Article at a Glance:

• In order to function and feel thier best each day, most adults need between 7-9 hours of rest at night.
• Sleeping is the most effective thing we can do to reset our brain and body health each day.
• Sleep disturbances are a common reaction to stress and are linked to a host of physical and mental health problems.
• Sedation is not sleep.
• Getting adequate sleep is crictical to mission success.

Why Sleep is so Important for People in the Military

Sleep requirements may vary slightly from person to person, but most adults consistently need between 7-9 hours of rest at night in order to feel and function at their best the following day. Unfortunately, there’s no such thing as sleeping-in in the military, as soldiers are highly disciplined top performers that are expected to adhere to standards based on the bedrock of readiness. Between rigorous training schedules, rotating shift work, and combat, more than 40% of soldiers often survive on less than five hours of sleep (National Sleep Foundation).  Under extreme circumstances, soldiers might even stay awake for days at a time, which can have profound consequences on health and performance.

Effects on the Brain and Body 

The reality is that sleeping is the most effective thing we can do to reset our brain and body health each day. Think of the brain as a filing cabinet for your mind, in which sleep helps sort the information, experiences, and memories that have accumulated throughout the day. Once these items have been sorted, more room is created in your brain to form new associations tomorrow. This process is crucial for military personnel that need to interpret data and make important and/or fast decisions on the job. 

The brain also acts as a plumbing system by discarding toxins from the body. This brain drain process is specifically activated during sleep and can help prevent the onset of neurological diseases. Conversely, sleep deprivation makes us exponentially more vulnerable to a slew of health conditions, including but not limited to: 

• Insomnia 
• Weight gain 
• Mood disorders 
• Diabetes 
• Heart Disease 
• Cancer 
• Alzheimer’s Disease 

For soldiers, inadequate sleep can also result in more accidents, poor morale, and impaired judgment. According to a 2015 report published by the U.S. Army, fatigue was a contributing factor in 628 Army accidents and 32 soldier deaths between 2011 and 2014. 

Sleep Disorders and PTSD in the Military 

85% of active duty military members are diagnosed with a sleep disorder, such as sleep apnea or insomnia. Sleep disturbances are a common reaction to stress and are linked to a host of physical and mental health problems, including increased risk of depression, suicide, posttraumatic stress disorder (PTSD), accidents and injuries, cardiometabolic disorders, and mortality (NCBI). 

The American Psychiatric Association defines Posttraumatic Stress Disorder (PTSD) as a psychiatric disorder that can occur in people who have experienced or witnessed a traumatic event such as a natural disaster, a serious accident, a terrorist act, war/combat, rape, or other violent personal assault. Also known as “shell shock” or “combat fatigue” throughout the years, the prevalence of PTSD in military soldiers varies by service era and can manifest in many ways.  

People with PTSD may experience intense thoughts and feelings or find themselves reliving specific events long after they originally occurred. This can result in overexpression of normal mental and physiological processes, such as the fight-or-flight response. When you’re in significant danger, like in combat, acute stress to the body causes a flood of hormones (e.g. adrenaline) that can potentially save your life in a life-threatening situation. However, PTSD can cause thoughts, emotions, and hormones to go rogue. Trauma-related nightmares (TRN) have been referred to as the “hallmark” of PTSD, with rates as high as 90% in military personnel.  Research also suggests that this type of sleep disturbance can subsequently worsen and perpetuate the symptoms of PTSD. 

The cognitive, emotional, and physiological stresses associated with sleep loss can drastically impair essential abilities for soldiers to fulfill their duties – such as reaction times, the ability to detect and engage the enemy, and squad tactic coordination (Performance Triad). While the military has historically prided itself on grooming soldiers that are able to function on suboptimal amounts of sleep, this poses serious safety risks — not just for individual soldiers, but for their peers, military leaders, and civilians as well. 

Sleep Affects Mood and Emotions Too 

For years, insomnia has been labeled as a core symptom of depression, but new research suggests that it’s actually the root cause of many mental health conditions, including depression, anxiety, and paranoia. According to the Great British Sleep Survey, sleep-deprived people are seven times more likely to experience feelings of helplessness and five times more likely to feel lonely than people who get the recommended 7-9 hours of sleep each night. 

Humans are notably 60% more emotionally reactive when they don’t get enough rest. The amygdala is responsible for triggering emotions, and it is excessively reactive when sleep deprived. We also lose some control from the prefrontal cortex – a part of the brain that is responsible for helping us make rational decisions. 

Matthew Walker, a sleep scientist,e and professor at UC Berkeley, says that “Without sleep, our brain reverts to a primitive pattern of uncontrolled reactivity. We produce unmetered, inappropriate emotional reactions, and are unable to place events into a broader or considered context.” Walker affirms that getting adequate sleep helps regulate (or put the brake on) the amygdala, our “emotional gas pedal”. 

