Sleep issues bedeviling Soldiers’ health


WASHINGTON (Sept. 10) – “I didn’t realize that all this time I’ve been in a formation of drunks,” the noncommissioned officer, or NCO, told Lt. Col. Kate E. Van Arman.

The NCO was referring to a quote Van Arman repeated to him from her top boss, Surgeon General of the Army Lt. Gen. Patricia Horoho: “If you have less than six hours of sleep for six days in a row you are cognitively impaired as if you had a .08-percent alcohol level. We never will allow a Soldier in our formation with a .08-percent alcohol level, but we allow it [sleep deprivation] every day [in Soldiers who] make those complex decisions.”

Adding to what Horoho said, Van Arman pointed out that after being awake 17 hours, response time has been shown to be the equivalent to a person with a blood alcohol content of .05 percent and 24-hours awake translates to a blood alcohol concentration, or BAC, of .10 percent.

Van Arman, medical director, Traumatic Brain Injury, or TBI, Clinic on Fort Drum, New York, spoke at the 2015 Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, held at the Defense Health Headquarters in Falls Church, Virginia, Sept. 9.

Although her topic was “Sleep Disorders Among Military Mild TBI Patients,” much of what she said applies to all Soldiers, whether or not they have TBI.

Sleepless in the Army

It’s not just the Soldiers who are partying all night who lack sleep, Van Arman said. Demands of Army life are responsible for a lot of it. For instance, Soldiers who misbehave can be ordered to do extra duties as punishment, up until midnight, she said. Assuming that revile is at 6 a.m., that’s six or less hours of sleep.

Staff duty often requires a Soldier to be awake for 24 hours, she said. When the pre- and post-briefs are added, it’s closer to 30. Overall, one-third of military members sleep less than five hours per night and two-thirds less than six, she said.

Deployed Soldiers get an astonishing average of just three hours of sleep per night, she said, particularly those serving in the combat arms branches. It’s not for lack of them trying to sleep though, she said. Those deployed or on extended exercises attempt to sleep whenever or wherever they can, on the ground or when being transported in vehicles or airplanes.

A lot of it, though, is fitful sleep which throws off their circadian rhythms, she said. The battlefield, even the peacetime “battlefield,” can be a noisy place with others snoring, lights, helicopters flying and so on, not to mention weather.

While being sleepless in the Army seems to be the norm, there are other professions that have sleepy people, particularly in jobs where that sort of thing would be concerning. For instance, 72 percent of U.S. commercial airline pilots reported being drowsy to the point of nearly falling asleep and 45 percent admitted to actually dozing off on occasion, she said.

Culture of Caffeine

All this sleeplessness results in a “culture of caffeine,” Van Arman said.

During a recent visit to the Fort Drum shoppette, Van Arman noticed “a big refrigerator of monster sodas and energy drinks popular with Soldiers.”

Last year energy drinks in the United States netted $27.5 billion and energy drink consumption went up 5,000 percent since 1999, she said.

A meta-analysis of caffeine on cognitive performance showed that 100 to 300 milligrams of caffeine results in mood improvement, she said. That’s about one or two cups of coffee.

Anything greater than 400 mg, though, results in mood deterioration, she said, adding that while the extra caffeine may result in a person staying awake, it mays not improve decision making. Another thing to be careful about with caffeine, she said, is not to take it within six hours of bedtime, as it will result in fitful sleep.

TBI Soldiers

Sleep problems are “the absolute No. 1 military disorder when people come back from deployments. Among TBI Soldiers, it is the No. 2 problem, after headaches,” Van Arman said. Sleep disorders include insomnia, sleep apnea, nightmares, fragmented sleep, restless leg syndrome and bruxism (teeth grinding).

Some 300,000 military members have some form of TBI, so that’s a pretty significant number, she said, providing a number of other facts/statistics of service members with TBI: 97 percent complain about some sort of sleep problem, primarily insomnia; 34 percent have sleep apnea; 90 percent report napping during the day, and; 50 percent have fragmented sleep.