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.

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Sleep in the Military

Promoting Healthy Sleep Among U.S. Servicemembers

by Wendy M. Troxel, Regina A. Shih, Eric R. Pedersen, Lily Geyer, Michael P. Fisher, Beth Ann Griffin, Ann C. Haas, Jeremy Kurz, Paul S. Steinberg

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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?

Sleep disturbances are a common reaction to stress and are linked to a host of physical and mental health problems. Given the unprecedented demands placed on U.S. military forces since 2001, there has been growing concern about the prevalence and consequences of sleep problems for servicemembers. Sleep problems often follow a chronic course, persisting long after servicemembers return home from combat deployments, with consequences for their reintegration and the readiness and resiliency of the force. Therefore, it is critical to understand the role of sleep problems in servicemembers' health and functioning and the policies and programs available to promote healthy sleep. This report provides the first comprehensive review of sleep-related policies and programs across the U.S. Department of Defense (DoD), along with a set of actionable recommendations for DoD, commanders, researchers, and medical professionals who treat U.S. servicemembers. The two-year multimethod study also examined the rates and correlates of sleep problems among post-deployed servicemembers, finding negative effects on mental health, daytime impairment, and perceived operational readiness. The research reviewed evidence-based interventions to treat sleep disturbances among servicemembers and veterans and exposed several individual- and system-level barriers to achieving healthy sleep. Implementing evidence-based treatments is just one step toward improving sleep across the force; as the research recommendations highlight, it is equally important that policies and programs also focus on preventing sleep problems and their consequences.

Key Findings

Sleep Problems Can Have Both Short- and Long-Term Negative Effects, but Evidence-Based Interventions Can Help

  • Sleep problems are common across the force, but their prevalence is particularly high among servicemembers who have deployed to conflict environments.
  • A survey of personnel showed that insufficient sleep duration, poor sleep quality, fatigue and daytime impairment, were all common. Sleep problems can compromise operational effectiveness and make it difficult for servicemembers to resume their lives after returning home from a deployment.
  • Sleep problems can lead to the development of serious mental health conditions, including post-traumatic stress disorder, depression, and traumatic brain injury. Treating sleep disturbances early on may be an important preventive strategy to reduce the risk of downstream mental health consequences.
  • There is evidence that cognitive-behavioral therapy and imagery rehearsal therapy for insomnia may be effective in helping to alleviate sleep problems and address these correlated conditions, but dissemination of these strategies remains a challenge.

Policies and Programs Promoting Sleep Health Are Available to Servicemembers, but Barriers Challenge Their Implementation

  • Policies to guide treatment for sleep disorders and promote healthy sleep practices among servicemembers and veterans often lack specificity. For example, operational policies mandating sleep plans lack detailed guidance for implementing the plans.
  • Even with evidence-based policies and programs to promote sleep health, it can be difficult for servicemembers to get the rest they need. Barriers to healthy sleep include possible stigma associated with taking breaks, widespread use of energy drinks and caffeine supplements, noisy and uncomfortable sleeping spaces, and a lack of a centralized repository for sleep-related policies and information to promote sleep health.

Recommendations

  • Increase servicemember and line leader education about healthy sleep behaviors and knowledge about the factors that inhibit or promote adequate, restful sleep.
  • Fund or conduct longitudinal studies on sleep and the effects on operational readiness and resilience.
  • Continue to research evidence-based practices for promoting healthy sleep in military populations, and disseminate evidence-based treatments.
  • Educate families on the signs and symptoms of sleep disturbances.
  • Improve screening for sleep disturbances in primary care settings, and develop provider education programs and clinical practice guidelines with a focus on both preventing and treating sleep disorders.
  • Increase the use of mobile technologies for assessing and clinically managing sleep disorders with the goal of identifying and monitoring sleep problems so they do not become chronic and debilitating.
  • Improve continuity of care for sleep disorders across the deployment cycle.
  • Make appropriate revisions to training and operational policies to minimize inconsistencies and align with current clinical guidelines about optimal sleep duration.
  • Educate line leaders on creating sleep plans that align with current research and consider the physical sleep environment and shift schedules.
  • Create standardized operational and training policies DoD-wide to improve sleep duration and quality and reduce impairment.
  • Link data on safety mishaps to evaluate the role of sleep and fatigue.
  • Prioritize sleep in reintegration policies to provide a recovery period for post-deployed servicemembers.
  • Disseminate positive messaging about sleep as an operational imperative to increase awareness and reduce cultural barriers to healthy sleep.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    Epidemiology of Sleep Problems in the Military

  • Chapter Three

    Assessing Sleep Disturbances and Consequences Among Post-Deployed Servicemembers

  • Chapter Four

    Review of Sleep Policies and Programs

  • Chapter Five

    Evidence-Based Interventions to Treat Sleep Disturbances Among Servicemembers

  • Chapter Six

    Barriers to Achieving Healthy Sleep Among Servicemembers

  • Chapter Seven

    Conclusions and Recommendations

  • Appendix A

    Sleep Terminology

  • Appendix B

    Methods and Review of Published Studies on Sleep in the Military

  • Appendix C

    Methods and Review of Published Studies on Interventions for Sleep Disorders in the Military

  • Appendix D

    Review of Sleep Metrics

  • Appendix E

    Description of Source Measures Included in the Sleep Survey

  • Appendix F

    U.S. Department of Defense Policies Related to Sleep

  • Appendix G

    Key Informant Interview Protocol

  • Appendix H

    Sleep in the Armed Forces Working Group Proceedings

Research conducted by

This research was sponsored by the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury and conducted within the Forces and Resources Policy Center of the RAND National Defense Research Institute, a federally funded research and development center sponsored by the Office of the Secretary of Defense, the Joint Staff, the Unified Combatant Commands, the Navy, the Marine Corps, the defense agencies, and the defense Intelligence Community.

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