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On Research

Ashley Johnson's blog

A blog by Associate Editor Ashley Johnson


ashley.johnson@nsc.org


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When sleep won’t come

November 22, 2013

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Most of us have a night when we can’t fall or stay asleep. For many military veterans, those nights are the norm.

Veterans often find their sleep schedule has been thrown off by time spent in a war zone, and they can’t easily get it back on track when they return home. While deployed, they may have gone on night missions – in effect, shift work – that required a sense of hyper vigilance. Stress could result from seeing friends and enemies wounded, missing their families, and being in an unfamiliar setting. And returning to their own bed back at home doesn’t shield them from combat-related nightmares.

A recent study in the journal Current Psychiatry Reports highlights the link between insomnia and other health conditions among military personnel.

“The thing about insomnia,” lead author Dr. Adam Bramoweth told me, “is it’s a symptom of a lot of psychiatric disorders, but insomnia is also its own disorder.”

Bramoweth is a postdoctoral fellow in psychology at the VISN 4 Mental Illness Research, Education and Clinical Center at the Department of Veterans Affairs Pittsburgh Healthcare System. His study compiles recent research on deployment-related insomnia. Bramoweth noted that post-traumatic stress disorder is more prevalent among vets with insomnia, and sleep disturbances may be a precursor to depression. Insomnia also was found to often accompany traumatic brain injury.

Insomnia is more than a nuisance; lack of sleep can leave people too tired to function well at work and may be a risk factor for other health problems.

“The way I like to put it in perspective is it really can impact every area of your life,” Bramoweth said. “When it’s chronic in nature, it can be detrimental to quality of life and functioning.”

People with insomnia may try to compensate for lack of sleep at night by sleeping in on the weekend or going to bed earlier. “And what that does is really just messes up your schedule so your body doesn’t always know when it’s supposed to be tired,” Bramoweth said.

Another issue is someone with insomnia may develop a negative association with the bed. Because they fear a night of tossing and turning, being in bed produces anxiety, which works against going to sleep. That’s why they may fall asleep on the sofa but feel alert when actually getting into bed.

Treatment for insomnia focuses on adopting a consistent sleep schedule. Bramoweth said the National Institutes of Health recommends cognitive behavioral therapy for insomnia to help people develop strategies to address their sleep troubles.

When treatment is successful, it’s not necessarily the number of hours of sleep that change but the quality of sleep, according to Bramoweth. Instead of waking up repeatedly, the person rests soundly, which translates into feeling refreshed the next day. The person also learns a number of techniques to draw on if insomnia returns.

Although a major issue in itself, insomnia often is not the only issue with which a veteran is struggling.

One of Bramoweth’s hypotheses is that vets feel lack of sleep is the “safest” symptom to report. Health care professionals need to be sensitive to comments that could indicate other health issues are at play. That way, vets receive treatment for insomnia as well as any underlying conditions – such as PTSD or depression – of which difficulty sleeping is just a symptom.

The opinions expressed in "Research Spotlight" do not necessarily reflect those of the National Safety Council or affiliated local Chapters.

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