Sleep is one of the most important behaviors we can do everyday. So many processes take place while we are sleeping, including growth, tissue repair, memory consolidation, and immune defenses. When we do not get enough sleep, these processes cannot happen, leaving us prone to injury, illness, and other health problems. Veterans, specifically, are at high risk for having sleep disturbances. There are a variety of reasons for this, but the mental, emotion and physical stress of being a veteran means that sleep is even more imperative to this special population. Below is some information on why veterans cannot sleep and what are some steps they can take to get their sleep schedule back on track.
Prevalence of sleep disturbances in veterans with PTSD
Post-traumatic stress disorder (PTSD) is the brain’s response to experiencing or witnessing something traumatic. For veterans, that can be a myriad of experiences, all of which change the formation of the brain into being hyperactive and alert with constant replays of the trauma that they may have experienced.
Insomnia, or the inability to fall asleep, is actually a diagnostic criteria for PTSD, which means that sleep issues and PTSD go hand in hand. Insomnia can be due to the hyperarousal state of the brain, frequent nightmares, and other physiological effects that cause the brain to be unable to go to sleep. Insomnia is reported in over 90% of military personnel with PTSD and almost 30% of those with PTSD.
Why veterans can’t sleep
PTSD is just one of the reasons that veterans cannot sleep. It is a complex array of symptoms including emotional, physical and chemical stress into an ongoing state of hyperarousal for many military returning from combat. PTSD is difficult to diagnoses, and even more difficult to treat and live with.
Traumatic brain injuries (TBI) are another source of sleep problems. Concussions are mild TBIs and the more extreme and severe the impact is to the head, the more damaging it can be to the brain. TBI can alter behavior and brain chemistry. It can also lead to ongoing pain for months or years following injury.
Emotional trauma, chronic stress, depression and anxiety are also other culprits of sleepless nights. Most americans are familiar with the extreme tol that combat can have on military. They may lose peers on the job and loved ones at home. Hypervigilance and paranoia caused by stress and sleep deprivation are very common in the overwhelming uncertainty of combat. Also witnessing some of the violence and atrocity that happens in combat can create great psychological burdens on veterans.
Alongside emotional pain is also physical pain. A lot of veterans are dealing with residual injuries that even when treated, can cause other issues like headaches, neurological pain in chest, limbs, long-term painful conditions like arthritis and other chronic conditions that cannot necessarily be treated. Painsomnia happens when pain keeps individuals from falling asleep.
Tinnitus is “ringing of the ear” and can be common in those with hearing trauma. When soldiers come under fire, they experience the noise from explosions, incoming missiles, and other destructive efforts. Normally, they are not wearing protective headphones, and are subject to some damage. Tinnitus is a chronic ringing that can take place after. It can be so loud and distracting, that it alters some of their ability to live normally after returning.
Substance abuse is another huge source of sleep disturbances. Cigarettes, energy drinks and alcohol can have a negative impact ont he quality of life for both civilians and military members. Prescription drugs can also be abused and for those turning to illicit drugs, ina way to self-medicate against the stresses, may be having some sleep disturbances. Withdrawing from these substances can also be so painful, that it distributes their sleep.
Sleep problems common in veterans
There are sleep disorders that are common in veterans. One of them is nightmares. They are also diagnostic of PTSD and more than half of combat veterans report a significant nightmare problem several times a week. Several times a week, some traumatic event replays itself over and over, disrupting sleep every time. Veterans can also experience night terrors. These are anxious moments in the middle of the night that are terrifying for them and anyone else who may experience it like bed partners and other family members.
Sleep apnea is another problematic sleep problem for veterans. Many cases are not related to the common causes like obesity and poor health, but due to the neurological or physical damage suffered during service, or even substance abuse.
Movement disorders in the middle of the night like restless leg syndrome (RLS), parasomnias, and REM behavior disorder (RBD) can also impact sleep. RLS is an uncomfortable feeling or sensation that can only be relieved by moving the leg. Parasomnias are sleep disorders in which the central nervous system activates during sleep, often around arousals or transitions between sleep stages. This can lead to RBD and sleep paralysis. RBD takes place during the REM (rapid eye movement) cycle of sleep which is normally when dreams happen. Normally, the body is paralyzed during this part, but in RBD, it’s not meaning that these individuals act out their dreams. This can be traumatizing to everyone around them and they put themselves at risk of doing something dangerous like driving. Sleep paralysis is the opposite and involves the sleeper being awake, but being able to move. This can happen as they are falling asleep or waking up. Panic can happen, especially if the person is having hallucinations.
Another issue is also enuresis, or wetting the bed. It’s a form of night-time urinary incontinence that is more common in women, potentially due to the long-lasting psychological and psychiatric stresses of military service.
Improving sleep in veterans
Treating sleep in veterans is multidisciplinary. First, it needs to be determined that there are no physiological or neurological deficits that are causing sleep issues. When that is established, the cognitive-behavioral approaches can take place. Treatment options include: therapy, relaxation techniques, sleep restriction to reset circadian rhythms, medications, improved sleep hygiene, lifestyle changes, addiction rehab, and non-habit forming medications.
If you are having trouble sleeping, and it is causing debilitating effects on your life, DHS may have services that can work for you and your family. Please see what we offer and decide if we are a good fit for your family!
Resources:
https://www.ptsd.va.gov/professional/treat/cooccurring/sleep_problems_vets.asp
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