Got sleep? If only it were as easy as grabbing a glass of milk. Anyone who has wrestled in the darkness — fighting off nightmares or tossing and turning through sleepless nights — knows how hard it can be to grab good Z's. The real-life nightmares of combat, not to mention all of the other sleep-sucking demands of military life, only make it worse for those in uniform.
The good news: A slew of new sleep tactics are helping troops get the shut-eye they need.
Even better, many combat veterans are finding that as they are able to get a better grip on good sleep, symptoms of post-traumatic stress disorder are diminishing or disappearing altogether.
Here are some of the latest strategies straight from the front lines of the sleep wars.
Like elite athletes who mentally rehearse to improve performance, you can train your brain to dream your way out of nightmares. Doctors call it image rehearsal therapy, but you can call it the "nightmare buster."
"You can revise your nightmares and create new dreams from them with new images," says Dr. Barry Krakow, one of the country's top sleep doctors, who pioneered the technique. "We like to call it ‘intentional daydreaming.‘"
It works like this: If you're having a recurring nightmare, spend a few minutes every day rewriting the story so that just before it starts to get bad, it turns into something else.
So, for example, if you're having an explosion nightmare, rehearse in your mind's eye that you turn around and see that's it's just a car backfiring.
"A lot of people discount this because it sounds way too simplistic," he says.
But it works. Krakow has been using the technique for years at his PTSD Sleep Clinic in Albuquerque, N.M., where about 15 percent of his patients are active-duty service members. In fact, the technique works so well, a growing number of doctors — including some in the military — have begun to consider it a PTSD treatment unto itself.
Check out the resources at www.nightmaretreatment.com, but be advised that Krakow says some people may need coaching from a therapist or sleep doctor.
Breathe easy, sleep easy
Some of Krakow's latest research has connected sleeping problems with breathing problems.
In a study in this month's issue of the journal Sleep, Krakow found that chronic insomniacs wake about 30 times a night, almost always just before their breathing stops or slows down enough to register a drop in oxygen intake.
"If someone walks in the door with insomnia and PTSD, I know he's probably also got sleep apnea," Krakow says.
And most don't even know it.
Sleep breathing problems often boil down to a case of rhinitis, an inflammation or irritation of the membranes inside your nose. The allergic variety is common among those who suffer from hay fever, for example, but the nonallergic variety is common among those who suffer from anxiety.
"And, of course, PTSD is an anxiety disorder," Krakow says.
He recommends some relatively easy fixes that come down to what he calls "simple nasal hygiene," starting with nasal saline spray, used twice daily.
"We've had tons of people tell us just that one tip on cleaning out their nose with nasal saline made them sleep better," he says.
Nose-opening nasal strips — such as the Breathe Right variety favored by football players to maximize their air intake during games — also can work wonders.
Nasal antihistamines and neti pot washes, also know as nasal irrigation — pouring water into one nostril and draining it from the other — can be helpful, as well.
The tough cases
Insomnia can also be a sign of PTSD, particularly for those ramped up in a continuous state of alert.
"If you have hyperarousal, you're not going to be sleepy. PTSD triggers this," Krakow says. "People have to relearn how to tap into their sleepy feelings again. That can be a very involved process."
It's a problem of taming the "racing thoughts" that many describe as the reason they can't get to sleep.
"We've learned that we can modify the IRT program for nightmares and modify the imagery for insomnia. So, when you get into bed, instead of ruminating and having racing thoughts, you try to replace them with more pleasant images."
For the toughest cases, he says patients need to start analyzing what he calls their "emotional intel."
"That's where you're going to have the most direct result at bedtime," Krakow says. "Being able to say, ‘I'm having these racing thoughts because I simply don't want to deal with the feelings I had during the day.‘"
Saying you're "stressed out" isn't enough. You've got to be able to name specifically what's going on. That comes only with the help of a good therapist.
"Emotions have purpose. They want to deliver information," Krakow says. "When you actually feel the emotion, that tends to be the biggest time you get an epiphany or the hit. It comes to you, and you realize why you've been having this feeling. The next step is, what … to do with that intel."
If the emotion is, say, frustration — maybe a conflict at work or with family — you might need a daily frustration-burning workout after work, for example.
Secret weapon against jet lag
As one of the military's top sports docs, Army Col. Kevin DeWeber has spent a career traveling around the world with elite athletes. In the process, he has refined his own personal prescription for beating jet lag.
Like most experts, he'll tell you about the importance of resetting your internal clock by getting at least a half-hour of bright sunlight on the first few mornings you're on the ground.
"Not super early, but by midmorning," he says.
Melatonin, one of the natural body-clock chemicals that's also available as an over-the-counter supplement, is also helpful at night to ease you into sleep, he says.
"Also, your body will want to nap, but you need to try to minimize that as best you can" by taking only short naps, and only if you have to.
Whenever he's flying west, though, DeWeber breaks out his secret weapon for beating jet lag: "A soft collar will work wonders in helping you sleep on the flight," he says.
Available at most pharmacies, soft collars are a common stabilizer for anyone who has suffered a neck strain or sprain.
On a plane, however, they will keep your mouth shut and your head from flopping around. No fold-out tray necessary.
For eastbound flights, he tries not to sleep.
"If you're flying east, you're basically shortening you're day, so it's better to stay awake if you can," he says.