FALLS CHURCH, Va. (Army News Service, Dec. 14, 2015) -- Staff Sgt. Jacob Miller said he realized he was putting himself and others in danger more than once.
Miller, who spoke at the Army Office of the Surgeon General-sponsored Performance Triad Sleep Summit, Dec. 9, was describing his thoughts while driving home tired after long duty hours, sometimes 26 at a stretch, as a drill sergeant.
Since those long days "on the trail," Miller said Army guidance has directed more time for sleep for drill sergeants, but enforcement of that is still needed.
Miller, who was named the 2015 Drill Sergeant of the Year, added that a shift in culture and leader engagement are also necessary to change old thinking that going without sleep is the mark of a dedicated worker.
Besides safety, Miller said fatigue can impact Family relationships. Lack of sleep or poor quality sleep adds to the stress of daily life and decreases quality time with the Family.
The other two periods of sleeplessness, Miller said, were during two tours in Iraq as a military policeman. He said effects on performance were "really noticeable," but there were times when lack of sleep was unavoidable because of mission demands.
Col. Ramona Fiorey, acting director of Quality and Safety, U.S. Army Medical Command at the Pentagon, said senior Army leaders are taking sleep, along with activity and nutrition, seriously now. Those three things are termed Performance Triad and are considered key factors to increasing performance and resilience and reducing injuries and accidents.
SLEEP DATA LACKING
Lt. Col. Angela Simmons, chief, Center for Nursing Science and Clinical Inquiry, Madigan Army Medical Center, Joint Base Lewis-McChord, Washington, said there's a lack of data linking safety to sleep within the Army and more needs to be done in that respect.
Col. Samual Sauer, director of Trauma Care Delivery, Joint Trauma Center, United States Army Institute of Surgical Research, Joint Base San Antonio, Texas, said "you can't fix what you can't measure." He noted that data for how lack of sleep results in accidents is hard to come by because there's no definition of what fatigue is, so it's not being measured.
The solution, he said, is to "develop a standardized lexicon to use at safety centers for analysis." That would facilitate data collection.
SLEEP TRAINING NEEDED
Maj. Sharron Lankford, G-3/7 at Army Medical Department Center and School, Joint Base San Antonio, Texas, said Performance Triad, including sleep, needs to be built into programs of instruction at the school houses, as well as at recruit training.
Maj. Joseph Dombrowsky, a family physician sleep specialist on Fort Belvoir, Virginia, said primary care physicians are "ill-equipped" to handle sleep issues because of lack of training in diagnosis and treatment.
Furthermore, many physicians are not getting adequate sleep, he said, so "if they don't do it for themselves, how can they help their patients?"
Maj. Scott Williams, chief of the Sleep Clinic at Walter Reed National Military Medical Center, Maryland, said it's important that sleep get its own "area of concentration," or AOC. Having its own AOC would mean that doctors, health providers and military psychologists could get in-depth sleep training, which would enable them to have sleep be their secondary specialty.
Maj. Amy Thompson, a brigade combat team surgeon on Fort Riley, Kansas, said she'd like all of her doctors and physician assistants to get training in sleep-related issues, as she has seen the negative impacts lack of sleep has on readiness. She suggested that training take the form of a mobile training team since travel costs for everyone would be prohibitive. About a 20-hour block of instruction would suffice.
Lt. Col. Ingrid Lim, sleep lead for Performance Triad, Office of the Surgeon General, Falls Church, Virginia, said there's an entire chapter on sleep in Field Manual 6-22.5 "Combat and Operational Stress Control Manual for Leaders and Soldiers."
However, not many Soldiers review the field manuals, she noted. The topic of sleep needs to be in other places too, when appropriate, such as Army Doctrine and Training Publications, the Engineer Handbook, the Ranger Handbook and so on.
As a result of the Performance Triad Sleep Summit, a number of working groups have been tasked with moving sleep to the forefront in terms of incorporating sleep into training and publications, she said. "It's still in the very early stages, but we're hopeful progress will be made."
PILOT STUDIES
Lim said five brigades have been involved in Performance Triad pilot studies and mid-term data is being collected.
Although information is still being collected, one significant change for Performance Triad has already been made, based on observations and interviews with participants, she said.
At the beginning of the study, squad leaders were tasked with coaching their Soldiers about Performance Triad. Now, the emphasis is on having platoon sergeants and platoon leaders take the lead on it because they can influence Soldiers "two levels up and two levels down."
She explained that while senior Army leaders and young Soldiers understand the importance of sleep, the mid-level leaders still don't have it in their culture. Platoon sergeants and leaders have a lot of influence with their first sergeants and company commanders and can better affect change.
(A follow-up article will address types of sleep problems Soldiers have and effective treatments.)
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