Sleep Problems Among US Veterans

Last updated: May 10, 2019

The information on this website is not intended to replace a one-on-one relationship with a qualified health care professional and is not intended as medical advice. Read our full medical disclaimer.

After their return from deployment veterans often suffer from a number of problems. PTSD, pain and sleep problems are only a few of them and often come interconnected.

In war they had to face challenges like prolonged stress, repeated injuries, constant sleep deprivation, and more. Unfortunately, only recently has there been more attention paid to their sleep disorders upon returning home. The sleep problems that affect veterans most often are insomnia, restless leg syndrome, sleep-related breathing, movement disorders, parasomnias, and circadian rhythm disorders.

Here we look at these disorders; their causes, symptoms, and consequences. Possible treatments are listed and shortly described.

Why can’t veterans sleep?

The reasons why many veterans stay up all night or wake up frequently are connected to the experiences they went through while deployed. These are some of the most frequent reasons.

PTSD (Post-Traumatic Stress Disorder) is a number of symptoms occurring after a person has been through immense pain and suffering. These symptoms are manifested as going through the trauma over and over again, having flashbacks and nightmares, avoiding thinking or getting reminded of the traumatic event, and being overly active and aware (insomnia and hyperarousal). All of these manifestations are followed by complex emotional and physical reactions, making it difficult to sleep.

TBI (Traumatic Brain Injury) is an injury to the head which occurred after strong head trauma (severe hit or falling on the head, for example), leading to a concussion or another type of brain injury. Memory loss isn’t the only consequence, but also the way the brain works. Some nerve cells are “rewired”, brain chemistry may change and some brain parts can be damaged. This can lead to circadian rhythm disorders (described below), frequent wakings, or an inability to fall asleep.

Pain and hearing problems. Many veterans have to constantly deal with pain. Chronic pain may cause not only emotional problems but also an inability to fall asleep. Many can be woken up from sleep by severe pain. Broken and injured joints may leave a veteran with arthritis, and nerve pathways from amputated limbs may send continuous pain signals to the brain (known as ghost limbs). Headaches and chronic buzzing in the ears resulting from long-term exposure to loud noises (tinnitus) also cause insomnia.

Abuse of and withdrawal from psychoactive substances. This includes illegal drugs as well as alcohol and nicotine. They are often used to deal with stress, depression or PTSD symptoms and can be very dangerous. Unfortunately they, together with many antidepressant drugs, negatively influence one’s sleep and sleep cycles. Some repress REM sleep; some repress restorative deep sleep and some repress sleep altogether, making a person additionally sleep deprived. Those undergoing withdrawal will likely have a hard time, which will take its toll in sleep, but they should know that perseverance is important as they are heading towards a healthier lifestyle.

What are some common sleep problems and disorders veterans suffer from?

There is no single sleep disorder that only veterans face – all of them are present among the general public but are a lot more common among veterans due to their traumatic and stressful experiences.

Research about veteran sleep-related problems has shown inconsistent results, as clinical methods such as polysomnography haven’t matched veterans’ claims. This means that scientists monitored many factors like brain waves, heart rate, and body movements; only to find that veterans didn’t have any recordable sleep issues. However, veterans would keep reporting that it took them too long to fall asleep and that they had too many wakings. This unusual problem is known as paradoxical insomnia. Paradoxical insomnia is a frequent symptom of PTSD sufferers.

Insomnia. Insomnia is defined as ‘difficulty initiating or maintaining sleep’. In the generation of veterans who fought in Vietnam, 91% of PTSD sufferers and 63% of non-PTSD veterans have reported frequent problems with insomnia. Insomnia usually begins during deployment due to fear and unnatural daily and nightly schedules and persists after they return home while adjusting to the new environment and battling consequences of combat.

Circadian rhythm disorders. With an unpredictable or constantly changing sleep-wake schedule, fueled with stress, the circadian rhythm (or the internal biological clock) starts shifting away from the natural rhythm. It leaves a person constantly exhausted and ‘jetlagging’. When necessary a severe “Panama Shift Schedule” is employed. It is a 24/7 coverage system where each shift is 12 hours and in which a person is active for 3 days and rests for 2 days. After a prolonged period of shift work, a person will have a hard time adjusting to a new environment.

