From Battlefields to Bedtime: Sleep Disorders and PTSD in Veterans

May 29, 2023 | Blog, Sleep Disorders, Veterans

As we commemorate Memorial Day and pay tribute to the brave individuals who have served in the military, it is important to recognize the ongoing challenges they may face upon their return to civilian life. This blog explores the relationship between sleep disorders, post-traumatic stress disorder (PTSD), and veterans’ well-being.

What is the Impact of Active Duty on Sleep?

The demanding nature of military service, including combat exposure, prolonged periods of vigilance, and unpredictable schedules, can disrupt the circadian rhythm and lead to sleep disturbances.1 Active duty stressors trigger hyperarousal, making it difficult for service members to relax and fall asleep. Fragmented sleep and reduced sleep quality further impair physical and cognitive functioning, increasing the risk of developing sleep disorders and exacerbating the likelihood of PTSD.2

How Does the Transition From Active Duty to Home Impact Sleep?

The transition from active duty to civilian life poses its own challenges and can affect sleep patterns. Veterans often experience emotions such as loss, grief, and disconnection during this transition. Emotional factors, combined with lifestyle adjustments and the absence of military routines, disrupt sleep patterns. Anxiety, depression, and insomnia can intensify, requiring support and resources to promote healthy sleep habits.3

PTSD and Sleep Disorders: A Two-Way Relationship

PTSD, a psychiatric condition that develops after traumatic events, significantly impacts veterans. Symptoms such as intrusive thoughts, flashbacks, hyperarousal, and avoidance behaviors contribute to sleep disturbances.4

On the other hand, sleep disruptions can exacerbate psychological distress, impair cognitive function, and increase the risk of developing other mental health disorders.5 ,6 Thus, sleep disturbances may act as both a consequence and a trigger of PTSD symptoms.7

Which Sleep Disorders Are Veterans Most Likely to Experience?

The following are the most common sleep disorders veterans suffer from:

  • Insomnia, characterized by difficulty falling asleep, staying asleep, or experiencing non-restorative sleep, is a prevalent sleep disorder among veterans.8
  • Nightmares, often vivid and distressing, are another common sleep disturbance experienced by individuals with PTSD. These nightmares can be related to past traumatic events and can significantly disrupt sleep patterns.9
  • Sleep apnea, a condition marked by repeated pauses in breathing during sleep can further exacerbate sleep difficulties.10

The impact of these sleep disturbances on veterans’ overall health and quality of life is substantial. Sleep deprivation and poor sleep quality can contribute to physical health issues such as cardiovascular problems, chronic pain, and impaired immune function. Mental health outcomes are also affected, as inadequate sleep can worsen symptoms of anxiety, and depression.11

Understanding the Mechanisms

Several mechanisms contribute to the relationship between sleep disturbances and PTSD in veterans. Neurobiological factors, such as an overactive amygdala and dysregulated stress response systems, play a role in both conditions.12 Sleep disturbances can also disrupt the consolidation of emotional memories, further exacerbating PTSD symptoms.13

Available Treatment Options

Recognizing the intertwined nature of sleep disturbances and PTSD, healthcare professionals have developed treatment strategies that address both conditions simultaneously. Here are a few key approaches:

  • Cognitive-Behavioral Therapy for Insomnia (CBT-I): Modifying sleep-related behaviors and thoughts has shown promise in improving sleep quality among veterans with PTSD.14
  • Prazosin: This medication has been shown to alleviate nightmares and improve sleep in individuals with PTSD.15
  • Complementary Approaches: Mindfulness meditation, yoga, and acupuncture may serve as adjunctive therapies to promote better sleep and reduce PTSD symptoms.16

As we honor our veterans, it is essential to acknowledge the challenges they face, including sleep disturbances and PTSD. By understanding the complex relationship between sleep, PTSD, and veteran health, we can work towards effective interventions and support systems.

Learn More

Somnology has assisted 22,000 veterans nationwide, evaluating 800 monthly for sleep issues. We’ve saved the U.S. Department of Veterans Affairs 60% on sleep diagnostics. Our team offers veterans wearable sleep assessment gear, enabling home monitoring. Data goes to our SLaaS® platform, connecting with specialists for tailored remote consultations. For more on SLaaS® and sleep, check out our blog.

