By Mr. Ronald W Wolf (Army Medicine)November 20, 2014
SAN ANTONIO (Nov. 20, 2014) -- Trauma, the kind a Soldier may have faced in combat in Afghanistan or Iraq, has effects beyond physical wounds and traumatic brain injury. Disturbances in the ability to get a good night's sleep following traumatic incidents are a real consequence of deployment for Soldiers. Army Medicine researchers are helping to focus on this issue.
In most cases, normal sleep patterns resume within 2 weeks for returning Soldiers who have trouble sleeping, for example, adjusting to changing time zones. Sometimes, however, normal sleep does not return so readily and is interrupted by sudden waking and movements, hypervigilance, shouting, and nightmares.
Although reestablishing normal sleep is only one important component of post-deployment readjustment, it is critical for Soldiers with post-traumatic stress disorder (PTSD). Proper sleep is acutely needed to help those with PTSD recover, and clinical help may be needed with sleep-related issues, such as nightmares, which are reported to be common in perhaps as many as 80 percent of those with PTSD.
An Army Medicine research team, led by Col. Vincent Mysliwiec, has proposed the term "trauma-associated sleep disorder" as a unique sleep disorder to help clinically address sleep difficulties. The team includes researchers at the University of Pittsburgh, School of Medicine.
The team's sleep disorder patients all reported no sleep disturbances prior to their traumatic experiences. In most cases, sleep difficulties occurred after return from a 6- or 12-month deployment, although one patient had not deployed but instead had a personal traumatic breakup with a fiancé.
Typical sleep problems included difficulty falling and staying asleep, nightmares, thrashing while asleep, and sudden waking with feelings of extreme anxiety. Sleep researchers also report that spouses often resort to sleeping in separate rooms as they fear bodily injury from nighttime thrashing of their bed partners.
Defining a new sleep disorder will provide another diagnostic tool for physicians to help individuals with disruptive sleep behavior. Currently, there is no specific diagnosis that covers trauma-related sleep disorders.
Mysliwiec and associates call for additional research in for their proposed diagnosis of trauma-associated sleep disorder. The clinical population in their study is small and more definitive answers on how to provide clinical care are likely to be learned with a larger group of subjects. Information to be gained includes the most appropriate medications or combinations of medications and refining the understanding of factors that influence trauma-associated sleep disorder.
Army Medicine emphasizes that sleep is an edge for the well-slept Soldier, as important as exercise and nutrition; this emphasis was made clear recently at a professional meeting hosted by the National Sleep Foundation.
In the past, Soldiers have viewed sleep "as the enemy--the enemy of productivity, the enemy of vigilance, the enemy of being able to outlast our adversaries," said Maj. Gen. David Wilmot, Deputy Surgeon General for the Army National Guard, during a keynote speech to the National Sleep Foundation on Nov. 7, 2014.
"We helped to create a 'war on sleep', and to propagate that the foolish notion that the need for sleep was a sign of weakness," he said.
The enemy is the inability for Soldiers to get healthy sleep. Here a few tips for those who simply need to improve their sleep routine:
• Keep the bedroom quiet, dark, cool, and comfortable.
• Follow a routine. Go to bed and wake up at the same time. This can help encourage to body to feel sleepy at bedtime.
• Remove electronics from the bedroom
• Stop caffeine use 6 hours before bedtime.
• Avoid alcohol as a sleep aid. It may actually cause less restful sleep.
Army Medicine aims to create a culture that prioritizes and values sleep. Part of this change in culture is providing clinicians with the diagnostic tools necessary to improve sleep for Soldiers recovering from trauma, and Col. Mysliwiec and his group are one of the leading research teams in this area.
For all Soldiers, Army Medicine is helping to change the individual and military mindset that sleep is of low importance in maintaining good health. Sleep and proper sleep habits are now widely understood to be both a key to overall health and an important component to speed recovery from both physical and cognitive trauma.
The bottom line: Soldiers should receive a good night's sleep and not have to fight their battles privately to get it.