Sleep and military members: emerging issues and nonpharmacological intervention

Cary A Brown, Robyn Berry, Ashley Schmidt, Cary A Brown, Robyn Berry, Ashley Schmidt

Abstract

Background. Many individuals who work in the military experience sleep deficiency which presents a significant problem given the nature of their work. The cause of their sleep problems is likely multifactorial, stemming from the interplay between their personal health, habits and lifestyle juxtaposed with the stress of their military work such as emotional and physical trauma experienced in service. Objective. To present an overview of sleep deficiency in military members (MMs) and review of nonpharmacological treatment options. Discussion. Although there are a number of promising nonpharmacological treatment options available for people working in the military who experience problems sleeping, testing interventions within the context of the military are still in the early stages. Further research utilizing rigorous design and standardized, context appropriate outcome measures is needed to help treat this burgeoning problem.

References

    1. Brown CA, Berry R, Schmidt A, Tan M. Rehabilitation and the military: working together for a good night’s sleep. 2012. .
    1. Park J. A profile of the Canadian forces. Statistics Canada, perspectives. Catalogue. 2008;(75-001-X)
    1. Canada Veterans Affairs. Survey on transition to civilian life: report on the health of regular force veterans. 2011. .
    1. Peterson AL, Goodie JL, Satterfield WA, Brim WL. Sleep disturbance during military deployment. Military Medicine. 2008;173(3):230–235.
    1. National Center on Sleep Disorders Research. National Institutes of Health Sleep Disorders Research Plan. 2011. National Institutes of Health, .
    1. Van Cauter E, Spiegel K. Sleep as a mediator of the relationship between socioeconomic status and health: a hypothesis. Annals of the New York Academy of Sciences. 1999;896:254–261.
    1. Buxton OM, Marcelli E. Short and long sleep are positively associated with obesity, diabetes, hypertension, and cardiovascular disease among adults in the United States. Social Science and Medicine. 2010;71(5):1027–1036.
    1. Krystal AD. Sleep and psychiatric disorders: future directions. Psychiatric Clinics of North America. 2006;29(4):1115–1130.
    1. McCracken LM, Iverson GL. Disrupted sleep patterns and daily functioning in patients with chronic pain. Pain Research and Management. 2002;7(2):75–79.
    1. Bray RM, Spira JL, Olmsted KR, Hout JJ. Behavioral and occupational fitness. Military Medicine. 2010;175(supplement 1):39–56.
    1. Mysliwiec V, McGraw L, Pierce R, Smith P, Trapp B, Roth BJ. Sleep disorders and associated medical comorbidities in active duty military personnel. Sleep. 2013;36(2):167–174.
    1. McLay RN, Spira JL. Use of a portable biofeedback device to improve insomnia in a combat zone, a case report. Applied Psychophysiology Biofeedback. 2009;34(4):319–321.
    1. Cook JM, Harb GC, Gehrman PR, et al. Imagery rehearsal for posttraumatic nightmares: a randomized controlled trial. Journal of Traumatic Stress. 2010;23(5):553–563.
    1. Forbes D, Phelps AJ, McHugh AF, Debenham P, Hopwood M, Creamer M. Imagery rehearsal in the treatment of posttraumatic nightmares in Australian veterans with chronic combat-related PTSD: 12-month follow-up data. Journal of Traumatic Stress. 2003;16(5):509–513.
    1. Forbes D, Phelps A, McHugh T. Treatment of combat-related nightmares using imagery rehearsal: a pilot study. Journal of Traumatic Stress. 2001;14(2):433–442.
    1. Lu M, Wagner A, Van Male L, Whitehead A, Boehnlein J. Imagery rehearsal therapy for posttraumatic nightmares in U.S. Veterans. Journal of Traumatic Stress. 2009;22(3):236–239.
    1. Long ME, Hammons ME, Davis JL, et al. Imagery rescripting and exposure group treatment of posttraumatic nightmares in Veterans with PTSD. Journal of Anxiety Disorders. 2011;25(4):531–535.
