Lack of Sleep Is Part of Triad That Challenges Army Medicine

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By Sandra Basu

WASHINGTON – Sleep is part of the prescription when it comes to improving the health of troops and families, according to the Army Surgeon General.

“When you look at a lot of studies that are out there, if you are operating with five hours or less of sleep for five days in a row, you are actually functioning as if you are legally intoxicated,” said Army Surgeon General Lt. Gen. Patricia Horoho. “Think about that. We have our soldiers making critical decisions every day, and we are as a nation sleep-deprived.”

In fact, 70% of the demand on the military healthcare system is related to issues that can be tied back to either sleep, inactivity or nutrition, Horoho said during a recent panel session held at the Association of the United States Army annual meeting.

Calling them the “Performance Triad” she said that sleep, activity and nutrition are areas on which Army Medicine will focus to improve the health of the force.

“This is an area that I think we can have the biggest impact to really making sure that we are ready and resilient and able to respond to whatever the future challenges are for our Army,” Horoho said during the panel session.

A soldier tries to get some sleep this fall in the mountains near Sar Howza, Paktika province, Afghanistan.

Sleep and Troops

Various studies have examined sleep problems in the military population. An Army study published last year in the journal SLEEP found that more than seven out of every 10 soldiers suffered from short sleep duration (SSD).1

For that study, researchers examined the sleep habits of 3,152 soldiers and compared the prevalence of co-morbid medical conditions with sleep duration. After controlling for combat exposure, they found that SSD was associated with symptoms of depression, PTSD, panic syndrome and high-risk health behaviors, such as tobacco and alcohol abuse and suicide attempts, according to the study. Other research has found that insomnia symptoms were unique predictors of suicide attempts.2

As part of the Army’s effort to address sleep problems Col. Jeff Clark, who leads Army Medicine’s Performance Triad Sleep Health Work Group, said that Horoho recently chartered a work group to develop a Sleep Health Action Plan.

“This Sleep Health Work Group is one subset of the Performance Triad, which also includes an Activity Work Group and a Nutrition Work Group,” he said in a written statement to U.S. Medicine. “The Army Medicine Sleep Health Work Group’s mission is to develop a comprehensive Sleep Health Action Plan in order to change our Army’s (leaders, soldiers, civilians, families) mindset about sleep and transform sleep into a foundational component of individual and collective cognitive and physical well-being and readiness.”

Clark further explained that, although the Sleep Health Action Plan is based “on a universal approach to this public-health challenge,” there also will be increased screening for sleep disorders during annual health assessments and primary-care visits.

“The Action Plan, which is still awaiting approval, will outline specific measures to promote the sleep health of our leaders, soldiers, civilians and families,” he said.

“Poor sleep health” is a national public health issue, he explained.

“The vision is to have healthy and ready soldiers, civilians and families who have the knowledge, understanding, awareness, and life skills in order to prosper — personally, professionally, spiritually and in their relationships,” Clark said.

Getting Help

At the same forum where Horoho spoke, Sergeant Major of the Army Raymond F. Chandler III stressed that troops who have sleep problems should be encouraged to come forward to seek help.

Chandler made his comments in response to a question about whether troops who complain of sleep problems and are taken off deployment should be dismissed from the Army as unsatisfactory.

“They should not be dismissed from the Army because they are not unsatisfactory. They are doing what it is that we expect them to do, which is to say ‘I have a problem,’ and they are looking for help,” Chandler said.

Chandler said he personally has experienced sleep problems, getting about two to three hours of sleep a night for five years, awaking as often as nine times a night.

He pointed out that military medical professionals are equipped to help troops with sleep issues.

He also noted that some sleep problems relate to overuse of energy drinks.

1. Luxton DD; Greenburg D; Ryan J; Niven A; Wheeler G; Mysliwiec V. Prevalence and impact of short sleep duration in redeployed OIF soldiers. SLEEP 2011;34(9):1189-1195

2. Ribeiro JD, Pease JL, Gutierrez PM, Silva C, Bernert RA, Rudd MD, Joiner TE Jr. Sleep problems outperform depression and hopelessness as cross-sectional and longitudinal predictors of suicidal ideation and behavior in young adults in the military. J Affect Disord. 2012 Feb;136(3):743-50. Epub 2011 Oct 26.

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