Clinical Topics   /   PTSD

Study: Much of Sleep Disruption in Returning Troops May Be Normal Reaction to Combat Stress, Not PTSD, Other Conditions

USM By U.S. Medicine
June 14, 2011

Washington – A normal reaction to combat stress may explain many of the sleep disturbances experienced by troops, not PTSD, TBI, major depression or other psychiatric disorders, according to new research.

That retrospective study, based on data from Walter Reed Army Medical Center (WRAMC) and presented recently at the American Psychiatric Association’s annual meeting, looked at sleep problems such as obstructive sleep apnea (OSA), excessive awakening and insomnia.

Sleep problems are common among servicemembers. In 2008, the U.S. Army reported that 8% of soldiers in Afghanistan were taking mental health-related medications to treat sleep problems, while, in Iraq, soldiers averaged only 5.6 hours of sleep per night. These sleep difficulties often continue to plague troops after returning home from a deployment.

In the recent research, lead investigator U.S. Army Capt. Vincent F. Capaldi, II, Sc.M., M.D., and his colleagues sought to understand the relationship between common combat-related conditions among active duty military personnel and the frequency of a diagnosis of obstructive sleep apnea (OSA) and other sleep problems.

For the study, Capaldi and his colleagues collected data from the electronic medical records of redeployed active-duty soldiers who had participated in an overnight polysomnographic sleep study at WRAMC. Participants included men and women between the ages of 20 and 55 who had complained of sleep disturbances.

The researchers discovered no statistically-significant difference in the rate of sleep apnea, excessive awakening, hypoxia or daytime sleepiness among sufferers of PTSD, TBI and their control group of “other,” which included patients with depression, anxiety and no diagnosis.

Servicemembers who sought relief from the sleep clinics had higher rates of psychiatric diagnosis than either the general population or veterans who either have normal sleep or whose sleep disruptions were not severe enough to cause them to seek medical help. It is well known that sleep disruptions occur in both PTSD and TBI, with nightmares and insomnia central to the diagnosis, and OSA, restless legs, sleep terrors, nocturnal anxiety attacks and sleep avoidance occurring in some cases.

Researchers found, however, that many of the symptoms experienced by soldiers who suffered from those conditions actually occurred in similar frequency as civilians treated at sleep clinics. For example, sleep apnea, which occurred in 76.8% of the soldiers in the study, occurs at a similar rate in civilians seeking treatment.

“In this study, we discovered surprisingly few and subtle differences in the sleep issues of soldiers with various psychiatric diagnoses, as well as between civilian and military sleep patterns among those with disturbed sleep,” Capaldi said in a written statement.

Research did show that participants with a PTSD diagnosis had more sleep arousals and higher rates of sleep apnea than participants without PTSD, which study authors said was consistent with prior PTSD research. In addition, the study found that participants with a TBI diagnosis experienced significantly less sleep apnea, spent less time awake over the course of the night and spent more of their time asleep in slow-wave sleep, which also was consistent with prior research on TBI sleep patterns and symptoms.

Capaldi said that, while sleep problems often start in the battlefield due to the 24-hour operations and the stress of war, it certainly does not mean that every soldier who has deployed will develop sleep problems or that all troops returning with sleep problems will be diagnosed with PTSD.

Still, “if a patient is complaining of sleeping difficulties it could be that they are, indeed, having other symptoms related to PTSD, and should be screened for PTSD,” he said.

Capaldi recommended routine screening for sleep problems in all combat veterans. “As part of a comprehensive evaluation, we know a lot of patients have sleeping problems,” he said. “It would be good to address those concerns because it can cause patients to not be compliant in other areas of their medical management, if they are feeling tired or fatigued or more agitated.”

Capaldi is a resident physician in psychiatry and internal medicine at WRAMC. Melanie L. Guerrero, M.D., and William D.S. Killgore, M.D. also participated in the study.

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