Wounded in Action: What the Sleep Community can Learn from Sleep Disorders of US Military Service Members

Abstract

Editorial-Shattuck and BrownThe tragic events of September 11, 2001, changed the fabric of American society in a myriad of ways. On that single day, thousands of lives were lost, all commercial flights were cancelled, and our nation and the world adjusted to a new normal that acknowledged terrorist organizations could dramatically disrupt our existence. For most civilians, the changes following the 9/11 attacks were slight inconveniences: for example, screening in airports and public buildings was heightened and travel restrictions were intensified. However, for members of the U.S. military, the events of 9/11 resulted in a significant increase in operational tempo and combat tours away from family and friends to support the operational mission of the "global war on terror."The military population enters service after being closely screened for illness and disability. In general, members of the military start out as comparatively healthy young men and women, entering the service between 17 and 20 years of age. 1 The entry and retention standards for US military service are rigorous: applicants must meet and maintain minimum standards in physical fitness, body fat, medical screening (to include both physical and mental health), and aptitude. 2,3 However, these relatively healthy individuals do not stay that way. The reasons for the change in their health status-in particular, the development of sleep disorders-is of paramount interest to the sleep community.The military has long been known for its culture of insufficient sleep. For many individuals in the military, sleep is considered a luxury or even a weakness. In his illuminating article on the ethical responsibilities of military commanders, Shay 4 argues that leaders must get adequate sleep in order to properly care for their troops. He cites historical examples dating back to the ancient Greeks which explore the origins of the mythical warrior who rarely sleeps. For millennia, military life and combat exposure have been inextricably linked to psychological stress and problematic sleep. Studies of "battle fatigue," now termed posttraumatic stress disorder, or PTSD, from as far back as the U.S. Civil War document the central role of sleep disorders following combat exposure. [5][6][7][8] The military culture requires round-the-clock operations, which produces acute and chronic sleep deprivation levels in a population that makes high-risk decisions and oper-EDITORIAL

The association of insomnia and sleep apnea with deployment and combat exposure in the entire population of US army soldiers from 1997 to 2011: a retrospective cohort investigation

“…Survey research suggests the risk of poor sleep quality and quantity in service members increases as a function of the number of deployments and the amount of combat exposure while deployed [16–18]. Given the dramatic increases in sleep disorders in military populations, it has been suggested a systematic, longitudinal evaluation of the impact of deployments and military service on chronic sleep problems postdeployment should be conducted [19]. Some evidence suggests that deployed and postdeployed service members sleep less and the quality of their sleep is diminished compared with those with no deployment experience, but there is no definitive longitudinal evidence directly associating deployment with postdeployment sleep disorders [8, 20].…”