It is not uncommon for health-care providers to see former and present military personnel about sleep complaints. Having experienced the traumas of war, these patients often report sleep disorders related to post traumatic stress disorder (PTSD). However, former soldiers are increasingly seeing physician assistants for a wider range of sleep disorders, including insomnia. These conditions may be related to a traumatic brain injury (TBI) or a history of concussions.
A recent study in the journal SLEEP showed an increased incidence of insomnia and sleep disturbance in military personnel who had multiple TBIs, a concerning discovery in light of the fact that military personnel are often exposed to explosions that cause concussive injuries. Researchers estimate that 8% to 20% of soldiers who have served in Iraq and Afghanistan have sustained a TBI.
In the study, the likelihood of clinical insomnia was 5.6% in those who had no exposure and no TBI. Of those with a single TBI, the incidence of insomnia rose to 20.4%, and those with multiple TBIs showed a rate of 50%.
The severity of insomnia was also evaluated. It was found that a patient with a single TBI has a two to three times greater chance of developing moderate to severe insomnia and sleep disturbance than one who had never experienced a TBI. Patients with a history of a single TBI had more difficulty with initiating sleep than they did with maintaining it or waking too early. Those with multiple TBIs experienced all three types with equal frequency.
Although the reason is unclear, those with a mild TBI may have more symptoms than those with more traumatic injuries. It could be that the individuals with more severe TBIs are being treated for more severe cognitive symptoms whereas sleep problems might be perceived as less pressing of an issue. It is reported that 86.9% of soldiers have been in the vicinity of two or more explosions during their career, so do not discount those who have had mild exposure.
Preliminary studies have shown that cognitive behavioral therapy helped improve sleep outcomes. However, further study is recommended.
Military personnel suffer from not only TBIs, but from other health problems as well, including depression, PTSD, chronic pain, anxiety, and cognitive difficulties. Take the time to ask the important questions when you do your history and physical regarding veterans and active duty personnel. Insomnia issues may be overlooked, and treatment could make a huge difference in the lives of those who have fought for us.
Sharon M. O’Brien, MPAS, PA-C, works at Presbyterian Sleep Health in Charlotte, N.C. Her main interest is helping patients understand the importance of sleep hygiene and the impact of sleep on health.