Tackling Combat Trauma Head On Helps Resolve Sleep Disorders

BETHESDA, MD —A problem with insomnia, one of the shared symptoms of TBI and PTSD, sometimes can be overshadowed by what seem to be more serious, immediate symptoms. For those suffering from sleep disorders, however, exhaustion can quickly take over their lives.

At the National Intrepid Center of Excellence (NICoE), which brings patients in for weeks at a time in order to tackle all of their symptoms comprehensively and holistically, sleep problems are taken very seriously. The treatment for those disorders frequently takes into account the combat trauma at the heart of the PTSD or TBI.

Earlier in the war, an Oregon National Guard soldier takes a few moments to catch up on some sleep on the hood of a Humvee in the north side of Fallujah. – Photo courtesy of the Defense Imagery and Video Distribution Center.

A good sleeper is someone who spends most of the night quietly asleep, awakens physically and mentally refreshed, has no great desire to nap during the day, wakes easily, dreams regularly and looks forward to going to bed. Someone with a sleep disorder sleeps in short, shallow spurts, awakens exhausted and can even dread going to sleep. Many patients suffering from PTSD and TBI resemble the latter more than the former.

In May, physicians at NICoE began testing returning veterans experiencing sleep disorders. Among patients who arrived at NICoE suffering from a TBI, 46% also were suffering from sleep disorders and 25% from excessive sleepiness.

Patients and, when applicable, their spouses were interviewed and given a polysomnogram — a one-night sleep study that gives NICoE physicians a picture of how the patient sleeps, Anthony Panettiere, MD, told an auditorium of physicians, researchers and veterans’ family members at the recent Trauma Spectrum Conference held at NIH.

“Insomnia is very present in the population we see at NICoE, but it’s almost never a problem for the sleep study. [The patients say], it’s because the technician was watching out for [them]. They’re safe in a locked building. They have someone watching them like a sleep-tech sentry. And, because of that, they’re able to relax better than normal and fall asleep.”

Constructing a Sleep Architecture

Panettiere, a neurology and sleep-medicine physician, uses that one night study to help construct a patient’s sleep architecture, which shows how much deep, restful sleep a patient gets.

“It’s possible to only get three hours of sleep, but if you get all that deep sleep done, then you can wake up and go out and be in combat and be relatively effective,” Panettiere said.

He also has patients wear a wrist monitor that tracks physical movement. Some patients complain that they get as little as an hour of sleep during a night, but the monitor shows that they are getting six or seven. If the patient is waking up frequently, however, they might not realize they are sleeping, or reap many benefits.

“If [they] keep waking up due to pain or hypervigilance, they’ll perceive that they’re not asleep,” Panettiere said. “It’s the equivalent of 40 naps. It’s not good. They’re very tired. But, they’re getting more sleep than they think they are.”

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