CAMP HOVEY, South Korea -- He lied restlessly in bed and wide awake. The clock stared back at him with an ominous glow of its digital numbers: 3:32 a.m. He couldn't remember the last time he had a good night's sleep.
He turned over. He just couldn't get comfortable. No matter how much he tried, it just didn't seem to be a way to get into a position that would allow him to fall asleep.
The moon shined oppressively through the windows and invaded his bedroom with its white light. His mind kept racing through the next day's problems and yesterday's faults.
What if he did this? What if he did that? Maybe if he was just able to focus on his family and get his work done than none of this… Wait! This is what he was thinking a few hours ago. His mind was going in circles. He knew he needed help.
Many people have experienced similar situations to the one described above and according to a paper from the Institute of Medicine Committee on Sleep Medicine and Research titled Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem, an estimated 50-70 million Americans chronically suffer from sleep disorder and wakefulness, hindering daily functioning and adversely affecting health and longevity.
"The first thing a person should do if they are experiencing sleep problems is examine their sleep setting, in other words the bedroom," said Maj. Adrian Johnson, a behavioral health officer with Company C, 302nd Brigade Support Battalion, 1st Armored Brigade Combat Team, 2nd Infantry Division. "If the bedroom has inviting things such as a television and a game system, which people may think aids them in falling asleep, it actually detracts from good sleep. The bed should be used only for sleeping or intimate activities with your partner."
For most Soldiers, if they are told to put on their physical training gear they would assume they are going to do PT and that's because overtime they have learned when they are in their PT gear that is what they do, said Col. Vincent Mysliwiec, a sleep medicine specialist with 121st Combat Support Hospital, Brian Allgood Army Community Hospital in Yongsan, South Korea. For individuals who have difficulty falling asleep, a lot of times they learn to do other things in their bed and it is typically a chronic process where they might have started playing on their computer, looking on their phone, watching TV, or worrying in bed. Overtime they learn not to sleep in bed.
By removing all those distractions, people can turn their bed back into a place to sleep, said Mysliwiec. This also means if they go to bed, don't fall asleep and start to toss and turn, they should get out of bed. If they awaken in the middle of the night and can't fall back to sleep, they need to get out of bed.
"I strongly discourage individuals from watching the clock at night," said Mysliwiec. "We don't want them to focus on time because, especially in our military culture, the duty day is very structured and you have to be on time and so you should not look at the clock at night. The clock should be in your room with the alarm set, but it should be something that you have to get out of bed to turn off and should be something that you cannot see from your bed."
It is about creating a peaceful, good sleeping environment and keeping to the same sleep schedule, said Mysliwiec. If people value their sleep, they need to put time and effort into planning things such as how to make their bed and room temperature comfortable, and ensuring they have a sleep ritual to help them unwind a little bit. They need that relaxation period because the brain doesn't turn off instantaneously.
People should not exercise two to three hours before going to bed because that stimulates the heart and body, said Johnson. If the heart rate is elevated, it is going to take that much longer for a person to fall asleep.
"Sleep is an essential biological requirement, just like food and water, and so if we don't get enough water, we know that we will become a heat casualty, especially in certain environments or if we are physically active," said Mysliwiec. "Sleep is the equivalent whereby throughout our day we do many mental activities which drain our mind and make us fatigued."
Mysliwiec said being tired and sleepy are two different things. Being sleepy is having the sensation of wanting to close your eyes and nodding off, while being tired is not wanting to move. People commonly combine both sensations when they say they feel sleepy.
"Sleep is a different state of being," said Mysliwiec. "We can exist in three states of being: rapid eye movement sleep, non-REM sleep, and wakefulness." The difference between non-REM sleep and REM sleep is as different as non-REM to wakefulness or REM to wakefulness."
They are all very distinct states of being, Mysliwiec said. He makes the distinction because during non-REM sleep the body recovers and secretes important hormones that allow the body to grow and recuperate. This differs from REM sleep, which is where people will typically process memories, have most of their dreams and a time for their mind to recover.
"Our bodies run according to a certain circadian rhythm," Johnson said. "Essentially a day time clock and a night time clock. If you are depriving your body of that opportunity to get natural sleep, you will begin experiencing symptoms of sleep deprivation."
"If you deprive someone of REM sleep, they will not think well, will be more depressed and more anxious," said Mysliwiec. "If you deprive someone of non-REM sleep, a lot of times their body is not going to recover fully…."
A lot of it is determined from the sleep architecture because, as a person goes through seven to eight hours of sleep a night, they are going to have more slow wave sleep upfront and later on have periods of REM sleep, Mysliwiec said. There is a distribution throughout the sleep period where a pattern can be seen. People have to go through that whole pattern to have restorative sleep.
People can think of sleep as a resource, such as fuel, water and nutrition, said Mysliwiec. There are missions that have to go for 24 hours and people can function without sleep, but there is going to be a decrement in their ability to perform their military duties. People should plan missions with sleep in mind.
Mysliwiec said people can lessen the effects of sleep deprivation during long operations by taking precautions such as allowing Soldiers seven to nine hours of sleep regularly for five to seven days before the mission and allowing Soldiers to sleep who are not mission essential at the moment.
"When you come off of mission, then you have to allow them recovery sleep," Mysliwiec said. "They are going to sleep maybe ten to twelve hours, depending how long they received insufficient sleep during the mission. Typically they will be recovered back to a near-normal baseline in two to three days of allowing more than usual sleep."
Mysliwiec said he is a big proponent of avoiding medications to help an individual sleep. The reason is because people have the potential to become reliant on medication when they use it for more than one to three days. They find they cannot sleep without the medication.
"The big problem, in terms of military personnel, is if you take any kind of medicine to help you sleep how do you awaken without having an impairment," said Mysliwiec. "If you take it and there is an alert in two hours, are you then fully mission capable to perform your required military duties? I am going to say at that point in time you are going to be impaired because most of the medications… are going to be active in your system longer than that."
"One of the things you want to be aware of for an individual experiencing sleep difficulty is sometimes there are medical reasons that might impede sleep," Johnson said. "You want to check with your primary care physician first if you are experiencing issues because they may be medically related."
In addition to the commonly know insomnia there are other parasomnias such as hypersomnia, said Johnson. Hypersomnia is a disorder related to sleeping too much. A person experiencing hypersomnia may have difficulty waking or they are just sleeping all throughout the day.
"These sleep disorders can cause distress, whether it be occupationally, socially, or emotionally," said Johnson. "Stress could be in their private life with their family because they are sleeping all day and not spending time with the family. When sleep problems create significant distress in some area of their life, they should seek help."