    1. Nappi CM, Drummond SPA, Thorp SR, McQuaid JR. Effectiveness of imagery rehearsal therapy for the treatment of combat-related nightmares in veterans. Behavior Therapy. 2010;41(2):237–244.
    1. Wanner J, Long ME, Teng EJ. Multi-component treatment for posttraumatic nightmares in Vietnam veterans: two case studies. Journal of Psychiatric Practice. 2010;16(4):243–249.
    1. Harb GC, Cook JM, Gehrman PR, Gamble GM, Ross RJ. Post-traumatic stress disorder nightmares and sleep disturbance in Iraq war veterans: a feasible and promising treatment combination. Journal of Aggression, Maltreatment and Trauma. 2009;18(5):516–531.
    1. Swanson LM, Favorite TK, Horin E, Arnedt JT. A combined group treatment for nightmares and insomnia in combat veterans: a pilot study. Journal of Traumatic Stress. 2009;22(6):639–642.
    1. Ulmer CS, Edinger JD, Calhoun PS. A multi-component cognitive-behavioral intervention for sleep disturbance in Veterans with PTSD: a pilot study. Journal of Clinical Sleep Medicine. 2011;7(1):57–68.
    1. Berlin KL, Means MK, Edinger JD. Nightmare reduction in a Vietnam veteran using imagery rehearsal therapy. Journal of Clinical Sleep Medicine. 2010;6(5):487–488.
    1. Perlman LM, Cohen JL, Altiere MJ, et al. A multidimensional wellness group therapy program for veterans with comorbid psychiatric and medical conditions. Professional Psychology. 2010;41(2):120–127.
    1. Hryshko-Mullen AS, Broeckl LS, Haddock CK, Peterson AL. Behavioral treatment of insomnia: the Wilford Hall Insomnia program. Military Medicine. 2000;165(3):200–207.
    1. Tan G, Dao TK, Smith DL, Robinson A, Jensen MP. Incorporating Complementary and Alternative Medicine (CAM) therapies to expand psychological services to veterans suffering from chronic pain. Psychological Services. 2010;7(3):148–161.
    1. Edinger JD, Sampson WS. A primary care “friendly” cognitive behavioral insomnia therapy. Sleep. 2003;26(2):177–182.
    1. Edinger JD, Olsen MK, Stechuchak KM, et al. Cognitive behavioral therapy for patients with primary insomnia or insomnia associated predominantly with mixed psychiatric disorders: a randomized clinical trial. Sleep. 2009;32(4):499–510.
    1. Watson CG, Tuorila JR, Vickers KS, Gearhart LP, Mendez CM. The efficacies of three relaxation regimens in the treatment of PTSD in Vietnam War veterans. Journal of Clinical Psychology. 1997;53(8):917–923.
    1. Nakamura Y, Lipschitz DL, Landward R, Kuhn R, West G. Two sessions of sleep-focused mind-body bridging improve self-reported symptoms of sleep and PTSD in veterans: a pilot randomized controlled trial. Journal of Psychosomatic Research. 2011;70(4):335–345.
    1. Cooper NA, Clum GA. Imaginal flooding as a supplementary treatment for PTSD in combat veterans: a controlled study. Behavior Therapy. 1989;20(3):381–391.
    1. Shapiro CM, Warren PM, Trinder J, et al. Fitness facilitates sleep. European Journal of Applied Physiology. 1984;53(1):1–4.
    1. Pouliot Z, Peters M, Neufeld H, Delaive K, Kryger MH. Sleep disorders in a military population. Military Medicine. 2003;168(1):7–10.
    1. Swales P. Sleep and posttraumatic stress disorder (PTSD) 2011. .
    1. Lamarche LJ, De Koninck J. Sleep disturbance in adults with posttraumatic stress disorder: a review. Journal of Clinical Psychiatry. 2007;68(8):1257–1270.
    1. Mellman TA, Kulick-Bell R, Ashlock LE, Nolan B. Sleep events among veterans with combat-related posttraumatic stress disorder. American Journal of Psychiatry. 1995;152(1):110–115.
    1. Lettieri CJ, Eliasson AH, Andrada T, Khramtsov A, Raphaelson M, Kristo DA. Obstructive sleep apnea syndrome: are we missing an at-risk population? Journal of Clinical Sleep Medicine. 2005;1(4):381–385.
    1. Okpala N, Walker R, Hosni A. Prevalence of snoring and sleep-disordered breathing among military personnel. Military Medicine. 2011;176(5):561–564.
