Factoring In Combat Experiences

Since May 1994, Panettiere and his colleagues at NICoE have studied patients with sleep disorders. Most were male, and all were people who had no complaints before being injured.

Approximately 41% had sleep-disordered breathing, such as sleep apnea, which is nearly double the rate in this group as seen in the average population. With sleep apnea, patients can actually stop breathing in the middle of the night and wake themselves up. This can cause significant fluctuations in heart rate and blood pressure. 

“In normal sleep your heart rate drops about 20%, and in this condition it goes up about 20%,” Panettiere said. “So when a patient says they feel like they’re worse in the morning than when they went to bed, they’re probably right, at least physiologically.”

The most common treatment is positive airway pressure (PAP) therapy, also widely used in the general population.

For other sleep-disorder symptoms, such as nightmares and insomnia, Panettiere has developed more veteran-specific solutions.

“If you had PTSD and TBI together, your chance of having insomnia is 92.9%,” Panettiere said. “Insomnia is not an area of medicine a lot of doctors are interested in doing. It takes a lot of time, a lot of visits, and there’s not a procedure tied to it. But I’ve always had an interest in it, and there’s a time in everyone’s life when they’ll suffer from insomnia.”

One of the common ways a person tries to combat insomnia — staying in bed for as long as necessary until they fall asleep — is doubly ineffective for a veteran suffering from combat-related trauma and stress. “For our troops, all that quiet with nothing to do but ruminate. Instantly, they’re back in Iraq, thinking about what could have, should have, all those things,” Panettiere said.

Instead of having these memories and thoughts creep up on them when they are at their most vulnerable, Panettiere advises veterans to tackle them head-on.

“I tell soldiers to write it down in a journal,” he said. “Don’t do it in bed. Do it in the family room. You know you’re going to think about it. It’s not going away. It’s going to be there. You have unprocessed feelings. You’re taking it out of your head that day, closing that day down and setting up a perimeter of sleep to start the next day.”

The treatment for recurring nightmares — image-rehearsal therapy — is also proactive. Panettiere has veterans record the dream in detail.

“That can be tough for them, particularly if it’s combat-related,” he said. “I tell them to write it down, then change the beginning, the middle or the end of the story to something less emotional.”

The veterans are told to read over the dream sometime during the day, so it is fresh in their memory. Soon, the veteran is dreaming that scenario regularly, rather than the previous nightmare.

“Then I have them change it again,” Panettiere said. “To something even less [disturbing].”

Eventually, the dream no longer resembles the event that spawned the original nightmare. This is particularly effective in combination with the mental healthcare the patient receives from other physicians at NICoE.

“The psychologist and psychiatrists are a huge benefit for me,” Panettiere said. “I could not treat these [sleep disorders] without the veterans working on other issues.”

National Intrepid Center of Excellence (NICoE)

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