Combat Stress Center.com

Sleeping in Iraq

LtC John P. Allen

785th Med. Co. (CSC)

             Each year, 30 to 40 percent of adults in the US will have problems sleeping.  One third of these suffer the more severe condition of “chronic” insomnia, meaning that they have problems falling asleep or staying asleep at least three nights a week.  Sleep problems are especially common and troublesome for service members in combat situations and I would estimate that around 20 to 25 per cent of the soldiers seen in combat stress clinics are bothered by sleep difficulties.

Some physical problems can cause sleep difficulties.  An example of this is a very serious condition called sleep apnea which involves stopping breathing frequently while asleep.   If the self-help and behavioral techniques described below do not work to take care of a sleep problem or if it has lasted a month or so or is impairing daytime activities, medical attention should be sought to find out if there are possible physical reasons.

           Insomnia drains one’s energy, causes irritability and unhappiness, and reduces concentration for and performance of complex tasks.  It also leads to in coordination and memory losses as well as reducing driving skill.  Sometimes insomnia is directly related to combat stress, but more frequently it comes from depression, anger with one’s situation, worries about issues at home, and loneliness for friends and family—problems that military personnel assigned overseas must often cope with.  Conditions such as irregular work shifts, lack of exercise, and frequent loud noise from mortars, rockets, aircraft, generators, and heavy machinery at night also cause it to be difficult to get to sleep, stay asleep or enjoy good quality, restful sleep.

Service members themselves and professional mental and medical health professionals can help resolve sleep problems.

           What can soldiers do to improve their own sleep?  There are many practical aids for sleeping.  Examples of these are presented in the accompanying sidebar.  Additionally, a strategy called “sleep restriction” may help in falling to sleep faster and having good quality sleep.  In this procedure, the person computes the average amount of time in bed that is actually spent in sleep and then goes to bed so late that only this much time is allowed prior to the normal time of getting up.  The least amount of time in bed should not be less than five hours.  Slowly, the time in bed is increased by going to bed earlier in 20 minute increments, adding to the time only when he or she is still able to fall asleep within 10 to15 minutes.  The goal is that 85 to 90% of the time spent in bed is actually sleeping.

           Maintaining a personal sleep diary is also a good idea.  Every morning the person completes a chart showing the time for going to bed the night before, the time for waking up, and the total amount of time actually sleeping.  It is also important to jot down the personal stressful events, sleep environmental conditions, and self-help sleeping aids (such as those indicated in the sidebar) that may have affected the night’s sleep.  Information recorded in the diary can help the person see how changes in sleep-related activities are influencing sleep.  Diary information is also useful if the service member goes to a medical or behavioral health professional for assistance with sleep.  Finally, the person can monitor progress made across time by reviewing past and current entries in the sleep diary.

           What type of procedures do mental health services offer to help with sleep?  Mental health professionals can help service members understand their sleep difficulties and can provide additional practical recommendations.  Most commonly, they train the individual on various types of relaxation therapy that can relieve worries and tension that might be getting in the way of restful sleep.  Of all of the behavioral techniques to bring about and maintain sleep, relaxation therapies have been studied the most thoroughly and appear to be the most effective.  Often these therapies are combined with other strategies, including in some instances short-term use of sleep medications.

           What about use of sleep medications?  Prescribed sleep drugs work immediately, whereas it takes some time for the behavioral techniques to have an effect.  The effect of the medications, however, ends as soon as one quits taking them.  The behavioral means of dealing with sleep problems can assist for the rest of life.  Various medications may also have harmful side effects, such as physical and psychological dependence; need for dose increase over time; and adverse reactions when combined with alcohol and other psychoactive drugs.  Finally, some medications cause a “rebound effect” in that, when they are stopped, the person may have more serious problems sleeping.  Nevertheless, if a sleep problem cannot be treated effectively with behavioral techniques, prescribed medications for some period of time is probably a good idea.

           How effective are the behavioral techniques for improving sleep? A recent review of scientific studies of behavioral treatments for sleep disorders showed that 70% to 80% of patients benefited.  On average they increased their sleep time by around 30 minutes and reported better sleep quality.  The effects of the treatment lasted at least six months after they completed treatment.

Sidebar: Some Recommendations on Sleeping Better…

Avoid naps during the day

Use the bed only for sleeping.

Avoid stimulants like nicotine and caffeine late at night or if you do wake up during the night.

Don’t eat a heavy meal or engage in vigorous exercise for a few hours before going to bed.  Exercising earlier in the day, however, may make it easier to sleep at night.

Take a hot shower an hour and a half before going to bed.

Make sure that your bed is as comfortable as possible and that your sleep environment is good—dark, quiet, and cool.

           Each day try to go to bed and get up at the same time.  Avoid sleeping in on days off.

Develop some consistent bedtime “rituals” like reading a book for a few minutes when you go to bed. If you don’t fall asleep within 20 minutes of the time you go to bed, get up and do some other activity until you feel tired and then try again to fall asleep.  Also, if you wake up during the night and haven’t gotten to sleep again for 15 or 20 minutes, get up and do some other activity until you feel tired and then try again to fall asleep. It is important that you associate the bed with sleeping rather than worrying or tossing and turning.

           Minimize external stimuli like noise and light while trying to sleep.

If the alarm clock distracts you, move it away from the bed.