ACA Blog

Natosha Monroe
Oct 05, 2010

Why So Many Veterans Have Sleep Issues & Could This Lead to Misdiagnoses? Part Two

If one doesn’t sleep an entire night through for months on end and even up to a year, it’s no wonder it takes them a while to readjust once they are back home. When I was in Guantanamo Bay for a year with nightly-interrupted sleep, it took me over a year once I was back home to sleep an entire night through without waking up. And that wasn’t even a combat zone! Before the deployment, I never had sleep issues—I am one of those people who goes straight to sleep once my head hits the pillow and I stay asleep until my alarm goes off in the morning.

Another issue I had once I was back home was an annoying buzz in my ears whenever things were quiet. I figure this was due to the fact that on a deployment, one rarely if ever has complete silence. And if there was an alone moment/quiet moment it still wasn’t completely quiet due to the loud generators which are used to run everything electrical—so I never had complete quiet. Once I was home, it took a long time to be able to stand the complete silence I used to enjoy so much pre-deployment. So this can be another issue when it comes time to go to sleep back home.

Some things that have worked for me and that Troops have shared have worked for them as well:
1. Creating a “sleep mode.” This can be done by using different techniques such as changing the lighting in the bedroom/sleep area before bedtime. Right now I do this in my little room. I have two small lamps. One bulb in one lamp is much brighter than the other: I use this lamp in the morning to help me wake up and during the day. I use the softer lamp light (it’s actually not a regular light bulb) in the evenings before my bedtime. Another idea is bedding: Make sure the bed is comfortable. On deployments this can be difficult or impossible at times. The mattress I was given upon arrival literally had 2 springs sticking up through the top. I was able to get a really great mattress pad sent via mail that softened the blow a bit. Still, the mattress gave me a back ache each night. Luckily, I switched rooms and got a better mattress. I also spent a little money on really nice Egyptian cotton sheets and a fluffy comforter. I even have a calming-scent lotion I will use before bed to make me feel more relaxed. Little things, but they add up. I look forward to that comfy bed now.

2. Staying away from caffeine in the afternoons and evenings. This is HUGE with members of the military—you should see all the high-caffeine products dispensed here! Many times Soldiers are afraid of falling asleep at work or in a watch tower, for instance. Just imagine being on a 12-hour straight shift in a watch tower knowing a) if you fall asleep or are drowsy you might miss seeing the enemy approach your camp with a weapon or a bomb or b) if you do fall victim to the ZZZ Monster you will be disciplined with an Article 15 and may even lose rank or pay. Sad, but this does happen to Troops. So many turn to caffeine products, thus making it very difficult for their systems to be able to relax when it’s time.

3. Not watching TV/video games/computer prior to sleep time and/or in the bed. When space is limited (you may just have a cot and a few inches around it) it can be difficult to not watch/use media in bed. But these visual stimuli really can hinder one’s ability to fall asleep. Also it’s important to psyche the mind/body out to realize that the bed is for sleeping and that’s it—nothing else. This includes the cell phone.

4. If the issue is falling asleep, try to figure out why. Is it noise? Perhaps get an iPod and set the sleep timer so it will go off after you’ve fallen asleep. Choose soft, relaxing music that will not distract. Is it not being comfortable? Make sure you are as comfortable as possible to include not being hungry or thirsty. Is it racing thoughts or stressful thoughts? If so, try to take care of that at another point in the day—find a friend or chaplain or mental health professional to vent to, don’t try to handle it all on your own. Another idea is to write the stresses down in a journal and then shut it as though to close the topic—put the worries and thoughts away until later. This part is easier said than done, I realize. Especially if a person is in a situation where it is unrealistic to “not worry” such as an area where he/she may come under attack. But you have to try and practice.

5. Is the issue nightmares or strange or vivid dreams? With deployed Troops in particular, medication may be the root of this issue. Most Troops are on some form of medication to reduce the symptoms/likelihood of malaria, for instance. One particular medication for malaria causes very vivid dreams more so than the other types available. If a medication may be the source of nightmares or other sleep issues, talk about this possibility with the prescribing physician—maybe the medication can be changed. If it’s a recurring nightmare, this is where therapy is necessary to get to the root of the recurrent themes and work to try to resolve the issue at hand. Again, easier said than done so that’s why professional help may be necessary.

6. Alcohol is also another culprit of poor sleep. Many people believe that drinking “helps them sleep” while in reality a drunk sleep is not quality sleep—thus why the person feels like crap the next day, right? Same with some sleep aids. I wish I had a dollar for how many times I’ve heard clients and people in general mention they “drink to get to sleep at night.” My question to them is—what’s making it hard to fall asleep otherwise? Let’s work on that. Because the person may think he/she is sleeping but it is not as restful a sleep as non-alcoholic sleep.

A combination of some or all of these things may be necessary to get good, regular, quality sleep back in the client’s life. But when sleep is off, there are reasons. Help the client figure out those reasons. Offer up solutions and suggestions and empower him/her to learn how to sleep better. Without proper sleep, a person is not 100%. For whatever reason, living things require sleep. Even plants sleep—have you ever seen a mimosa tree or a morning glory vine at night? You can literally see the leaves curl up and go to sleep. And how much more do we as humans need to recharge! When I look through the DSM-IV at criteria for things such as PTSD or Depression, for example, I have found myself thinking, “Wow, just the lack of sleep can cause some of these symptoms!” Could this lead to misdiagnoses? It’s definitely possible. Can lack of sleep lead to irritability, difficulty concentrating, feeling of detachment, headaches, reduction in awareness of surroundings (“being in a daze”), depersonalization, loss of interest, anxiety, worry, restless, fatigued, confusion, hallucinations, loss of pleasure, psychomotor agitation…I could go on…ummm…yes, lack of sleep can cause these symptoms.

It is the professional’s job to tease these things out and to decide whether or not a lack of sleep is leading to any of these—not the client’s job to mention them or bring them up. Just telling a client to pop a pill may really limit the support one is able to give. Given the experiences and/or environment some Troops have been in, they may be sleeping as little as one to two hours a night which can become a very real problem—I hear this from Troops often. They don’t even realize the toll a lack of sleep takes on the body and the mind. Trust me, I had no idea how “out of it” and emotional and exhausted one could feel until I did two things a) pulled 12-14 hour watch/guard rotations in Army situations and at times had to stay awake for up to 3 days for training purposes and b) worked long night shift hours this past year at the Pentagon. If you haven’t experienced sleep deprivation in a while (or ever) I challenge you to stay awake for 2-3 days (doing this in a controlled, safe manner of course) to see what it’s like. Something as “little” as getting regular sleep can go a long way in improving someone’s mood, health, or even diagnosis.

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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