Sleep Apnea and Insomnia on the Rise Among U.S. Military Personnel

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Rates of sleep apnea and insomnia have been dramatically rising for over a decade in the U.S. military, according to a new study published in the journal Sleep. While sleep disorders have been on the rise in the general public as well, rates in the military, particularly for obstructive sleep apnea (OSA) and insomnia, have been significantly higher, with over 30-fold increases between 2005 and 2019. Researchers have been tracking these trends for some time, and previous studies have noted a high prevalence of sleep-related health conditions in the military, especially those related to combat and post traumatic stress disorder (PTSD). But the new study, conducted by the University of Texas Health Science Center at San Antonio (UT Health San Antonio), was the first to use universally applied diagnostic medical codes from health records in several branches of the armed forces (i.e. the Defense Medical Epidemiology Database). Consistent with the findings of previous studies, the Army had the highest rates of both sleep apnea and insomnia, but increases were evident in each branch observed (Army, Air Force, Navy, and Marines). The study also found that female service members were potentially at increased risk for underdiagnosis, which coincides with similar findings in the general populace. The study authors hope that such findings will give military administrators the incentive to prioritize the sleep-health needs of service members throughout the armed forces.

A Changing Military Culture

The president’s recent announcement that America will end its long war with Afghanistan, a major pat of American military culture in the last 20 years, comes on the heels of waning global pandemic. Along with these major shifts are cultural changes that affect all aspects of society, including the military. The U.S. is not alone in its redefinition and reevaluation of human sleep needs, an issue with serious consequences in the military arena.

Increased attention on the importance of sleep health is a significant milestone for an institution long known for its culture of minimal sleep and maximum vigilance. The nature of military work, particularly during deployment in war operations, has traditionally involved strict, often ad-hoc shift work schedules that, according to some specialists, run counter to natural circadian patterns. Despite high expectations for optimal physical and mental health and resilience, the demands of deployment can be difficult to sustain on limited sleep, often involving high-stress environments and life-or-death situations.

The war on terror, lasting from 2001 to the present day, has been a time of high military alert and multiple operations around the world. During war times, deployments can be longer and more demanding, leading to more sleep problems. Soldiers are expected to keep very specific, regimented sleep times, but if insomnia or sleep apnea is keeping them up, the consequences can be dangerous not only for the soldier, but for others involved in the operation, including civilians.

According to study co-author Alan Peterson, Ph.D., between 2008 and 2012 (during the wars in Afghanistan and Iraq), the Army in particular had “longer and more frequent deployments —21 months—compared to 12 to 16 months for the other services.” As Dr. Peterson points out, the longer and more frequent deployments may contribute to the unusually high rate of sleep problems in the Army, a trend that could potentially be reduced by the deescalation of military operations in the MIddle East.

As the study authors conclude, comprehensive policy changes, as well as a shift in military culture, may be required to better serve the health needs of American soldiers. This would not only help soldiers during deployment, but, as the authors explain, could ease the transition back to civilian life.

Prioritizing Sleep Health

While changes within a large institution like the U.S. military tend to move slowly and in small increments, there are recent signs that sleep health is becoming a higher priority. The Army’s new Manual for Holistic Health and Fitness, published in 2020, officially recognizes the practice of field napping as a means of rest and relaxation during deployments and operations. This practice has been used unofficially for over a century but is now officially part of Army regulation.

At the same time, beginning in 2019, the U.S. military healthcare insurance company Tricare began its full coverage of portable CPAP machines for deployed service members. Tricare continues to provide regular CPAP machines to military personnel with a sleep apnea diagnosis, but their coverage now extends to portable devices for those in active duty who meet certain requirements, for example, traveling regularly on assignment. These changes may seem small, but to the large number of individual suffering from sleep disorders, it can make a big difference and even save lives.

As the Sleep study authors emphasize in their concluding paragraphs, continued research in these areas, along with directed interventions and proactive diagnosis and treatment may be required to reverse the negative trends of such exponential rates of sleep disorders. But some of these efforts have already begun, beginning with a series of improvements to the military health system with long-term goals to incorporate more holistic practices, streamline casualty-care procedures, and embrace more individualized, patient-centered approaches to care. In fact, the Defense Health Agency was planning a major downsizing in 2018 that was halted by the global effects of the COVID-19 pandemic. With a renewed focus on respiratory conditions and their relation to sleep health, it is likely that care structures for the treatment of sleep disorders will become further developed in the near future.