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Sleep Problems Can Have Both Short- and Long-Term Negative Effects, but Evidence-Based Interventions Can Help

• Sleep problems are common across the force, but their prevalence is particularly high among servicemembers who have deployed to conflict environments.
• A survey of personnel showed that insufficient sleep duration, poor sleep quality, fatigue and daytime impairment, were all common. Sleep problems can compromise operational effectiveness and make it difficult for servicemembers to resume their lives after returning home from a deployment.
• Sleep problems can lead to the development of serious mental health conditions, including post-traumatic stress disorder, depression, and traumatic brain injury. Treating sleep disturbances early on may be an important preventive strategy to reduce the risk of downstream mental health consequences.
• There is evidence that cognitive-behavioral therapy and imagery rehearsal therapy for insomnia may be effective in helping to alleviate sleep problems and address these correlated conditions, but dissemination of these strategies remains a challenge.

Policies and Programs Promoting Sleep Health Are Available to Servicemembers, but Barriers Challenge Their Implementation

• Policies to guide treatment for sleep disorders and promote healthy sleep practices among servicemembers and veterans often lack specificity. For example, operational policies mandating sleep plans lack detailed guidance for implementing the plans.
• Even with evidence-based policies and programs to promote sleep health, it can be difficult for servicemembers to get the rest they need. Barriers to healthy sleep include possible stigma associated with taking breaks, widespread use of energy drinks and caffeine supplements, noisy and uncomfortable sleeping spaces, and a lack of a centralized repository for sleep-related policies and information to promote sleep health.

Sleep disturbances are a common reaction to stress and are linked to a host of physical and mental health problems. Given the unprecedented demands placed on U.S. military forces since 2001, there has been growing concern about the prevalence and consequences of sleep problems for servicemembers. Sleep problems often follow a chronic course, persisting long after servicemembers return home from combat deployments, with consequences for their reintegration and the readiness and resiliency of the force. Therefore, it is critical to understand the role of sleep problems in servicemembers' health and functioning and the policies and programs available to promote healthy sleep. This report provides the first comprehensive review of sleep-related policies and programs across the U.S. Department of Defense (DoD), along with a set of actionable recommendations for DoD, commanders, researchers, and medical professionals who treat U.S. servicemembers. The two-year multimethod study also examined the rates and correlates of sleep problems among post-deployed servicemembers, finding negative effects on mental health, daytime impairment, and perceived operational readiness. The research reviewed evidence-based interventions to treat sleep disturbances among servicemembers and veterans and exposed several individual- and system-level barriers to achieving healthy sleep. Implementing evidence-based treatments is just one step toward improving sleep across the force; as the research recommendations highlight, it is equally important that policies and programs also focus on preventing sleep problems and their consequences.

• Chapter One

  Introduction

• Chapter Two

  Epidemiology of Sleep Problems in the Military

• Chapter Three

  Assessing Sleep Disturbances and Consequences Among Post-Deployed Servicemembers

• Chapter Four

  Review of Sleep Policies and Programs

• Chapter Five

  Evidence-Based Interventions to Treat Sleep Disturbances Among Servicemembers

• Chapter Six

  Barriers to Achieving Healthy Sleep Among Servicemembers

• Chapter Seven

  Conclusions and Recommendations

• Appendix A

  Sleep Terminology

• Appendix B

  Methods and Review of Published Studies on Sleep in the Military

• Appendix C

  Methods and Review of Published Studies on Interventions for Sleep Disorders in the Military

• Appendix D

  Review of Sleep Metrics

• Appendix E

  Description of Source Measures Included in the Sleep Survey

• Appendix F

  U.S. Department of Defense Policies Related to Sleep

• Appendix G

  Key Informant Interview Protocol

• Appendix H

  Sleep in the Armed Forces Working Group Proceedings