Sleep, readiness go hand in hand
Despite the medically proven linkage between sleep and readiness, all too often sleep is viewed as a luxury by some service members. Getting a good night's sleep can result in increased productivity at work, as well as a reduction in injuries, errors and accidents. (U.S. Marine Corps photo by Cpl. Aaron S. Patterson)
WASHINGTON — The quality of soldiers' sleep has a direct bearing on readiness, according to an Army researcher.
Despite the medically proven linkage between sleep and readiness, all too often sleep is viewed as a luxury by some soldiers, Army Col. (Dr.) Vincent Mysliwiec said.
Mysliwiec provided some tips on getting a good night's sleep, which he said will result in increased productivity at work, as well as a reduction in injuries, errors and accidents.
Many soldiers already know they should be getting at least seven to eight hours of sleep each night, but more than half of them probably get six or less, he said. And many are unaware that the time they go to sleep can be just as important as how long they sleep, he added, noting that soldiers tend to shift their sleep patterns on weekends, going to bed much later and waking up much later than on weekdays because of their military requirements.
That shifting of sleep times throws off the circadian rhythm, the body's biological clock, he said. If the circadian rhythm is askew, fitful sleep or even a sleep disorder could result.
A shift of one hour probably won't throw off the circadian rhythm — say going to bed at 10 p.m. and waking at 6 a.m. on weekdays and 11 p.m. to 7 a.m. on weekends. But a shift more dramatic than that could cause problems.
A note of interest: Travelers flying from the West Coast to the East Coast often report difficulties sleeping because of the three hours lost during the time zone shift, he added. Flying the other way has less of an impact.
Fire Watch Duty
Soldiers often are called upon to stand fire watch duty, which may be for one-hour-a-night shift rotations. Mysliwiec said that type of schedule can lead to fitful sleep, depriving soldiers of the quality sleep they need. It's much healthier to let a soldier go without sleep for one night and stand fire watch, allowing him or her to catch up on sleep the next day, he said.
If conducting a long-duration operation that's known ahead of time, it is beneficial for soldiers to get some sleep before it starts, he said, even if it's just an hour or two, so the sleep debt doesn't accrue quite as fast. Mysliwiec called this "prophylactic napping."
Once the mission is completed, soldiers should be allowed time for recovery sleep, he added.
The two most common sleep disorders in the Army are insomnia and obstructive sleep apnea, Mysliwiec said. Narcolepsy — a tendency to fall asleep on duty — doesn't appear to be a common sleep disorder among soldiers.
Daniel Taylor, a sleep researcher, found that about 20 percent of the 4,000 soldiers he studied at Fort Hood, Texas, had insomnia, Mysliwiec said. The study also showed that insomnia was linked to a greater severity of post-traumatic stress disorder, depression, fatigue, stress, headaches, anxiety, mental health, alcohol use and pain.
Obstructive sleep apnea also is linked to a greater severity of post-traumatic stress disorder, anxiety, depression, chronic pain and traumatic brain injury, though Mysliwiec noted that a linkage does not necessarily point to the cause of that ailment or disorder, but instead indicates a possible contributor. Studies have shown that, if left untreated, people with obstructive sleep apnea are cognitively impaired and twice as likely to be involved in a motor vehicle accident, he said.
From 1998 to 2013, the diagnostic rate for obstructive sleep apnea for soldiers increased about 600 percent, most likely because the disorder was under-recognized in the past, he said. Likewise, the diagnosis for insomnia is much higher today than when Mysliwiec entered the Army in 1988. From about the time operations in Iraq and Afghanistan started, there was a greater awareness of these sleep disorders, he said.
The preferred treatment for sleep apnea is continuous positive airway pressure device, or CPAP, he said. CPAP is a mask that fits over the nose and mouth and gently blows air into the airway to help keep it open during sleep. To improve readiness, Army sleep physicians and dentists are also working together to treat obstructive sleep apnea with oral appliances. For some soldiers, oral appliances can be as effective as CPAP.
For insomnia, the preferred treatment is cognitive behavioral therapy for insomnia, Mysliwiec said. There are two key tenets of cognitive behavioral therapy for insomnia. The first is called "sleep restriction." That means limiting your time in bed if not sleeping.
If a person is in bed for eight hours but sleeps in it for just six, sleep efficiency is 75 percent, which is not good. Their sleep quality would improve if they spent just six and a half hours in bed but slept for six hours, Mysliwiec said.
Rather than lie awake in bed, the person should get out of bed and do something relaxing and sedentary, such reading a book, knitting or doing a puzzle -- “the more boring the better," he said. But watching TV and using an electronic device creates light stimulation, which is not sleep-inducing, he added.
The second tenet of cognitive behavioral therapy for insomnia, he said, is called "stimulus control." That means using the bedroom only for sleep or relationships, not as an entertainment room.
The bedroom must also be kept dark. "If you see my bedroom, there's nothing there, basically, but the bed. There are no electronics, and my cell phone, which is used as my alarm, is 10 feet away on silence mode where I can't see the light," Mysliwiec said. "My bedroom is geared toward sleep. You have to have the mindset for sleep. We're a high-risk organization and it's a stressful occupation. You have to be heavy on [the] preventive side" when it comes to managing sleep.
Help is Available
How do soldiers get help for sleep problems? They ask for it, Mysliwiec said. A soldier may seek help after getting involved in some sort of accident in which fatigue is a contributing factor, or the soldier may be diagnosed as suffering from a sleep disorder while seeing the doctor for some other reason.
Increasingly, the Army's wellness centers at various installations are providing sleep information and help for those who ask for it, Mysliwiec said.
Mysliwiec and other sleep specialists brief Army leaders on sleep and readiness as part of their normal duties.
For soldiers seeking more guidance on sleep in the operational setting, Mysliwiec said he highly recommends reading just four pages on sleep contained in Chapter 2 of Army Techniques Publication 6-22.5, "A Leader's Guide to Soldier Health and Fitness," dated Feb. 10, 2016.
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