The Stigma Around Getting Help 

Resiliency, even under the most extreme pressure, and/or without adequate rest, is perceived as a strength in the military. The downfall to this “always ready” mentality is that it’s not sustainable or safe. Despite public and familial encouragement for soldiers to talk to professionals about their mental state, the stigma that displaying psychiatric symptoms is a sign of weakness or cowardice persists.  

According to military standards, any history of mood disorders requiring medication and/or outpatient care for longer than six months by a mental health professional disqualifies individuals from appointment, enlistment, or induction into military service. Because of the Armed Forces’ strict criteria, many active soldiers consciously avoid talking to doctors at all because they don’t want to risk losing their job. (This can have its own set of consequences when soldiers return to civilian life – at work and at home.) Those that do eventually work up the courage to get help – whether it be to induce sleep or reduce pain – often receive antidepressants, anti-anxiety medications, or sleeping pills that fall within the category of high-dose opioids. This prompts another huge issue: chronic use of these medications can exacerbate sleep problems and/or lead to opioid addiction. 

Sleep is the Best Drug 

Hypnotics like Ambien and Lunesta do NOT provide the kind of sleep that your body actually needs.  According to Professor Walker, these drugs switch off your prefrontal cortex and put you into a state of unconsciousness. “The drugs actually sedate you,” he says, and “sedation is not sleep.” 

Earlier this year, the FDA released a safety announcement that highlighted the potential health risks associated with hypnotic drugs: 

Serious injuries have happened with certain common prescription insomnia medicines because of sleep behaviors, including sleepwalking, sleep-driving, and engaging in other activities while not fully awake. These complex sleep behaviors have also resulted in deaths. These behaviors appear to be more common with eszopiclone (Lunesta), zaleplon (Sonata), and zolpidem (Ambien, Ambien CR, Edluar, Intermezzo, Zolpimist) than other prescription medicines used for sleep. 

As a result, we are requiring a Boxed Warning, our most prominent warning, to be added to the prescribing information and the patient Medication Guides for these medicines. We are also requiring a Contraindication, our strongest warning, to avoid use in patients who have previously experienced an episode of complex sleep behavior with eszopiclone, zaleplon, and zolpidem. 

Using alcohol or drugs may help induce sleep faster at night, but sedation prevents the occurrence of REM, the “dream” stage of sleep. During REM sleep, the brain shuts down all muscle function (except the diaphragm) and is completely devoid of noradrenaline — a hormone that is commonly associated with anxiety and mood disorders. This is also when key emotional and memory-related structures of the brain are reactivated. REM is like overnight therapy in that it allows us to re-process difficult or traumatic experiences in a safer, calmer environment.  

Note that in cases of REM Behavior Disorder (RBD), brain control of muscle paralysis is impaired, resulting in people acting out dreams during REM sleep, sometimes causing injuries to themselves or their partners. It is estimated to affect less than 1% of the general population, and veterans with PTSD make up a huge part of that demographic (Science Daily). 

Natural Methods for Inducing Better Sleep, Faster 

Soldiers are taught the military method to help induce sleep in under two minutes, but that doesn’t make up for the lack of total sleep they are getting each night. Here’s a list of ways that military personnel can improve the quality of their rest, even if they have a limited time to do so: 

• Turn the bedroom into a cave-like environment by keeping the temperature cool and the room as dark as possible. Soldiers that are deployed in warmer areas can use fans and cold, wet rags to help cool the body down. Sleep-hacking glasses that specifically block out 100% of blue, green and violet light will help the brain transition into an alpha (or meditative) state so that you can fall asleep faster and rest more deeply. 
• Minimize screen time in the hours leading up to sleep. It’s not just the junk light from your digital device’s LED screen that can prolong sleep; these devices are stimulating and make it difficult for your brain to “shut off”. 
• Limit caffeine intake. Caffeine is a stimulant, meaning it gives you a boost of energy. Since it can take 6-8 hours to eliminate caffeine from the body, it’s recommended that you stop consuming this substance around 2 PM. This may be more difficult for soldiers to adhere to, especially if they are working rotating shifts. Just remember to give yourself time to digest in the hours leading up to bedtime. 

The Bottom Line 

Getting adequate sleep is critical to mission success – in training, on the battlefield, and at home. While overdosing on pills is clearly not the right answer, proper dosages of prescribed medication may help soldiers mitigate pain and improve the quality of their sleep. More work still needs to be done to remove the stigma around getting help from doctors, especially when it comes to mental health. It is critical that we all pay more attention to soldiers’ sleep in order to protect their health on and off duty. As Walker says, “Sleep is the greatest legal performance-enhancing drug that most people are probably neglecting.”