References:

  1. Good, C. H., Brager, A. J., Capaldi, V. F., & Mysliwiec, V. (2020). Sleep in the United States Military. Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology, 45(1), 176–191.
  2. Saguin, E., Gomez-Merino, D., Sauvet, F., Leger, D., & Chennaoui, M. (2021). Sleep and PTSD in the Military Forces: A Reciprocal Relationship and a Psychiatric Approach. Brain sciences, 11(10), 1310.
  3. Bond, G. R., Al-Abdulmunem, M., Drake, R. E., Davis, L. L., Meyer, T., Gade, D. M., Frueh, B. C., Dickman, R. B., & Ressler, D. R. (2022). Transition from Military Service: Mental Health and Well-being Among Service Members and Veterans with Service-connected Disabilities. The journal of behavioral health services & research, 49(3), 282–298.
  4. Gilbert, K. S., Kark, S. M., Gehrman, P., & Bogdanova, Y. (2015). Sleep disturbances, TBI and PTSD: Implications for treatment and recovery. Clinical psychology review, 40, 195–212.
  5. Medic, G., Wille, M., & Hemels, M. E. (2017). Short- and long-term health consequences of sleep disruption. Nature and science of sleep, 9, 151–161.
  6. Mayo Foundation for Medical Education and Research. (2022, December 13). Post-traumatic stress disorder (PTSD). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/post-traumatic-stress-disorder/symptoms-causes/syc-20355967
  7. Richards, A., Kanady, J. C., & Neylan, T. C. (2020). Sleep disturbance in PTSD and other anxiety-related disorders: an updated review of clinical features, physiological characteristics, and psychological and neurobiological mechanisms. Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology, 45(1), 55–73.
  8. Hughes, J. M., Ulmer, C. S., Gierisch, J. M., Nicole Hastings, S., & Howard, M. O. (2018). Insomnia in United States military veterans: An integrated theoretical model. Clinical psychology review, 59, 118–125.
  9. Smith, A. B., Espie, C. A., & Kyle, S. D. (2014). Sleep disturbance and its association with military-related PTSD: A systematic review. Journal of Sleep Research, 23(6), 587-596. doi:10.1111/jsr.12183
  10. Alexander, M., Ray, M. A., Hébert, J. R., Youngstedt, S. D., Zhang, H., Steck, S. E., Bogan, R. K., & Burch, J. B. (2016). The National Veteran Sleep Disorder Study: Descriptive Epidemiology and Secular Trends, 2000-2010. Sleep, 39(7), 1399–1410.
  11. Lancel, M., van Marle, H. J. F., Van Veen, M. M., & van Schagen, A. M. (2021, November 2). Disturbed sleep in PTSD: Thinking beyond nightmares. Frontiers. https://www.frontiersin.org/articles/10.3389/fpsyt.2021.767760/full
  12. Sherin, J. E., & Nemeroff, C. B. (2011). Post-traumatic stress disorder: the neurobiological impact of psychological trauma. Dialogues in clinical neuroscience, 13(3), 263–278.
  13. Koffel, E., Khawaja, I. S., & Germain, A. (2016). Sleep Disturbances in Posttraumatic Stress Disorder: Updated Review and Implications for Treatment. Psychiatric annals, 46(3), 173–176.
  14. Kelly, M. R., Robbins, R., & Martin, J. L. (2019). Delivering Cognitive Behavioral Therapy for Insomnia in Military Personnel and Veterans. Sleep medicine clinics, 14(2), 199–208.
  15. Hudson, S. M., Whiteside, T. E., Lorenz, R. A., & Wargo, K. A. (2012). Prazosin for the treatment of nightmares related to posttraumatic stress disorder: a review of the literature. The primary care companion for CNS disorders, 14(2), PCC.
  16. Gallegos, A. M., Crean, H. F., Pigeon, W. R., & Heffner, K. L. (2017). Meditation and yoga for posttraumatic stress disorder: A meta-analytic review of randomized controlled trials. Clinical psychology review, 58, 115–124.