Sleep in the United States Military

Abstract

The military lifestyle often includes continuous operations whether in training or deployed environments. These stressful environments present unique challenges for service members attempting to achieve consolidated, restorative sleep. The significant mental and physical derangements caused by degraded metabolic, cardiovascular, skeletomuscular, and cognitive health often result from insufficient sleep and/or circadian misalignment. Insufficient sleep and resulting fatigue compromises personal safety, mission success, and even national security. In the long-term, chronic insufficient sleep and circadian rhythm disorders have been associated with other sleep disorders (e.g., insomnia, obstructive sleep apnea, and parasomnias). Other physiologic and psychologic diagnoses such as post-traumatic stress disorder, cardiovascular disease, and dementia have also been associated with chronic, insufficient sleep. Increased co-morbidity and mortality are compounded by traumatic brain injury resulting from blunt trauma, blast exposure, and highly physically demanding tasks under load. We present the current state of science in human and animal models specific to service members during-and post-military career. We focus on mission requirements of night shift work, sustained operations, and rapid re-entrainment to time zones. We then propose targeted pharmacological and nonpharmacological countermeasures to optimize performance that are mission-and symptom-specific. We recognize a critical gap in research involving service members, but provide tailored interventions for military health care providers based on the large body of research in health care and public service workers.Neuropsychopharmacology (2020) 45:176-191; https://doi.

Fatigue in Aviation: Safety Risks, Preventive Strategies and Pharmacological Interventions

“…These long-term detrimental effects of circadian rhythm disruption and fatigue have also been observed in other occupational areas. For example, poor sleep hygiene in the military has been associated with cardiovascular disease, substance abuse and mood disorders ( Good et al, 2020 ). Moreover, the International Agency for Research on Cancer in 2019 classified shift work involving circadian disruption as a probable human carcinogen, with positive associations between night shift work and cancers of the breast, prostate, colon and rectum ( Straif et al, 2007 ; International Agency for Research on Cancer (IARC), 2019 ).…”

Guiding principles for determining work shift duration and addressing the effects of work shift duration on performance, safety, and health: guidance from the American Academy of Sleep Medicine and the Sleep Research Society

“…5,[21][22][23][24] Mental fatigue is associated with considerable risks to employees, employers, and society at large. 5,9 Acute, short-term risks include reductions in performance, effectiveness, and productivity 5,25,26 ; increased errors and do-overs 26,27 ; absenteeism 24,28 ; "presenteeism," wherein the worker is on task but performing below capacity 26,28 ; ineffective teamwork 29 ; immoral or unethical behavior 30,31 ; reduced job satisfaction 32 ; degraded quality of life 33,34 ; decreased morale 29 ; reduced safety 35,36 ; workplace accidents and injuries 4,[37][38][39] ; motor vehicle crashes during the commute 40 ; and high-profile industrial catastrophes. 41,42 In addition to degraded physical and mental health, 43 long-term risks include reduced individual and community well-being as well as economic losses.…”

How sleep can help maximize human potential: The role of leaders

“…Field applications of sleep science are built on consensus guidelines 8,70 and statements 71 with tailoring to military populations and operational needs. Field interventions must be aligned with the relevant scientific data but also integrate smoothly into operations and support rather than limit mission accomplishment.…”