The Insomnia Paradox

A Marine in uniform and military working dog lay on the ground.
Marine Corps Cpl. Carlos Deleonsantiago rests with his military working dog, Fero, at Marine Corps Air Ground Combat Center Twentynine Palms, Calif., Feb. 16, 2020. DoD Photo by USMC Lance Cpl. Cedar Barnes

This post is part of a year-long series, The Paradox Problem. You can go here to see the introduction to the series, and see all the articles in the series here.

Of the many different challenges that veterans face, one of the most aggravating and infuriating is insomnia. The need to sleep, the desire to sleep, but the inability to do so. Sleep is important for a whole host of reasons; some are intuitive and obvious, others are subtle and hidden. The paradox related to sleep is that often, veterans are extremely tired, but sleep doesn’t come.

This is the Insomnia Paradox:

Some service members and veterans are physically exhausted, but find getting to and staying asleep difficult

The interesting thing about this paradox is that sleep is such an integral part of the military. Service members are legendary for their ability to catch sleep when they can. If there is a surface that is perfectly horizontal, or perfectly vertical, and any and every angle in between, a troop can figure out a way to catch a few zzz’s. If leaders have been waiting for a mission to start, they have to make sure to calculate enough time to kick some feet and wake folks up…because guaranteed the troops are going to get some sleep when they can. After the military, however, this can be a challenge.

Service Members and Veterans are Physically Exhausted…

Military service is a physically demanding occupation. It’s not unique in this, of course, but the nature of the military is that there is a lot of physical exertion. There are the daily sessions of physical fitness, of course, but there is also mission training, developing endurance, doing hard things for a long time with little rest or sustenance. And that’s often a point of pride for many who served. The ability to do the most, march the farthest, climb the fastest…it was a competition, certainly, but it was also a demonstration of dependability.

Years of this takes a toll on service members. The amount of strain that is put on the human body is significant…it builds muscle, certainly, and it also has a cumulative effect. The limits that those in the military push their bodies to are often beyond what those who haven’t served can do, and sometimes goes beyond the limits of what any body can do. As reported in this 2010 article about injury-related musculoskeletal conditions, a review of injuries in active duty non-deployed service members found nearly three quarters of a million injury related conditions in a single year. That’s a whole lot of wear and tear on the body…which leads to physical exhaustion.

Which Was Common (and Even Encouraged) In Military Service…

This is possibly a mini-paradox within the insomnia paradox. Service members and veterans often found it a point of pride that they were able to accomplish much on a small amount of sleep. A service member’s time in the military wrecks normal sleeping patterns. An old Army slogan was, “in the Army, we do more before 9AM than most people do all day.” Even after years of military service, some veterans find themselves up by 5AM at the latest…me included. 24 hour duty, two-day missions, sleep deprivation is a feature of the military, not a bug. Ranger School, one of the most elite military schools, is famous for the fact that attendees only get zero to four hours of sleep per day.

Our sleep is regulated by circadian rhythms and we have different sleep requirements at different ages. The more we disrupt our circadian rhythms, or restrict or reduce our sleep, the greater we feel insufficient sleep as a stressor. This is acceptable, and even encouraged in the military, when the goal is to accomplish complex tasks under stress. This can be problematic after years (or decades) of disrupted or restricted sleep. For a further exploration of the discussion of the impact of sleep and it’s impact, check out this article.

But Getting to and Staying Asleep is Difficult

As mentioned, above, sleep is important. We all know it is, because we know what happens to us when we don’t get enough sleep. Some start to lose focus. We become uncoordinated; often our mood and behavior is impacted. Those who served with me and know me well understand that I can get pretty sharp when I’m tired…easily angered, less in control, more likely to say something to someone that I normally wouldn’t say. Lack of sleep or improper sleep leads to sluggishness during the day, and possibly even sleep in inconvenient or dangerous situations.

Insomnia as a general phenomenon, and insomnia in the military-affiliated population in particular, is widely researched and documented. Difficlutly sleeping can be categorized as either short-term or adjustment insomnia and chronic insomnia. Chronic insomnia is the long-term pattern of difficulty sleeping, which many service members and veterans experience. In addition to these categories, there are several types of insomnia. Sleep onset insomnia refers to difficulty getting to sleep; no matter how long it takes us to get to sleep, we wake up at the same time. Sleep maintenance insomnia is related to the inability remain asleep once we get to sleep. Early morning awakening insomnia is when we wake up long before we intend to do so.

Resolution

There are a number of different ways that veterans attempt to resolve the problem of insomnia. Some are less than helpful; drinking significant amounts of alcohol to be able to get to sleep is not a good method of adapting to sleeplessness. There are also a number of pharmacological interventions; some service members and veterans readily accept the use of medications to induce sleep, others are less willing to use them. This article identifies a number of different medication and therapeutic related interventions. One of the most effective non-medication interventions is Cognitive Behavioral Therapy for Insomnia (CBTi). This is an intervention that is widely used through the Department of Veterans Affairs, and more can be found about it here.

Insomnia can also be related to trauma exposure and posttraumatic stress disorder. Nightmares are often reasons for insomnia…the desire to not sleep in order to avoid them, waking up during sleep because of them. Therapy and medication to address nightmares and processing underlying trauma associated with them is one way to address this; remove the cause, resolve the condition. As with many of the difficulties that those who served in the military experience, raising this as a concern with your medical or mental health provider is a good first step.


This post is part of a year-long series, The Paradox Problem. You can go here to see the introduction to the series, and see all the articles in the series here. This paradox, and many others, were identified in a 2015 article in the Journal of Traumatology, authored by Carl Castro, Sara Kintzle, and Anthony Hassan.

Castro, C. A., Kintzle, S., & Hassan, A. M. (2015). The combat veteran paradox: Paradoxes and dilemmas encountered with reintegrating combat veterans and the agencies that support them. Traumatology, 21(4), 299.


Do you want to help offset some of the costs of the Head Space and Timing Blog and Podcast? Want to show your appreciation and support? You can put some paper in the tip jar by going here or clicking the button below

Buy Me a Coffee at ko-fi.com




Facebooktwitterlinkedinmail
Duane France on FacebookDuane France on InstagramDuane France on LinkedinDuane France on Twitter
Duane France
Site Owner
Duane K. L. France is a combat veteran of both Iraq and Afghanistan, as well as a mental health counselor practicing in the state of Colorado. Do you want to join the conversation regarding veteran mental health? Share, like, and comment. Read Duane's previous posts and follow him on Twitter and LinkedIn. Keep the conversation about #veteranmentalhealth going.