a few hours of rest each night.

That sleep pattern worked for him during the three years he spent in combat zones, where it paid to be alert around the clock.

It’s not as productive when he’s helping raise his three young children and juggling his stateside assignment supervising ill and injured soldiers at Joint Base Lewis-McChord.

“I just want to sleep,” he said.

His experience struggling to find a healthy sleep routine at home is increasingly common for service members after a decade of deployments to Iraq and Afghanistan, said Lt. Col. Vincent Mysliwiec, Madigan Army Medical Center’s chief of sleep medicine.

Mysliwiec is the author of a study published today in the journal Sleep that breaks down ways that combat tours impact the rest service members are able to get when they return home.

His team studied 725 patients, primarily combat veterans, who had trouble sleeping and came to the Madigan lab for a study in 2010. The researchers found concerning levels of insomnia as well as sleep problems caused in part by combat-related ailments such as post-traumatic stress disorder and traumatic brain injuries.

In some cases, service members are getting a full night’s rest but feeling as if they’re sleep-deprived. Mysliwiec suspects those cases of “paradoxical insomnia” stem from the alertness service members maintain when they’re at war.

“When soldiers are deploying to combat, they’re not in a safe-sleep environment,” he said. “They need to be hyper vigilant.”

Mysliwiec found:

• Nearly two-thirds of patients slept six hours or fewer. That’s more than double the percentage of civilians who report sleeping fewer than six hours, according to past studies.

• About 51 percent of patients were diagnosed with obstructive sleep apnea or moderate-severe obstructive sleep apnea, a lack of sleep caused by a breathing obstruction. That’s comparable with a control group. But almost 25 percent were diagnosed with insomnia, a lack of sleep that happens for seemingly no reason – much higher than the control group.

• About 5 percent of patients received a diagnosis of paradoxical insomnia, meaning they had a full night’s rest but felt fatigued as if they were missing sleep – again, much higher than the control group.

• More than 58 percent of patients were diagnosed with a separate service-related illness in addition to their sleep disturbances. The most common were depression, anxiety, post traumatic stress disorder and traumatic brain injuries (TBI).

• Almost 25 percent of the patients were taking pain medications.

Mysliewic insists he doesn’t have to “sell sleep,” because everyone wants a good night’s rest. His job, he said, is to encourage patients to change their habits to get better sleep.

Some patients suffering from obstructive sleep apnea will benefit from devices that help them breathe, such as a mask-like machine called the continuous positive airway pressure (CPAP) machine.

Other patients must pay close attention to their daily rhythms so they’re tired when they go to bed. It doesn’t help to lie in bed staring at a clock, Mysliewic said.

“We’re looking for four and a half or five hours of quality sleep in bed,” he said.

But his efforts to “fix” sleep patterns for service members run up against an ethos in the military that troops should be able to get by on short sleep when circumstances demand it.

Army units often train at odd hours to test their abilities to make good decisions in stressful conditions. On a deployment, a soldier has to remain somewhat alert at least to respond to alarms, if not to take a guard shift or support a night patrol.

Getting by with limited rest “is very advantageous on a deployment cycle,” said Raines, a veteran of two infantry deployments to Iraq and one with a signal unit in Afghanistan.

But the Army is trying to change the tone of its messages on sleep, encouraging troops to view rest as a factor in their ability to perform at their best. Army Surgeon General Lt. Gen. Patricia Horoho, who formerly commanded Madigan, has been hitting that theme over the past year.

Without sleep, “you can still function, but you’re not functioning at your highest level,” said Eric Bean, a performance enhancement specialist at Lewis-McChord’s Comprehensive Soldier and Family Fitness program.

“It’s an element of energy management. We liken sleep to being as important as oxygen, food or water,” said Bean, who advises Army units on ways to improve health.

Mysliwiec contends that sleep management will play an important role in addressing war-related ailments such as anxiety, PTSD and traumatic brain injuries.

Short sleep is a characteristic of all of those conditions, and getting more rest will help people recover from them.

“Improving sleep will always help their PTSD, their TBI,” he said.

Raines understands that. As an officer in Lewis-McChord’s Warrior Transition Battalion, he supervises about 170 soldiers who are getting medical care and could be leaving the service. Many are receiving medication that could affect their sleep for behavioral health conditions or for pain.

He decided to seek out a sleep doctor when he talked to his soldiers about their conditions. His wife had been nudging him to get help, taking cellphone videos of him snoring.

He listened to his soldiers reporting feeling more energetic after they addressed their sleep disturbances. He wanted to feel that, too.

“Getting rid of that fatigue and feeling like you’re rested, that’s what people talk about,” he said.


U.S. Army Pfc. Christopher Williams sleeps in a hasty fighting position on a cold morning in the mountains near Sar Howza, Paktika province, Afghanistan, Sept. 4, 2009. Sleep patterns formed in combat zones can be tough to change after the troops return home, a new study finds.


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