Sleep apnea. This disorder is manifested through frequent nightly wakings because a person’s upper airway gets obstructed or closed. Among civilians it is most frequently caused by obesity, aging or substance abuse. Veterans suffer from obstructive sleep apnea (OSA) due to injuries suffered during deployment. Different studies have reported about 50% or higher percentage of breathing disorders in those suffering from PTSD.

Nightmares and night terrors. Nightmares are bad and unpleasant dreams, but night terrors are characterized by loud crying moving around and being seemingly awake and inconsolable – a person may remember a nightmare, but not an episode of night terror. A veteran will mostly dream about war and have gory scenes come back through nightmares.

Other disorders are sleep-related movement disorders and parasomnias also related to movement.

Periodic limb movement disorder (PLMD) is seen as repetitive movements of limbs throughout all sleep stages except for REM (during which the body is normally paralyzed in order to prevent injuries while enacting vivid dreams). PLMD is usually followed by daytime sleepiness and fatigue.

Some of the parasomnias are REM-sleep-related disorders. For example, sleep paralysis in which a person wakes up from a dream but is unable to move because their body is still paralyzed (which is normal for REM, but not for wakefulness). It’s perceived by the sufferer as a dangerous condition since they are afraid of suffocating. This one is rarely reported because sufferers can’t clearly describe what’s happening to them and are at a fear of being called “crazy”.

Another is REM sleep behavior disorder, in which the body isn’t paralyzed at all, so a person easily moves and might possibly hurt themselves or people around them, especially when having violent dreams.

Female veterans are at a higher risk of developing enuresis, or bedwetting. It is likely caused by chronic stress exposure.

When PTSD and sleep problems go untreated

Anyone with untreated sleep problems is likely to suffer from excessive daytime sleepiness (fatigue, inability to focus and learn, slow reaction time), depression (due to brain chemistry changes, hormonal imbalances and a lack of energy), poor quality of life (a person is emotionally unstable and not able to perform enjoyable activities). They may further engage in overeating and substance abuse.

When these consequences add up to PTSD there is a high possibility of suicidal thoughts and feelings of hopelessness. As soon as one notices such thoughts or notices a person close to them has them, they should seek professional help.

Treatments for sleep disorders

Continuous positive air pressure (CPAP) machine has proven very useful in the treatment of sleep apnea and has shown great success in treating nightmares. Various treatment types can be employed depending on the problem.

For substance abuse rehabilitation and withdrawal are a priority. In many cases significant lifestyle changes are needed – better diet and sleep hygiene and physical exercise to name a few. Various therapies are available such as psychotherapy, cognitive behavioral therapy, relaxation and therapy dog use. Medications are sometimes prescribed to fight depression, insomnia or pain.

Short-term sleep restriction may be employed to treat depression or set the circadian rhythm to match the actual day/night time. Light therapy may be used to mitigate depression and increase mood.

Unfortunately a large number of veterans fail to seek help, getting deeper into sleep problems and PTSD symptoms which can have devastating consequences on their mental and physical health and sometimes results in suicide. To prevent this they should not refrain from contacting professional facilities which offer help to veterans.

Additional resources

  1. Khazaie H, Ghadami M. R and Masoudi M. Sleep disturbances in veterans with chronic war-induced PTSD. Journal of Injury and Violence Research. July 2016. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4967368/ Accessed March 23, 2019.
  2. Leskin G. A, Woodward S. H, Young H. E, Sheikh J. I. Effects of comorbid diagnoses on sleep disturbance in PTSD. Journal of Psychiatric Research. 2002.
    https://www.ncbi.nlm.nih.gov/pubmed/12393315/ Accessed March 23, 2019.
  3. Tamanna S, Parker J. D, Lyons J, Ullah M. I. The effect of continuous positive air pressure (CPAP) on nightmares in patients with posttraumatic stress disorder (PTSD) and obstructive sleep apnea (OSA). Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine. 2014. https://www.ncbi.nlm.nih.gov/pubmed/24932142  Accessed March 23, 2019.
  4. Why our veterans can’t sleep. American Sleep Apnea Association. https://www.sleepapnea.org/why-our-veterans-cant-sleep/ Accessed March 23, 2019.

The information on this website is not intended to replace a one-on-one relationship with a qualified health care professional and is not intended as medical advice. Read our full medical disclaimer.