An Initial Report of Sleep Disorders in Women in the U.S. Military

Abstract

Women in the U.S. military who have sleep disorders have a high rate of behavioral medicine and pain disorders. Interestingly, nearly 50% of active duty females referred for a sleep study have OSA while not necessarily manifesting the typical signs of obesity or increased age. The reasons for this finding are not completely understood, though factors related to military service may potentially contribute. The findings from our study indicate a need for increased awareness and evaluation of sleep disorders in women in the military, especially those with behavioral medicine disorders.

Sleep in the United States Military

“…OSA is pervasive in ADMP [5, 101, 102], similar to studies of OSA prevalence and severity with respect to biological sex in civilian populations [139–141]. However, salient differences between the patient populations of civilian studies [139–142], as compared to ADMP studies [5, 102], exist. Namely, ADMP diagnosed with OSA are younger (<35 compared to >40 years of age), have lower BMI (<28 compared to >30), and are more physically active than civilian counterparts; age, BMI, and physical activity are three key predictors of risk for OSA, in general.…”

“…Achieving adequate amounts of restorative sleep is an ongoing problem that is critical for reasons of personal safety, unit performance, and even a matter of national security. Although there are educational resources in place for optimizing sleep in military personnel (e.g., Army Office of the Surgeon General’s Performance Triad (P3) initiative), poor sleep hygiene in the long-term can increase sleep problems co-morbid with physiological and psychological issues that include: cardiovascular disease [1], substance abuse [2], post-traumatic stress disorder (PTSD), and mood disorders [3–5].…”

“…The first step in treating insomnia is identification of the underlying cause or causes contributing to the patient’s complaint, as often a symptom of an underlying psychiatric condition: PTSD, depression, generalized anxiety disorder, panic disorder, bipolar disorder, and substance dependence. In fact, several studies of active duty military personnel (ADMP) referred to a sleep clinic had insomnia co-morbid with chronic pain, PTSD, anxiety and/or depression [3–5].…”

“…Namely, ADMP diagnosed with OSA are younger (<35 compared to >40 years of age), have lower BMI (<28 compared to >30), and are more physically active than civilian counterparts; age, BMI, and physical activity are three key predictors of risk for OSA, in general. Greater than 30% of ADMP who present with a sleep disturbance have insomnia co-morbid with OSA [5, 101, 102]. Of greatest concern in the OSA studies in ADMP is the high degree of co-morbidity of insomnia and OSA with other physiological (chronic pain) and psychological (anxiety and depression) health states, specifically for women [5, 102].…”

“…Although there are far fewer female service members compared to males, recent US government regulations now allow females to serve as combat arms officers and in forward operating units. Whereas studies of insomnia co-morbid with OSA in ADMP do not show any sex differences in self-reported sleepiness and insomnia [5, 102], polysomnography revealed a two-fold longer sleep-onset latency for women with an insomnia-OSA diagnosis and differential time spent in light NREM and REM sleep compared to males [5, 102]. In addition, female service members with a sleep disturbance had greater co-morbidity of an insomnia-OSA diagnosis with anxiety/depression not seen in male counterparts [5, 102].…”