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By Brenda L. Mooney
TACOMA, WA - Short sleep duration (SSD) is widespread among active-duty military personnel, with more than 40% of the subjects in a recent study reporting less than five hours a sleep per night.
The mean self-reported home sleep duration was only 5.74 hours per night, according to the study from researchers at Madigan Army Medical Center in Tacoma, WA, who called for a “cultural change” in how sleep is viewed in the military.
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According to the American Academy of Sleep Medicine, most adults need about seven to eight hours of sleep each night to feel alert and well-rested during the day.
“While sleep deprivation is part of the military culture, the high prevalence of short sleep duration in military personnel with sleep disorders was surprising,” said Vincent Mysliwiec, MD, the study’s principal investigator, lead author and chief of Pulmonary, Critical Care and Sleep Medicine at Madigan. “The potential risk of increased accidents as well as long-term clinical consequences of both short-sleep duration and a sleep disorder in our population is unknown.”
He and the other authors noted that, “The dramatic self report of [short sleep duration] in our cohort is consistent with prior studies and suggests the need for a cultural change toward appropriate sleep practices throughout the military.”
According to the authors, the study, published recently in the journal Sleep, is the first to systemically describe primary sleep disorders and associated comorbidities in a large cohort of military personnel referred with sleep complaints.1
It found that 85.1% of participants undergoing sleep studies had a clinically relevant sleep disorder, most - 51.2% with obstructive sleep apnea (OSA). Insomnia was diagnosed in 24.7%.
While the levels of OSA were consistent with diagnoses of primary sleep disorders among civilians, insomnia and behaviorally induced insufficient sleep syndrome (BIISS) were much greater - 24.7% and 8.9%, respectively, compared with 4.2% and 0.8% in civilian sleep centers.
“In the nonmilitary setting, individuals with insomnia and BIISS may not have obtained [polysomnograms] to arrive at a diagnosis,” the authors wrote. “This highlights a potential difference in sleep evaluations, because military service is a high-risk profession and ensuring the correct diagnosis is imperative. Notably, our results more closely reflect a recent report describing the prevalence of sleep disorders in North American police officers, where 40.4% screened positive for a sleep disorder with OSA and insomnia as the most common diagnoses.”
To reach their conclusions, researchers employed a retrospective cross-sectional cohort analysis of 725 diagnostic polysomnograms performed in 2010 at Madigan Army Medical Center in Tacoma, WA. Study subjects were active-duty military personnel from the Army, Air Force and Navy, overwhelmingly men (93.2%) with combat experience (85.2%).
The study pointed out “there is a gap in our understanding of the long-term health outcomes of military personnel with SSD and sleep disorders. Prospective studies examining the early assessment and treatment of those with sleep disorders would contribute to the understanding of this growing phenomenon in our military and veteran population.”
Medical record review indicated that 58.1% of the study subjects had one or more medical comorbidities, including:
• 22.6% with depression;
• 16.8% with anxiety;
• 13.2% with post-traumatic stress disorder; and
• 12.8% with mild traumatic brain injury.
Insomnia was found to be twice as likely in those with PTSD, and one and one-half times more likely in those with depression or pain syndrome.
Nearly a fourth of the servicemembers having sleep studies at Madigan during the time period were taking pain medications.
As for short sleep duration, according to the study, “This finding is consistent with prior studies of military personnel who habitually report SSD. Compared with civilian reports, these findings are substantially higher than the 9.3% prevalence reported in the adult population in the United States.
“Although these data are not particularly surprising for military personnel, the unique aspect is that the prevalence of clinically relevant SSD (<5h) is not different across diagnostic groups. Further, the self-reported home sleep duration is not different between military personnel in the control group and those in whom insomnia or moderate to severe OSA is diagnosed.”
One issue, according to the authors, is the “prevailing culture that ‘depriving oneself of sleep is a means of demonstrating mental and physical toughness.’”
On the contrary, they argue, “SSD is a significant health concern and potentially contributes to the growing number of military personnel with both sleep and comorbid medical disorders.”
“Mysliwiec and colleagues have made a significant contribution to our understanding of the link between sleep disorders and service-related illnesses associated with combat operations,” Nita Lewis Shattuck, PhD, and Stephanie A.T. Brown, MS, postgraduate students at the Naval Postgraduate School in Monterey, Calif., wrote in a commentary on the study.
“Their findings highlight the need for policy and culture change in our military organizations and continued research to understand and ameliorate the injuries these veterans have sustained. Better appreciation of the causal factors associated with veterans’ health will lead to better policies for transition to civilian life and ultimately minimize the cost of veterans’ health care to society,” according to the commentators.
1. Mysliwiec V, McGraw L, Pierce R, Smith P, Trapp B, Roth BJ. Sleep disorders and associated medical comorbidities in active duty military personnel. Sleep. 2013 Feb 1;36(2):167-74. doi: 10.5665/sleep.2364. PubMed PMID: 23372263; PubMed Central PMCID: PMC3543057.
2. Shattuck NL, Brown SA. Wounded in Action: What the Sleep Community can Learn from Sleep Disorders of US Military Service Members. Sleep. 2013 Feb 1;36(2):159-60. doi: 10.5665/sleep.2356. PubMed PMID: 23372259; PubMed Central PMCID: PMC3543067.