ACA Blog

Natosha Monroe
Sep 28, 2010

Why So Many Veterans Have Sleep Issues…and Could This Lead to Misdiagnoses? Part One

A common issue we as counselors are likely to see among military clients is their inability to sleep well. First of all, trouble sleeping is not exactly specific to military members, as we all know. Many people in the general population have this problem as well. But I think it’s important not to jump to conclusions about a Veteran’s lack of sleep being due to PTSD, nightmares, or stress, but to instead consider very simple factors which, once understood, might be the true obstacles to sleep—and much more easily remedied. From a previous year-long deployment and now this one in Afghanistan, I can hopefully offer some ideas and insight one might not have considered otherwise in explaining possibilities for a lack of sleep among Veterans.



While I realize it may be quicker and easier to prescribe a sleep medication, it is my humble opinion that the client deserves a bit more of the professional’s time and attention in assessing the reason(s) behind the sleep problem and an offering of suggestions or solutions as well. If the client would rather take a pill, so be it. But I happen to have met numerous individuals who would rather at least try alternate methods first. (Warning: This will be longer than usual and is in two parts, but will hopefully provide some ideas for those working with Troops who have sleep issues.)

I had a couple of professors in my master’s program at Texas Wesleyan University who impressed upon me (effectively, I might add) the importance of asking open-ended questions to clients and not limiting or leading them to certain answers that we might be presuming. For instance, prompting the client with, “Describe your sleep last night” or “Tell me how you’ve been sleeping lately” might render more original information than, “Do you sleep at least 6 hours of uninterrupted sleep each night?” or even, “How was your sleep last night?” While I’m here in Afghanistan it is almost comical to ask, “Have you been sleeping well lately?” because I’m already aware the client is likely to laugh or think I’m an idiot because a) we live on an Army airfield and b) we’re in a combat zone. In other words, there are numerous possible things that keep anyone here from sleeping soundly. I honestly have yet to speak to anyone who has regular, uninterrupted sleep. Here are some reasons why:

1. Have you ever heard a jet flying way overhead—so far it’s but a tiny speck in the sky—and heard it rumbling? Or have you been near an airplane taking off nearby and had to cover your ears due to the noise? Now imagine that runway with all that noise being located across the street from your house. Imagine, as you’re trying to sleep, hearing multiple jet engines and afterburners rumble so loudly that you can feel it in your chest and in your teeth and can watch it rattle the walls of your house? That’s what we hear NIGHTLY here in some areas at Bagram. To make matters worse, mechanics work on the jets near some housing areas, so the jets are stationary on the ground (not high up in the air or rolling briefly past your house on their way down an airstrip). Literally I’ll be talking to a roommate when the jet engines are fired up and we start yelling until it’s useless and we laugh and start pantomiming to each other until it’s quiet again. Might this affect one’s quality of sleep? Probably. Miraculously I’m able to sleep through it, but it has to affect the soundness of my sleep to some degree. And it obviously affects my ability to fall asleep sometimes.

2. Have you ever been awakened in the night by an ambulance, fire truck, or police siren wailing by your house? Imagine waking up to a siren that is warning you of possible incoming. “Incoming” meaning rockets or other explosives hurled at your camp from the other side of a fence by people such as the Taliban. Now imagine your house is literally a stone’s throw from said fence like mine is. While I can’t discuss our safety procedures, let’s just say you aren’t supposed to continue to sleep through the warnings. And let’s not even mention the interruption of sleep if the landing site of said rocket or other explosive is at or very near your area. There are also such noises from the military camp—I was at one Forward Operating Base that fired Howitzers at night for practice which was the loudest BOOM! I’d ever heard and it rocked the house and shook it around me. Besides the actual explosions, impact noises, and sirens…sometimes noises that may sound like impact can get the heart rate up (natural response to previous encounters or getting revved up to react).

3. Ever had a noisy roommate living above you in an apartment or an inconsiderate college roommate or a bad neighbor? Imagine living in a tiny “house” with 8 others—all with different work schedules and levels of consideration? Or even worse, some Troops live in open-bay rooms or huge tents with little to no privacy whatsoever. On this note, here’s an example of one night of “sleep” I had recently—this is no exaggeration and this is not uncommon. 10:30pm, I get into bed to go to sleep—I have to get up at 6:00am the next morning. I immediately hear two people conversing and laughing loudly just outside my Bhut’s thin plywood-like walls. Shortly thereafter, I am drifting to sleep when I awakened by a loud SLAM! and my bed shaking. I startle as someone exits my BHut, not purposefully closing the door behind her but allowing it to slam shut right next to my bed. What then keeps me awake is being annoyed at the inconsideration and wondering which roommate it was and what I’d like to say to her about it. Ha.

The next thing I know I am awake again. I wonder what woke me up. Then I hear a conversation a roommate is having with her family via her laptop computer. I look at my watch and it’s after 1a.m. Great. I like this roommate, and I wonder why she would choose to do this so late—I think it might be an emergency. But then I hear her talking about things that are definitely not an emergency. I lay awake for quite some time, covering my head with my pillow. Finally I get up and ask her how much longer she thinks she will talk because it’s almost 1:30a.m. and I can hear every word she’s saying. She apologizes, lowers her voice, and I’m able to fall back asleep.

The next thing I know, I’m awakened by another roommate’s highly-annoying alarm clock across the hall. I groan when I recognize it as hers: very sweet girl, but her neighbors HATE the fact that she often does NOT wake up to her own alarm clock. Instead, it will literally go on beeping for as long as an hour before one of us gives up and gets out of bed to bang on her door to wake her up. Finally I get back to sleep. Then I wake up to someone’s radio alarm clock. I get back to sleep. Then I wake up to another loud SLAM! of the door. Then I go back to sleep. Finally I wake up to my own alarm on my watch and I begin my day. Now, how great was my quality of sleep?

4. Have you ever had a job where you did night shift work and had issues sleeping during the day or readjusting back to “regular” hours? Well, since we are in a combat zone, things have to be operating 24/7, which means a lot of people pulling night shift hours. So this is a whole other group of possible sleep issues.

5. Troops who live in more dangerous areas and/or who participate patrols, convoys (vehicles), or of course combative duties clearly do not sleep regularly. For periods of up to a year they may actually fear a deep, restful sleep—it can be deadly to sleep through a sound that might warn you of the approach of an attacker, for instance. A missed moment of reaction time could cost you life or limb…would you feel comfortable falling asleep?

This list is not all-inclusive of course, but just imagine months on end of interrupted sleep. Imagine a year’s worth of not sleeping an entire night through. It can be so frustrating. Last night I was so sleepy and just as I was getting to sleep, a roommates LOUD radio alarm clock went off….and kept going for hours. She is a night shift worker. She had set her alarm for PM instead of AM. Really? The other roommates and I groaned and complained and then tried various things to block out the loud noise. One thing that works is playing relaxing music on my iPod. But the issue is I have to have the music turn off at some point so I can wake up to my morning alarm. Also I’ve woken up tangled in the iPod headphones cord, ha.

Part Two of this blog will be coming next week.



Natosha Monroe is an Army Reserve Mental Health Specialist stationed in Afghanistan. She is a counselor and PhD candidate passionate about increasing Troop access to counseling services. Her blog contents are not representative of the Army or Department of Defense in any way.

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