The Importance of Sleep in Protecting Mental Health and Operational Readiness

 

Australian Marines sleep alongside the amphibious assault ship USS Essex (LHD 2) before training evolutions with Kingdom of Tonga, Indonesian, and U.S. Marines and Canadian soldiers.  Twenty-two nations, more than 40 ships and submarines, more than 200 aircraft and 25,000 personnel are participating in RIMPAC exercise in and around the Hawaiian Islands. The world's largest international maritime exercise, RIMPAC provides a unique training opportunity that helps participants foster and sustain the cooperative relationships that are critical to ensuring the safety of sea lanes and security on the world's oceans. (U.S. Navy photo by Mass Communication Specialist 2nd Class Eric Crosby/Released)

Australian Marines sleep alongside the amphibious assault ship USS Essex (LHD 2) before training evolutions with Kingdom of Tonga, Indonesian, and U.S. Marines and Canadian soldiers. Twenty-two nations, more than 40 ships and submarines, more than 200 aircraft and 25,000 personnel are participating in RIMPAC exercise in and around the Hawaiian Islands. The world’s largest international maritime exercise, RIMPAC provides a unique training opportunity that helps participants foster and sustain the cooperative relationships that are critical to ensuring the safety of sea lanes and security on the world’s oceans. (U.S. Navy photo by Mass Communication Specialist 2nd Class Eric Crosby/Released)

By Capt. Paul D. Rockswold, M.D., M.P.H., Navy and Marine Corps Public Health Center

Did you know that a good night’s rest is fundamental to protecting the mental and physical health of our Sailors and Marines? Although often viewed as a luxury, studies show that sleep plays an important role in preventing many chronic diseases and protecting mental health. In fact, sleep disorders contribute to, and may exacerbate, many mental health illnesses, including depression and post  traumatic stress disorder (PTSD), as well as the increased risk of suicide.

According to a report released by the Navy and Marine Corps Public Health Center (NMCPHC), nearly 30,000 Sailors and Marines suffer from sleep disorders. This trend indicates that turning the tide on the rise of mental health illnesses among service members requires evidence-based health promotion and disease prevention efforts that mitigate sleep disorders along with other contributing risk factors.

Public health educator at NMCPHC, Mr. Louis Steele recalls, “As an independent duty corpsman onboard a ship or in the field, sleep is not guaranteed on a nightly basis. When I was on my first independent tour onboard a frigate, I averaged about four to five hours of sleep per night while out to sea. Most nights I would hit my rack around 11 p.m. and wake up around 4:30 a.m.”

His experience running on little sleep is common throughout the U.S. Navy and U.S. Marine Corps. Five and half hours of sleep a night fall short of the seven to nine hours recommended by the National Sleep Foundation.

Steele goes on to say, “You will not get any complaints from me, because there are many rates in the Navy that are up all night. While out to sea the crew is always preparing for fires, being attacked, or assisting another ship vessel in distress.”

Sleep deficits are common during active duty missions, and these deficits create conditions that put Sailors and Marines at risk of developing sleep disorders and comorbid mental illnesses. A recent study published in the medical journal Sleep finds that people in the military who have severe trouble sleeping before being deployed are at a significantly higher risk of developing PTSD, anxiety, and depression when they return from deployment.

As reported by Nordqvist in Medical News Today (June 20, 2013), Dr. Philip Gehrman, assistant professor of psychology at Penn State’s Sleep Center and the Philadelphia Veteran’s Affairs Medical Center states, “Understanding environmental and behavioral risk factors associated with the onset of common major mental disorders is of great importance in a military occupational setting.” According to Gehrman, the study’s findings show, “that insomnia is both a symptom and a risk factor for mental illness and may present a modifiable target for intervention among military personnel.” In fact, the study’s investigators explain that insomnia symptoms had nearly as strong of an impact on mental health as did combat exposure, indicating the vital importance of sleep in protecting mental health.

In support of Force Health Protection and operational readiness across the Fleet, the Health Analysis (HA) and Health Promotion and Wellness (HPW) Departments at NMCPHC work to shed light on the sleep issues facing Sailors and Marines, including commonly associated health problems. HA data analysis of more than 70,000 sleep disorder visits indicates that 85 percent are men, 60 percent are ages 25-44, and 50 percent are senior enlisted ranks E5-E9. Roughly 16 percent of those diagnosed with a sleep disorder have also been diagnosed with major depressive disorder while 11 percent suffer from PTSD. Other common comorbidities include obesity, traumatic brain injury and chronic pain.

HA leverages sophisticated clinical health analysis to provide actionable information that drives evidence-based programs, products, and services developed and offered by HPW —such as webinars, web articles and audio CD’s – to promote healthy sleep habits among Sailors and Marines. These resources contain valuable information that raises awareness about sleep disorders and associated mental health impacts, as well as helpful tips and strategies for mitigating and/or preventing sleep disorder problems.

As a result of HA’s and HPW’s efforts, key stakeholders across Navy Medicine and the operational line have the sleep disorder report and analysis results at their fingertips. Sailors and Marines may not be able to get the recommended seven to nine hours of sleep a night due to operational activities, readiness training, and day to day mission requirements but resources are available to help.

HPW products and services promote healthy sleep habits throughout the operational cycle and are designed to help service members fall asleep faster and improve sleep quality. The department’s evidence-based products and services offer strategies and techniques to support good sleep hygiene by focusing on relaxation, stress reduction, diet and exercise, and complementary and alternative medical therapies.

By integrating the capabilities within HPW and HA, NMCPHC provides accurate, data-informed, and seamless health promotion and wellness support across the U.S. Navy and U.S. Marine Corps. This includes protecting the mental health of our Sailors and Marines, including those who may be wounded, ill and /or injured, by helping them get a good night’s rest!

The sleep disorder report and sleep health resources can be found on NMCPHC’s website at the following address: http://www.med.navy.mil/sites/nmcphc/wounded-ill-and-injured/Pages/sleep.aspx. Follow the Navy and Marine Corps Public Health Center on Facebook for the latest news and updates on clinical health analysis and health promotion and wellness.

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