    1. Mysliwiec V, Gill J, Lee H, et al. Sleep disorders in U.S. military personnel: a high rate of comorbid insomnia and obstructive sleep apnea. Chest. 2013
    1. Germain A, Shear MK, Hall M, Buysse DJ. Effects of a brief behavioral treatment for PTSD-related sleep disturbances: a pilot study. Behaviour Research and Therapy. 2007;45(3):627–632.
    1. Smith MT, Huang MI, Manber R. Cognitive behavior therapy for chronic insomnia occurring within the context of medical and psychiatric disorders. Clinical Psychology Review. 2005;25(5):559–592.
    1. Schreiber S, Barkai G, Gur-Hartman T, et al. Long-lasting sleep patterns of adult patients with minor traumatic brain injury (mTBI) and non-mTBI subjects. Sleep Medicine. 2008;9(5):481–487.
    1. Castriotta RJ, Lai JM. Sleep disorders associated with traumatic brain injury. Archives of Physical Medicine and Rehabilitation. 2001;82(10):1403–1406.
    1. Buzzini SRR, Guskiewicz KM. Sport-related concussion in the young athlete. Current Opinion in Pediatrics. 2006;18(4):376–382.
    1. Evans RW. Posttraumatic headaches among United States soldiers injured in Afghanistan and Iraq. Headache. 2008;48(8):1216–1225.
    1. Shekleton JA, Parcell DL, Redman JR, Phipps-Nelson J, Ponsford JL, Rajaratnam SMW. Sleep disturbance and melatonin levels following traumatic brain injury. Neurology. 2010;74(21):1732–1738.
    1. Rognum TO, Vartdal F, Rodahl K. Physical and mental performance of soldiers on high- and low-energy diets during prolonged heavy exercise combined with sleep deprivation. Ergonomics. 1986;29(7):859–867.
    1. Curry J. Sleep management and soldier readiness: a guide for leaders and soldiers. 2005. Infantry Magazine, .
    1. Caldwell JA, Caldwell JL. Fatigue in military aviation: an overview of U.S. military-approved pharmacological countermeasures. Aviation Space and Environmental Medicine. 2005;76(supplement 7):C39–C51.
    1. Schutte-Rodin SL, Broch L, Buysee D, Dorsey C, Sateia M. Clinical guideline for the evaluation and management of chronic insomnia in adults. Journal of Clinical Sleep Medicine. 2008;4(5):487–504.
    1. Morin CM, Bélanger L, Bastien C, Vallières A. Long-term outcome after discontinuation of benzodiazepines for insomnia: a survival analysis of relapse. Behaviour Research and Therapy. 2005;43(1):1–14.
    1. Krueger GP. Sustained work, fatigue, sleep loss and performance: a review of the issues. Work and Stress. 1989;3(2):129–141.
    1. Freedman DX, Derryberry JS, Federman DD. Drugs and insomnia. The use of medications to promote sleep. Journal of the American Medical Association. 1984;251(18):2410–2414.
    1. National Institutes of Health Consensus Development Conference Statement. The treatment of sleep disorders of older-people. Sleep. 1991;14(2):169–177.
    1. Dongsoo K. Practical use and risk of Modafinil, a novel waking drug. Environmental Health and Toxicology. 2012;27e2012007
    1. McCann K. Sleep disturbances in soldiers with combat PTSD improved by bright light therapy. 2010. Science Daily, .
    1. Gevirtz RD, Dalenberg C. Heart rate variability biofeedback in the treatment of trauma symptoms. Biofeedback. 2008;36(1):22–23.
    1. Thomas BH, Ciliska D, Dobbins M, Micucci S. A process for systematically reviewing the literature: providing the research evidence for public health nursing interventions. Worldviews on Evidence-Based Nursing. 2004;1(3):176–184.
    1. Jackson N, Waters E. Criteria for the systematic review of health promotion and public health interventions. Health Promotion International. 2005;20(4):367–374.
    1. Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Controlled Clinical Trials. 1996;17(1):1–12.
    1. Sloberg BJ. Self-efficacy and the use of alternative medicine practices by active duty military stationed on board a United States naval warship [Ph.D. thesis] Cypress, Calif, USA: Touro University International; 2006.

Source: PubMed

3
구독하다