Understanding the Causes of Veteran Sleep Disorders
In conjunction with the Center of Behavior and Health at the Johns Hopkins School of Medicine, VetAdvisor®, LLC recently concluded a nationwide veteran focused survey. The purpose of the VetAdvisor® Sleep Survey (VSS) was to help researchers understand the causes of veteran sleep disorders, enhance overall understanding of these disorders, and determine the potential benefits of behavioral sleep coaching and consumer sleep monitoring devices in their treatment. A sleep coach is a wellness advisor who is an expert in sleep issues and their impact on veterans and military personnel.
Sleep coaches observe progress, determine evolving needs, and pro-actively send alerts and encouragement to help veterans overcome barriers to better sleep. Sleep coaching is a non-stigmatizing way to identify and connect veterans with both integrative well-being programs and appropriate sleep-related medical care.
Two thousand, eight hundred and sixty six volunteers completed the VSS (11.5% female, 80% white, 11% Black, 1.3% Asian, 3% other, 6% Hispanic/Latino). The mean age was 54 years (SD=13.3, ranging from 18 to 96). The five branches of the military were represented [Army, 56%; Navy, 16%, Marines, 10%, Air Force 16%, Coast Guard, 1%). Seventy two percent of respondents reported having been deployed to a combat zone and 53% reported participating in combat operations. Fourteen percent were officers.
The average amount of veteran participant sleep was 5.6 hours. 76% of veterans report that they do not typically get enough sleep. Even more alarming, 91% of the veterans surveyed reported often feeling tired, fatigued or sleepy during the day. “Having trouble falling or staying asleep” was by far the most frequent reason cited by veterans as a cause of not getting enough sleep (70%). Other common reasons included: “sleep is poor quality” (53%), “being too busy with work or family responsibilities” (13%), “being a night owl” (12%), and “liking to watch television late at night” (8%).
Importantly, 74.3% of respondents reported meeting general clinical criteria for insomnia (i.e., trouble falling asleep or staying asleep, 3 or more nights per week for at least a month with at least some significant sleep-related daytime symptoms). In the general population, the prevalence of chronic insomnia is 10-15%. Veterans who had actively engaged in combat were also more likely to report insomnia than those who had not actively engaged in combat (78.7% vs. 69.2%)
Considerations & Conclusions
The two most common reasons for sleep disruption were: 1) experiencing mental alertness/thoughts won’t slow down and 2) pain. While factors associated with normal daily living such as financial stress and worrying about daily concerns appeared to contribute to sleep disruption in both groups equally, the factors associated with trauma such as nightmares or feeling the need to be “on guard” were much higher in the active combat engagement group. Not surprisingly, when veterans were asked to rate the factor with the single greatest impact on their sleep, the groups differed as well. For those actively engaged in combat, the top 3 reasons in order were: 1) mental alertness/thoughts won’t slow down (15.7%), 2) pain (12.2%), and 3) nightmares/dreams (10.7%). For those not engaging in combat the top three reasons were: 1) pain (18.7%), 2) mental alertness/thoughts won’t slow down (15.3%), and 3) worrying about daily concerns (6.9%).