For at-risk veterans, finding pathways to good sleep is critical

I didn’t appreciate the importance of sleep until I’d faced a period in my life after military service when I couldn’t sleep. In the days following a catastrophic event that left me permanently disabled, sleep became my enemy.

What was supposed to be a function that restored my energy and bodily systems, instead would push me into a dream state where the “able bodied” version of me would run free in seemingly taunting fashion — reminding me of what I’d lost in vivid detail, eroding my self-identity every time I closed my eyes.

Waking up to reality had become my worst nightmare. Consequently, I would stay awake every night, as long as I could, for the first two years after I left the Marine Corps, alone with my thoughts as I contemplated every possible scenario that offered an escape.

So I wasn’t surprised when I read that over 90 percent of active-duty service members with post-traumatic stress suffer from insomnia. However, even given the statistical significance of sleeplessness among veterans, what did surprise me was how many people I knew, many being veterans of the wars in Afghanistan and Iraq, who suffered the same sleeplessness issues. The inability to fall asleep, staying awake while trying to sleep, waking up in the middle of the night, feeling drained in the morning and mentally fatigued. I hadn’t realized that insomnia was a dangerous tie that bound us together.

Dangerous because numerous studies have shown a connection between insomnia and suicidal ideations, suicide attempts, and death by suicide. Among women aged 25 to 44, including women veterans, there exists a high risk of suicide. This is due, in part, to insomnia. Add a history of military sexual trauma, combat survivor’s guilt, drug or alcohol misuse, relationship issues, a sense of isolation, feeling like a burden to others — all of which are common among veterans — and the risk of suicide increases exponentially.

Hopeful sign for combat veterans with nightmares, insomnia

Sleep disturbances are some of the most commonly reported psychiatric complaints by combat veterans. Hundreds of thousands struggle regularly with insomnia, both falling and staying asleep, and nightmares.

Oftentimes, the solution is medicinal in nature. Many start with a referral to a doctor who prescribes sedatives that work but may cause dizziness, daytime drowsiness, gastrointestinal problems or allergic reactions as a side effect. Self-medication of insomnia with alcohol is also not uncommon. However, while alcohol may initially make it easier for some to fall asleep, tolerance to alcohol’s sedative effect can actually exacerbate insomnia.

Moreover, one research study concluded “patients and clinicians should consider insomnia as an additional warning sign of potential suicidal behavior, not just a symptom of other warning signs, such as depression or alcohol use.” Some people have found herbal and dietary sleep supplements, such as valerian, melatonin and tryptophan to be effective. But even these can render inconsistent outcomes and have unwanted side effects.

Behavior-based remedies include maintaining a sleep schedule, using noise suppression and darkening a room in order to eliminate sleep disturbances.

Cognitive behavioral therapy for insomnia, or CBTI, is a highly effective goal-directed, four- to six-session treatment program administered by trained professionals in sleep therapy. These methods, while viable alternatives to medications, require changes in habit and lifestyle over time. Large lifestyle changes can present significant challenges for veterans who have been trained to keep rigorous daily routines and to fight sleep for long periods of time during active duty. Veterans may also have other service-related issues that contribute to sleeplessness, such as traumatic brain injury or post-traumatic stress, which can inhibit adherence to a new routine.

Another alternative therapy is the use of technology in battling insomnia. New technologies that don’t involve medicinal or behavioral solutions include white noise sound machines that block out distracting noises and produce soothing sounds that help to induce sleep. Continuous positive airway pressure, or CPAP, devices also help by opening the user’s airway in order to reduce sleep disturbances. The newest innovation to hit the sleep aid market, developed by Ebb, uses targeted cooling to reduce metabolic activity in the brain, helping to relax the mind and body to a point of restorative sleep. For veterans who have tried medications or behavioral therapies in the VA but still suffered insomnia, technologies such as these must also be an option for them and their VA providers to consider.

The importance of sleep cannot be overstated, particularly among military veterans or active-duty service members with post-traumatic stress or depression who face the highest risk of suicide. Functioning on very little sleep, whether on combat deployment or home alone after separation from service, will likely remain a challenge for many. However, the choice of insomnia remedies must be as expansive as possible, from traditional approaches to nontraditional or technology based solutions, in order to find the best pathway to good sleep and its contribution to complete mental and physical wellness.

Sherman Gillums Jr. is a retired U.S. Marine Corps veteran and chief advocacy officer for AMVETS National. Neither AMVETS nor the author officially endorse any product or medication mentioned in the article.

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