Not enough sleep is "more the rule than the exception" in the military, according to a new Defense Department report to Congress.
The report to House Armed Services Committee leaders found that sleep deprivation can contribute to "development of PTSD, depressive disorders and risk for TBI" and individuals in the military are twice as likely to sleep less than seven hours per night than civilians.
The report was ordered under the 2020 National Defense Authorization Act, calling for an analysis of the effects of sleep deprivation on readiness in the military.
The Defense Department found causes of sleep deprivation among troops that likely have existed for decades largely unchanged, if not worsened, including "austere deployment and training environments, cross-time zone travel and its impact on circadian rhythm, operational and occupational requirements such as operations tempo, and inhospitable sleep environments" to name just a few.
The Pentagon also acknowledged that these conditions contribute to service members' increasing, "pervasive" dependence on "stimulants and hypnotics" such as caffeine pills, energy drinks and sleeping pills to cope with the demands placed on them, "but such pharmaceutical interventions offer short-term solutions and are neither intended nor suitable for sustained implementation," the report said.
"Sleep may be the most important biological factor that determines service member health and combat readiness," according to the report. "The majority of service members report they receive less sleep than needed to perform their military duties well."
While some short-term sleep deprivation may be "an unavoidable cost" of operational and training demands on the military to ensure it remains always ready, "it is likely that prolonged and chronic sleep deprivation has the opposite effect on the readiness of the U.S. Armed Forces," according to the report.
As in other sleep deprivation studies, the Defense Department's findings include that impairment from sleep deprivation can equal the effects of being drunk and signfiticantly increase the risk of injury.
And the deliveries of cases of energy drinks aren't helping.
"To counteract the effects of sleep deprivation, service members consume large amounts of caffeine," the report said. "However, caffeine countermeasures cannot replace the need for sleep, and overuse of this stimulant drug in military settings can disrupt sleep patterns and increase levels of sleep deprivation."
Energy drinks, for example, can bring significant health risks in some cases, up to and including cardiac arrest and other heart conditions.
Continued sleep deprivation can exacerbate serious medical and psychological health conditions and symptoms, including depression, post-traumatic stress disorder and TBI, and troops with these conditions "show a greater risk for sleep-related problems following combat deployment."
Estimates suggest that more than 90% of combat veterans with PTSD also experience significant chronic sleep deprivation and sleep deprivation before combat deployment "significantly increases the risk of subsequent PTSD," as well as depression, according to the report.
Troops with duty-related sleep deprivation are also far more likely to experience vehicle accidents or other work-related injuries. Consistent lack of sleep can also be a risk factor for other mood and anxiety disorders.
Sleep issues are one of the top-cited health concerns for veterans at the Department of Veterans Affairs. Up to 50% of veterans enrolled at VA have insomnia disorder. Obstructive sleep apnea is one of the most widespread conditions among veterans.
Civilian analyses have also found clear associations between sleep deprivation and risk for suicide. "The lowest risk of suicide is associated with eight hours of sleep per night, with an 11 percent increase in risk for each hour of sleep deprivation," according to the report. Veterans who reported sleep problems in the prior year died by suicide significantly sooner on average after their last contact with the Veterans Health Administration (75 days) than those without sleep issues (174 days),
Sleep deprivation is by no means a new issue for the military, though the most recent estimates show that about 64% of service members report less than seven hours of sleep per night. Air Force troops consistently report higher rates of sufficient sleep (seven hours or more) per night than other service branches.
In deployed settings, those rates are much worse. About 86% of soldiers in Afghanistan report sleeping less than seven hours per night, and studies of soldiers and Marines found about half reported sleeping five hours or less. That lack of sleep also often continued even after returning from deployments. Only about 3.6% of troops seek behavioral health care for sleep-related issues, according to the report.
A key factor in the harm resulting from sleep deprivation is military culture itself, the report found, despite evidence that troops perform better with more sleep.
"Culturally and operationally, a service member’s ability to maintain maximum performance while being sleep deprived has been lauded as a key skill for military personnel and has been perceived to demonstrate toughness," according to the report.
Among commands, attitudes on sleep range from viewing sleep as "a controlled ration" to arguing that a need for sleep "is a sign of weakness," the report found. Leadership plays a significant role in whether troops in a given unit are sleep deprived, and Army surveys found that only about one in four leaders encourage their soldiers to get enough sleep and only about 35% consider sleep an important part of operational planning.
The Defense Department study found that military commanders can help prevent and mitigate the effects of sleep deprivation among their troops, beginning with a commitment to duty schedules that allow for eight hours of sleep and adequate recovery time when mission requirements lead to reduced or disrupted sleep. Leaders can also monitor caffeine intake and decrease disruptions in sleep areas.
Shocking approximately no one, the report also found that the "sleep when you can" approach in the military is unlikely to foster quality results.
"It is unlikely that sleeping in tactical vehicles, military aircraft, large transient tents, hangars, or near machinery, is restorative," according to the report.
Read the full report.
If you or someone you know needs help, contact the Veteran Crisis Line 24/7 at 1-800-273-8255 (select option 1 for a VA staff member). Veterans, service members or their families also can text 838255 or go to veteranscrisisline.net.
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