Behaviors likely causing lack of sleep
February 23, 2012
VILSECK, Germany -- Health professionals here recognize a common theme they see among Soldiers.
"We live in a sleep deprived society," said Brian Olden, Behavioral Health service chief for Bavaria Medical Department Activity. "I have read research that in the United States that maybe as high as 60 or 70 percent of people have sleep problems at sometime in their adult life."
Proper and enough sleep is important to healing injuries and having a healthier, more enjoyable life. Life challenges seem greater than they are when sleep deprived. Many people choose to stay up late to watch TV, play video games verses sleeping.
While Olden and his colleague, Maj. Joseph Dougherty, acknowledge sleep problems among Soldiers appear on par with the civilian sector, the cause can easily be explained.
"Not all sleep problems in Soldiers are related to deployment or combat," Dougherty said, who is the psychiatry consultant for BMEDDAC and an adult and child psychiatrist at the Vilseck Health Clinic. "If you take a fairly large percentage of young, otherwise healthy, active duty Soldiers with a high op tempo, alternating training cycles, and alternating sleep and wake cycles, we can expect a designated number of those individuals will have what we consider sleep problems. A sleep problem does not equate to a mental health issue or mental health diagnosis. There should not be a presumption that if someone is having a hard time sleeping that they necessarily have a mental health issue; it is often something that can be addressed by changing the environment with sleep hygiene principles."
Sleep hygiene is a practice of establishing good sleeping habits, Olden said, who has more than 20 years of experience working with military personnel as a clinical social worker.
"I would say 80 to 90 percent of the issues can be resolved with improving sleep hygiene," Olden said. "Make the sleep environment conducive to sleep."
To make an environment conducive for sleeping, sleep deprived people should do something relaxing and enjoyable before bedtime; make the bedroom quiet, comfortable and dark. Remove the clock from eyesight of the bed and exercising regularly, except in the late evening, are other recommendations for sleep treatment.
"Exercise regularly, though not late at night, and do something relaxing just before bedtime. Reading is a good idea," he said.
Using over-the-counter medications is not a good sleep treatment remedy for sleep deprivation, Dougherty said.
"An over-the-counter approach is used by some Soldiers," Dougherty said.
Non-prescription sleep aids are used by some, Dougherty said. This approach does not solve the root of the problem, which is getting enough undisturbed sleep, he said. Nor does alcohol.
"What I tell the Soldiers is that alcohol is not the solution to your sleep problems; it's not the solution to any of your problems really, but especially not sleep," Olden said. "Alcohol will disrupt your sleep cycle later in the night".
The challenge for people using alcohol on a nightly basis is tolerance, Dougherty said. While one drink or two drinks might initially be perceived as effective, people will find that as they become more tolerant of the alcohol; it is no longer effective in helping them fall asleep.
"When you take a look at the effects of alcohol on what we call the sleep cycle, the effects can be rather short-lived," Dougherty said. "There are different phases of the sleep cycle that people go through once they fall asleep and the Rapid Eye Movement phase tends to have a variety of physiological changes that occur."
According to the American Sleep Association, there are five phases of sleep. One through four and the last phases known as Rapid Eye Movement sleep. The phases progress in a cycle from stage 1 to REM sleep, and the cycle starts over again at stage 1. A complete sleep cycle takes 90 to 110 minutes on average.
"REM sleep is very important," Olden said. "That is the type of sleep you have when you are dreaming. There have been a lot of studies that have shown that if you do not have REM sleep that you will not be well rested."
Being well rested and getting at least four cycles of sleep greatly affects a person's attitude, cognitive process and performance, but it has the opposite effect on people who do not get enough rest, Olden said.
As behavioral health experts, Olden and Dougherty are knowledgeable of sleep cycles and sleep problems, but other health care professionals just as capable of addressing sleep related issues, Dougherty said.
"Treatment of sleep problems, at first pass, is a primary care issue and is something that can be addressed by primary care providers, physician assistants, nurse practitioners and physicians," Dougherty said
Soldiers whose dreams are characterized by bad experiences or traumatic events are more likely to be referred to behavior health professionals because it may relate more with psychological matters that affect sleep.
Soldiers experiencing reoccurring dreams related to a tragic or traumatic event may cause people to avoid sleep or seek medication so they can sleep, Dougherty said.
"If someone implements sleep hygiene and still has difficulties with falling asleep and staying asleep, on a case-by-case basis, medications may be appropriate, Dougherty said.