By David VergunMarch 22, 2017
WASHINGTON (Army News Service) -- The quality of Soldiers' sleep has a direct bearing on readiness, according to Col. Vincent Mysliwiec.
Despite the medically proven linkage between sleep and readiness, all too often sleep is viewed as a luxury by some in the Army, he said.
The Army doctor and sleep researcher provided some tips on getting a good night's sleep, which he said will result in increased productivity at work, as well as a reduction in injuries, errors and accidents.
TIMING IS EVERYTHING
Many Soldiers already know they should be getting at least seven to eight hours of sleep each night. Yet probably more than half of them get six or less, he said. And many are unaware that the time they go to sleep can be just as important as how long they sleep for, he said.
Soldiers on weekends tend to shift their sleep patterns, going to bed much later and waking up much later than on weekdays because of their military requirements.
That shifting of sleep times throws off the circadian rhythm, the body's biological clock, he said. If the circadian rhythm is askew, fitful sleep or even a sleep disorder could result.
A shift of one hour probably won't throw off the circadian rhythm -- say going to bed at 10 p.m. and waking at 6 a.m. on weekdays and 11 p.m. to 7 a.m. on weekends. But a shift more dramatic than that could cause problems.
A note of interest: Travelers flying from the West Coast to the East Coast often report difficulties sleeping because of the three hours lost during the time zone shift, he added. Flying the other way has less of an impact.
FIRE WATCH DUTY
Soldiers are often called upon to stand fire watch duty, which may be for one-hour-a-night shift rotations. Mysliwiec said that type of schedule can lead to fitful sleep, depriving Soldiers of the quality sleep they need.
It's much healthier to let a Soldier go without sleep for one night and stand fire watch, allowing him or her to catch up on sleep the next day, he said.
If conducting a long-duration operation that's known ahead of time, it is beneficial for Soldiers to get some sleep, even if it's just an hour or two, before it starts, so the sleep debt doesn't accrue quite as fast. Mysliwiec termed this "prophylactic napping."
Once the mission is completed, Soldiers should be allowed time for recovery sleep, he said.
The two most common sleep disorders in the Army are insomnia and obstructive sleep apnea, Mysliwiec said. Narcolepsy --- a tendency to fall asleep on duty -- doesn't appear to be a common sleep disorder among Soldiers.
Daniel Taylor, a sleep researcher, found that about 20 percent of the 4,000 Soldiers he studied at Fort Hood, Texas, had insomnia, according to Mysliwiec. The study also showed that insomnia was linked to a greater severity of post-traumatic stress disorder, depression, fatigue, stress, headaches, anxiety, mental health, alcohol use and pain.
Obstructive sleep apnea is also linked to a greater severity of post-traumatic stress disorder, anxiety, depression, chronic pain and traumatic brain injury, though Mysliwiec noted that a linkage does not necessarily point to the cause of that ailment or disorder, but instead indicates a possible contributor.
Studies have shown that, if left untreated, people with obstructive sleep apnea are cognitively impaired and twice as likely to be involved in a motor vehicle accident, he said.
From 1998 to 2013, the diagnostic rate for obstructive sleep apnea for Soldiers increased about 600 percent, most likely because the disorder was under-recognized in the past, he said.
Likewise, the diagnosis for insomnia is much higher today than when Mysliwiec entered the Army in 1988. From about the time operations in Iraq and Afghanistan started, there was a greater awareness of these sleep disorders.
The preferred treatment for sleep apnea is continuous positive airway pressure device, or CPAP, he said. CPAP is a mask that fits over the nose and mouth and gently blows air into the airway to help keep it open during sleep.
In order to improve readiness, Army sleep physicians and dentists are also working together to treat obstructive sleep apnea with oral appliances. For some Soldiers, oral appliances can be as effective as CPAP.
For insomnia, the preferred treatment is cognitive behavioral therapy for insomnia, Mysliwiec said. There are two key tenets of cognitive behavioral therapy for insomnia. The first is called "sleep restriction." That means limiting your time in bed if not sleeping.
If a person is in bed for eight hours but sleeps in it for just six, his or her sleep efficiency is 75 percent, which is not good. Their sleep quality would improve if they spent just 6.5 hours in bed but slept 6 hours.
Rather than lie awake in bed, the person should get out of bed and do something relaxing and sedentary like reading a book, knitting or doing a puzzle. "The more boring the better," he said. Don't watch TV and don't use an electronic device because the light stimulation from those will not be sleep inducing.
The second tenet of cognitive behavioral therapy for insomnia, he said, is called "stimulus control." That means using the bedroom only for sleep or relationships, not as an entertainment room.
The bedroom must also be kept dark. "If you see my bedroom there's nothing there basically but the bed. There are no electronics, and my cell phone, which is used as my alarm, is 10 feet away on silence mode where I can't see the light," he said. "My bedroom is geared toward sleep. You have to have the mindset for sleep."
"We're a high-risk organization and it's a stressful occupation," he added. "You have to be heavy on [the] preventive side" when it comes to managing sleep.
How do Soldiers get help for sleep problems? They ask for it. A Soldier may seek help after getting involved in some sort of accident in which fatigue is a contributing factor, or the Soldier may be diagnosed as suffering from a sleep disorder while seeing the doctor for some other reason.
Increasingly, the Army's wellness centers at various installations are providing sleep information and help for those who ask for it, Mysliwiec said.
As for Mysliwiec, he and other sleep specialists brief Army leaders on sleep and readiness as part of their normal duties. Mysliwiec recently briefed Gen. Robert B. Abrams, U.S. Army Forces Command on the topic.
For Soldiers seeking more guidance on sleep in the operational setting, Mysliwiec highly recommends reading just four pages on sleep, contained in chapter 2 of Army Techniques Publication 6-22.5, "A Leader's Guide to Soldier Health and Fitness," Feb. 10, 2016.
(Follow David Vergun on Twitter: @vergunARNEWS)
(Editor's Note: Col. Mysliwiec has several roles in his current assignment. He's the Sleep Medicine Fellowship director at San Antonio Uniformed Services Health Educational Consortium, Joint Base San Antonio, Texas, where he trains sleep medicine fellows. He's the sleep medicine consultant to the Army Surgeon General. And, he's a sleep researcher, working out of the Wilford Hall Ambulatory Surgery Center, Lackland Air Force Base, Texas.
Daniel Taylor, a researcher at Northern Texas University who studied the Fort Hood Soldiers cited in this article, published his work in the journal "Sleep," titled "Prevalence, Correlates, and Predictors of Insomnia in the U.S. Army Prior to Deployment," volume 39, pages 1795-1806, Oct. 2016. )