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Sleep in the Military

Sleep in the Military: Promoting Healthy Sleep Among U.S. Servicemembers

Wendy M. Troxel
Regina A. Shih
Eric Pedersen
Lily Geyer
Michael P. Fisher
Beth Ann Griffin
Ann C. Haas
Jeremy R. Kurz
Paul S. Steinberg
Copyright Date: 2015
Published by: RAND Corporation
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  • Book Info
    Sleep in the Military
    Book Description:

    Given the unprecedented demands on the U.S. military since 2001 and the risks posed by stress and trauma, there has been growing concern about the prevalence and consequences of sleep problems. This first-ever comprehensive review of military sleep-related policies and programs, evidence-based interventions, and barriers to achieving healthy sleep offers a detailed set of actionable recommendations for improving sleep across the force.

    eISBN: 978-0-8330-8854-3
    Subjects: Public Health, Management & Organizational Behavior, Health Sciences

Table of Contents

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  1. Front Matter
    (pp. i-ii)
  2. Preface
    (pp. iii-iv)
  3. Table of Contents
    (pp. v-viii)
  4. Figures
    (pp. ix-x)
  5. Tables
    (pp. xi-xii)
  6. Summary
    (pp. xiii-xxiv)
  7. Acknowledgments
    (pp. xxv-xxvi)
  8. Abbreviations
    (pp. xxvii-xxx)
  9. CHAPTER ONE Introduction
    (pp. 1-8)

    Adequate sleep duration and quality are vital for optimal mental and physical health, cognitive functioning, and performance. Epidemiologic data show that sleep problems are highly prevalent in society in general and in the military specifically. For instance, the Centers for Disease Control and Prevention recommend seven to eight hours of sleep per night for adults. However, studies suggest that only about two-thirds of the general adult population report sleeping seven to eight hours per night (Krueger and Friedman, 2009). Among servicemembers, studies suggest that only one-quarter to one-third report getting the recommended amount of sleep for adults (Bray et al.,...

  10. CHAPTER TWO Epidemiology of Sleep Problems in the Military
    (pp. 9-34)

    This chapter specifically informs our first research question:What are the correlates and consequences of sleep problems among servicemembers in the post-deployment period?In this chapter, we provide background on the nature and consequences of sleep problems in military populations, with a specific focus on the post-deployed context, given that this has been identified as a high-risk period for sleep problems among active-duty servicemembers and veterans.

    As discussed in relation to our conceptual model, which is presented later in this chapter, sleep problems that may be initiated in the deployed environment may perpetuate into the post-deployed environment and have a...

  11. CHAPTER THREE Assessing Sleep Disturbances and Consequences Among Post-Deployed Servicemembers
    (pp. 35-66)

    As summarized in Chapter Two, the existing literature provides suggestive evidence that sleep problems are a prevalent and salient issue among servicemembers. Military deployments may be associated with an increased risk of sleep problems, and these problems are associated with numerous downstream consequences. These findings have generally been derived from studies that included single-or few-item assessments of isolated sleep symptoms (e.g., trouble sleeping or sleep duration). However, sleep is a multidimensional state, with both nocturnal characteristics (e.g., quality, duration, nightmares) and associated daytime consequences (e.g., sleepiness, fatigue). No study to date has examined multiple dimensions of sleep and associated daytime...

  12. CHAPTER FOUR Review of Sleep Policies and Programs
    (pp. 67-84)

    In Chapters Two and Three, we examined the prevalence of sleep disturbances, including insomnia, insufficient sleep duration, and nightmares, in servicemember populations, as well as their association with a host of adverse mental and physical health outcomes.

    In this chapter, we seek to answer the third research question: What are the current sleep policies and programs in the military? Sleep-relatedpoliciesin the military context can generally be thought of as instructions that dictate how sleep-related behaviors and sleep disorders among servicemembers are identified and treated. Policies can also serve as guidelines on and, in some cases, requirements for sleep...

  13. CHAPTER FIVE Evidence-Based Interventions to Treat Sleep Disturbances Among Servicemembers
    (pp. 85-100)

    As discussed in the prior chapters, sleep disturbances—including insomnia, insufficient sleep duration, and nightmares—are highly prevalent among servicemembers both during and after deployments, are associated with a host of adverse mental and physical health outcomes, and can compromise operational readiness by diminishing attention, emotion regulation, and concentration. In fact, sleep disturbances are the most commonly reported symptoms among servicemembers returning from deployments. Sleep disturbances are also highly comorbid with several of the signature “wounds” servicemembers have experienced in OEF/OIF combat operations, including PTSD, depression, TBI, and chronic pain conditions. Even with effective treatments for these co-occurring conditions, sleep...

  14. CHAPTER SIX Barriers to Achieving Healthy Sleep Among Servicemembers
    (pp. 101-116)

    Even the best evidence-based practices, programs, and policies to prevent and treat sleep problems among servicemembers may not mitigate barriers to achieving healthy sleep. In the military context, such barriers can be cultural, operational, or individual (knowledge-related); they can also include medical and treatment system barriers. Understanding these barriers—and their interactions with one another—is critical to implementing policy changes to address key sleep-related challenges that servicemembers face.

    One of the most robust ways to systematically assess the gaps between policies and their actual implementation and adherence is by soliciting the perspectives of representatives across DoD. In our case,...

  15. CHAPTER SEVEN Conclusions and Recommendations
    (pp. 117-134)

    In this chapter, we summarize key conclusions from the study and then provide some recommendations drawn from those conclusions.

    As we noted in Chapter One, this study was guided by five research questions:

    1. What are the correlates and consequences of sleep problems among servicemembers in the post-deployment period?

    2. What are the current programs and policies related to sleep in the military?

    3. What are the evidence-based interventions to treat sleep disorders among servicemembers?

    4. What are the barriers to achieving healthy sleep for servicemembers?

    5. What actions can be taken to promote sleep health among servicemembers?

    In this...

  16. APPENDIX A Sleep Terminology
    (pp. 135-140)
  17. APPENDIX B Methods and Review of Published Studies on Sleep in the Military
    (pp. 141-170)
  18. APPENDIX C Methods and Review of Published Studies on Interventions for Sleep Disorders in the Military
    (pp. 171-180)
  19. APPENDIX D Review of Sleep Metrics
    (pp. 181-192)
  20. APPENDIX E Description of Source Measures Included in the Sleep Survey
    (pp. 193-196)
  21. APPENDIX F U.S. Department of Defense Policies Related to Sleep
    (pp. 197-204)
  22. APPENDIX G Key Informant Interview Protocol
    (pp. 205-208)
  23. APPENDIX H Sleep in the Armed Forces Working Group Proceedings
    (pp. 209-226)
  24. References
    (pp. 227-252)