MARCH 16, 2023 – According to the Centers for Disease Control and Prevention, not getting enough quality sleep can decrease productivity and increase accidents, mistakes at work, and associated injuries and disability. Not getting enough sleep is also linked with many chronic diseases and conditions—such as Type 2 diabetes, heart disease, obesity and depression.
Quality sleep is especially important for maximizing the capabilities of military service members. For example, a 2020 military public health study found that Soldiers who had less than 6 hours of sleep were 10–15 percent less productive.
Military public health studies have also found that poor sleep is a leading medical factor associated with higher rates of suicide. In addition, short sleep duration may be a risk factor for higher rates of musculoskeletal injuries amongst Soldiers.
The Department of Defense recognizes the importance of sleep in military doctrine and in Performance Triad guidance, which provides approaches to improve sleep quality among service members. However, sometimes a medical condition prevents a service member from getting quality sleep.
Medically diagnosed sleep-related breathing disorders are routinely tracked in the military population. According to the 2021 Health of the Force, 9 percent of Soldiers had a sleep disorder, with rates ranging from 4 to 19 percent across installations.
The most common sleep disorder is obstructive sleep apnea, or OSA, a breathing disorder in which one stops breathing for 10 seconds or more during sleep, often repeatedly. A military public health study published in 2022 reported 87,404 diagnoses of OSA among active-duty Soldiers from the years 2014 through 2019.
“For those with OSA, the pause in breathing is caused by a physical obstruction—the pharynx collapses and blocks the upper airway,” says Army Lt. Col. Christa Goodwin, a military dentist and the study’s lead investigator.
“The result may be loud snoring or choking noises as one attempts to breathe. Ultimately, the brain and body become deprived of oxygen, causing the person to wake up, though the person is often unaware this is happening.”
Due to interrupted breathing during sleep, an individual with OSA may feel extremely tired upon awakening and experience excessive daytime sleepiness. This increases the risk of fatigue and depression, impairs physical performance, diminishes alertness, and decreases the ability to perform complicated cognitive tasks.
“Evidence demonstrates that good sleep contributes to better physical and mental health, says Goodwin, “so addressing OSA can improve military readiness.”
The good news is that OSA can be successfully treated.
“The gold standard treatment for OSA is a continuous positive airway pressure, or CPAP, device. The CPAP requires a power source to produce a steady stream of air through a mask which serves to keep the airway open,” says Goodwin. “However, studies have shown that adherence to the CPAP device is poor among military personnel.”
Department of Defense minimum standards of fitness require those with moderate to severe OSA obtain a waiver to deploy. Those treated for OSA with CPAP must be prepared to deploy with the supplies needed for the duration of the deployment, including air filters, tubing, masks, and rechargeable battery backup. Logistically, maintenance of the CPAP may be extremely difficult or impossible during deployments to austere locations.
“Oral appliance therapy is the leading alternative treatment to the CPAP for those with mild to moderate OSA,” says Goodwin. “These appliances look similar to a mouthguard and help keep the airway open by repositioning and/or stabilizing the lower jaw.”
Goodwin and her team at the Defense Centers for Public Health-Aberdeen, formerly the Army Public Health Center, investigated the impact of the oral appliance therapy on sleep quality and duration, physical fitness, cognitive behavior, alertness and daily performance among active-duty Soldiers diagnosed with OSA. Their study found that overall, the use of the custom-fabricated oral appliance significantly improved Soldiers’ sleep quality, duration and various other aspects of daily life.
“While the oral appliance can improve sleep quality and potentially offer cost savings, it is not suitable for all people with OSA,” says Goodwin.
If you think you may have a sleep disorder, seek the advice of a medical provider. The CDC recommends keeping a sleep diary for about 10 days prior to the visit and discussing its contents with your provider. In your sleep diary, record when you—
- Go to bed
- Go to sleep
- Wake up
- Get out of bed
- Take naps
- Exercise
- Drink alcohol
- Drink caffeinated beverages
- Take medications (over-the-counter or prescription) or supplements
Aiming for good sleep
Addressing any underlying medical conditions that may affect your ability to get quality sleep is critical, but for most there are general sleep hygiene practices that can always be improved on. The quality of your sleep depends on a combination of these factors:
- Number of hours spent sleeping (7 to 9 hours for adults)
- Regularity of one’s sleep schedule (consistent bed- and wake-up times)
- Ability to fall asleep (in less than 30 minutes)
- Ability to stay asleep (soundly with no disruptions)
- Environmental conditions (Reduce noises and light, maintain a cool room temperature, and sleep on a comfortable surface.)
- Personal behaviors (Avoid exercising to exhaustion, consuming heavy meals, taking certain medications, and consuming caffeine and/or alcohol near your sleep time. Turn off TVs and electronics to reduce blue lights before going to bed, and get bright light as soon as possible after waking from sleep.)
For additional information on improving your sleep, consider these sources:
- The Army’s Performance Triad initiative which provides tips on various topics such as how to stay asleep
- Army Wellness Centers, where you can request personalized assessments and guidance
- Falling asleep quickly through muscle relaxation, made popular as a “military method”
- The CDC’s Sleep and Sleep Disorders website
The Defense Centers for Public Health-Aberdeen advances Joint Force health protection with agile public health enterprise solutions in support of the National Defense Strategy.
Story by Douglas Holl, V. Hauschild, MPH
Defense Centers for Public Health-Aberdeen