Military service members often come home with special issues that remain unresolved for decades. They may have seen combat and even witnessed comrades die in battle. Yet they may tuck the trauma away deep down inside, never saying a word about their wartime experiences to family or friends. We Honor Veterans at SleepMS with direct collaboration with the Department of Veterans Affairs to offer comprehensive sleep medicine services to our vets.
Depending on each veteran’s needs, patients may benefit from the expertise of the following:
Nightmares and Night Terrors
Nightmares are considered a diagnostic marker of PTSD in combat veterans. More than half of them report a significant nightmare problem several times a week. This means they are facing recurrent nightmarish dreams. These often come to them in sleep as flashbacks of traumatic experiences from their service work abroad.
Sometimes, veterans can also experience something known as night terrors. These anxious moments in the middle of the night are terrifying, not only for those going through them, but for their bed partners, roommates, or families.
The difference between a nightmare and a night terror is twofold: Nightmare content is generally remembered the next day, whereas a person who suffers a night terror will seem awake and inconsolable during an episode, but have no memory of it the next day. Also, nightmares are actually vivid dreams with frightening content, whereas night terrors occur between stages of sleep during periods of arousal.
Over 90 percent of active-duty personnel with PTSD suffer from insomnia that is considered “clinically significant.” By comparison, those without PTSD suffering from insomnia only constitute 28 percent. Insomnia is typically viewed as a symptom, rather than as a full-fledged sleep disorder. Acute insomnia is temporary but disruptive. Chronic insomnia occurs with regularity over long periods of time (three months or more) and adds to sleep debt. Deployment-related insomnia is a form of sleeplessness that’s distinct among military personnel. New troops are fearful of combat exposure and injury. Immediately, they are forced into irregular sleep-wake schedules. Those who complete their service must then re-adjust to home life. When deployment-related insomnia not treated immediately and proactively, it can become a major risk factor for the development of PTSD, depression, and suicide.
All forms of sleep apnea can be problematic for veterans. Many cases are not related to obesity, poor health, or aging. Instead, they are related to neurological or physical damage suffered during service. They could also be the result of substance abuse. Click here to learn more.
Restless Legs Syndrome
Cases of restless leg syndrome (RLS) have been reported among veterans. In some cases, the condition is so severe as to be deemed a contributor to disability, for which the VA compensates. For veterans, RLS is often diagnosed as a neurological dysfunction under the larger spectrum of PTSD.
With RLS, one’s legs develop uncomfortable sensations and an urgent need to move at or near bedtime. The legs could become “jumpy,” itchy, or have an otherwise unpleasant feeling to them. This makes it difficult to fall asleep. The best method for immediate relief is a warm shower or mild exercise or massage. However, medications have evolved to help keep these sensations at bay.
Parasomnias constitute sleep disorders in which the central nervous system activates during sleep, often around arousals or transitions between sleep stages. Two forms of parasomnias that often occur in veterans with PTSD include REM behavior disorder (RBD) and sleep paralysis.
REM Behavior Disorder (RBD)
As we sleep, we eventually reach a state of rapid-eye-movement, or REM, sleep. This is commonly known as the “dream” stage of sleep, though dreaming can occur during other stages as well. During REM sleep, the brain shuts down all muscle function in the body except for the diaphragm. It continues to work to support breathing. However, all other muscle groups during REM maintain a (temporary) mode of paralysis.
When someone experiences RBD, the paralysis of muscle movement in the body does not take place. The result? The dreamer begins to act out their dreams.
Small studies of RBD in veterans suggest more than half of those with PTSD may experience RBD. For veterans, these dreams may also be nightmares or flashbacks of traumatic events their memories are still processing. These physical manifestations of their internalized trauma can become a danger to themselves or to anyone around them.
This strange sleep-related symptom is terrifying. It may make those who suffer from it fearful they will be labeled as insane if they report it. Sleep paralysis occurs either while falling asleep or waking up. Someone suffering from sleep paralysis may be awake and alert but unable to move their arms or legs. Panic can ensue, especially if the experience of being unable to move is enhanced by scary visual or auditory hallucinations. Research suggests that as much as 85 percent of PTSD patients experience sleep paralysis, while in the general population, the rate of frequency is only as high as 40 percent.
Also known as bedwetting, enuresis is a form of night-time urinary incontinence. For adults, enuresis is typically linked to untreated sleep apnea, diabetes, or other medical conditions. However, enuresis can happen to veterans for other reasons. Female military personnel has been found to experience bedwetting at a higher rate than the population. Researchers suggest this is related to the long-lasting psychological and psychiatric stresses of military service.
When poor sleep and PTSD collide
When veterans can’t sleep and have sleep disorders that are left untreated, a host of problems can occur.
Excessive Daytime Sleepiness
Poor sleep at night by any cause will result in daytime fatigue, the need to take naps, unrelenting sleepiness, and dullness to daytime thinking and focus known as “cognitive fog.”
Research shows that those with PTSD who experience disrupted sleep are at higher risk for developing suicidal ideation. This can lead to self harm and the taking of one’s life.
Prolonged or intense stress—experienced before, during, and after deployment—is associated with lower levels of serotonin in the brain. Serotonin is a hormone that regulates your ability to manage fear and anxiety. Lower levels of serotonin in the system are known to disrupt sleep. This can eventually lead to insomnia and mood disorders (which can also lead to insomnia). Other changes to brain chemistry (especially with the regulation of adrenaline) that are related to military service may leave some veterans with feelings of hypervigilance or paranoia. Veterans who experience these symptoms are on edge at night and incapable of relaxation.
In addition, anxiety-related increases in the hormone cortisol, another stress hormone, can lead to changes in the sleep architecture of veterans. It robs them of certain kinds of sleep and fragments their stages all night long.
Treatments for sleep problems among veterans are many. The trick is to confirm a diagnosis and get the proper therapy for each individual who suffers. Treatment options include one or more of the following:
cognitive behavioral therapy
sleep restriction to reset circadian rhythms
recreational or occupational therapy
improved sleep hygiene
lifestyle changes (smoking cessation, daily exercise, healthy diet)
treatment for drug withdrawal