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Sleep starved

Slipping by on six hours of sleep? Don’t. Military sleep experts say not getting a full eight hours can put you and your battle buddies at the same risk as having a few beers before driving a Bradley, shooting a Mk 19 grenade launcher or trying to determine whether a target is friend or foe.

And commanders who don’t have plans to ensure their troops get eight hours of sleep are misusing resources — and begging for trouble.

“We are giving our troops the best uniforms, and weapons are a priority,” said Nancy Wesensten, a sleep scientist at Walter Reed Army Medical Center in Washington, D.C. “But the one thing they really need for operational readiness is as much sleep as possible.”

She says it’s important to understand that:

• Sleep is a necessity.

• The culture that says it’s weak to need eight hours of sleep must change.

• Commanders must develop sleep plans.

• Researchers don’t yet fully understand the long-term effects of neglecting to sleep.

• Taking care of sleep problems, such as nightmares and insomnia, may be the first step toward addressing mental health issues that could come later.

Rest for the wicked

In the old days, military training involved sending troops to the field for three days and expecting them to perform well with no sleep.

“After three days, you’d collapse,” said retired Army Col. Greg Belenky, director of the Sleep and Performance Research Center at Washington State University. “You wouldn’t be good for anything.”

Such exercises gave little consideration to what would happen in a sustained conflict that lasted, say, six years. That began to change when the military began longer pre-deployment training, such as the two weeks many units now spend at the National Training Center at Fort Irwin, Calif.

Commanders came to realize that their troops were not performing up to standards — and sleep became as important as fuel, food and ammunition to a battle plan.

Anecdotally, researchers have found lack of sleep contributed to friendly fire incidents in the 1991 Persian Gulf War as well as to a navigational error that led to the capture of Army Pfc. Jessica Lynch in Iraq in 2003.

But as sleep scientists delved deeper into dreamland, they found those anecdotes were based in a nightmare: Just 24 hours without sleep impairs someone in the same way as a blood-alcohol content of 0.10 — legally drunk in all 50 states.

An Oregon Health and Science University study found chronic sleep loss makes it impossible to think clearly, handle complex mental tasks, form memories and solve problems. And, according to the National Highway Traffic Safety Administration, sleepiness is the main cause of more than 100,000 vehicle accidents each year, resulting in 76,000 injuries and 1,500 deaths.

‘Sleep debt’

Wilfred Pigeon, a clinical researcher at the VA Center of Excellence at Canandaigua, N.Y., and director of the Sleep and Neurophysiology Research Lab at the University of Rochester, said research shows that getting two or three fewer hours of sleep for several nights causes a “sleep debt” that eventually has the same effect as not sleeping for 24 hours straight. And trying to catch up on the weekend isn’t the answer; several full nights’ rest is required to make up the debt.

Belenky said decreasing sleep by even one hour a night for several nights in a row is enough to affect performance. And forget the “four-hour rule” that says troops working in high-tempo operational environments can function on four hours of sleep. The reality is performance will be poor — a stable level of bad. At less than four hours, cognitive abilities continue to degrade.

“Sleep is equal in importance to a healthy diet and exercise,” Belenky said. “But I recommend sleep over exercise if you’re not getting enough.”

Cultural shifts

Wesensten said military culture must change so that leaders realize troops need eight hours of sleep in every 24-hour period.

“The older generation seems to think that if a person needs sleep, he’s weak or unmotivated,” she said.

Most people need eight hours daily, she said, and commanders should plan for that. That can include naps — as long as each person gets eight hours total in a day.

Belenky said the lab at Walter Reed Army Medical Center, where he worked until he retired, developed the Actograph, a device that tracks sleeping habits by measuring arm movements. He said this could be a good way for commanders to know who is fresh enough for duty, who is pulling too many shifts and who is staying up late playing video games. Commanders should manage sleep just as they do fuel, he said.

Service members also should watch their own habits.

Retired Cmdr. Beverly Dexter, a psychologist at Camp Pendleton, Calif., noticed while serving in Iraq that the biggest problem was troops staying up late to play video games. Not only should they be sleeping, but video games can be so stimulating that they prevent people from sleeping later, she said.

She also saw troops stay up until 2 a.m. to wait for calls from home.

“The person back in the States should be the one staying up late for a phone call,” she said.

She also suggests limiting calls to friendly conversations and saving the broken washing machine or the unpaid insurance bill for an e-mail so a phone call doesn’t devolve into an argument. No one can sleep after a distressing phone call, she said.

A good commander will look for those habits and limit Internet time or set up a schedule when people must be in bed.

“If I ran into someone who actually did pay attention to sleep, I was delighted,” Dexter said. “Instead, people say, ‘Well, it’s a combat zone.’ You wouldn’t say that if you ran out of food and fuel.”

Kerry Kuehl, a co-author of the Oregon report, said there are long-term considerations, as well.

“Sleep is when you repair your immune system and your cardiovascular system,” he said. “Without sleep, it’s harder to combat disease and illness.”

There is evidence that lack of sleep also may contribute to mental health problems, including post-traumatic stress disorder, Wesensten said. Not sleeping may mean that the brain doesn’t get a chance to repair itself, which may increase vulnerability to stress or even post-concussive symptoms.

Wesensten said research has found that troops who get the least sleep also have the highest rates of mental health problems — though that may be because the high-operational tempo units are seeing the most trauma. Studies already have shown a link between lack of sleep and depression, a condition often connected to PTSD.

But Pigeon said sleeping problems might prove to be an inroad to addressing mental health issues. If a person has a hard time sleeping because he can’t turn his mind off or because he fears nightmares, he should see a doctor.

“We should jump on it,” Pigeon said. “Left untreated, poor sleep seldom resolves on its own. And it’s more acceptable to have a sleep problem than to have PTSD, so sleep is a perfect entrée for people to access services. Sleep could be a red flag that other things are coming, so it’s a great place to intervene.”

A doctor can recommend a short-term fix such as antihistamines to help a person sleep, but the drug’s effectiveness will quickly dissipate as a person builds tolerance. Troops also can get over-the-counter or prescription sleep aids such as Ambien.

Wesensten said the best plan is to find a good place to sleep; try to sleep at the same time every day; invest in earplugs and face masks and — for commanders — air conditioners; and use black-out paint on windows in sleeping rooms in combat zones.

“Sleep whenever you can for as long as you can,” she said.

Getting some shut-eye

• If you can’t sleep, get out of bed. Don’t condition your body into believing bed is for thinking.

• As a leader, keep good sleeping habits as an example for your troops.

• Don’t oversleep; it can be hard to fall asleep the next night.

• Find an alarm clock that is not obnoxious — out of respect for your battle buddies.

• If you have a nightmare, write down the dream, but change something in it. Then read it over a few times. Dream therapy can help establish sound sleeping habits. For info, visit www.nomorenightmares.org.