Sleep Issues in Military: When to Get Help & Treatment Options

Bottom Line Up Front: 40-60% of service members have chronic sleep problems (vs. 10-30% civilians). Common causes: shift work, deployment stress, PTSD, TBI, sleep apnea. Red flags: <6 hours sleep nightly, daytime exhaustion, microsleeps while driving, relying on energy drinks to function. Free treatment available: TRICARE covers sleep studies, CPAP machines, CBT-I (cognitive behavioral therapy for insomnia). Sleep medication is temporary fix - address root cause. Untreated sleep issues lead to depression, weight gain, accidents, career problems.

Why Military Sleep Problems Are Different

Unique Military Sleep Disruptors

1. Shift Work & Irregular Schedules

• Watchstanding (4 hours on, 8 hours off - Navy)
• 24-hour ops (rotating shifts - Security Forces, medical)
• Deployment schedules (work 12+ hours, sleep when you can)
• Result: Circadian rhythm destroyed

2. Deployment-Related

• Hypervigilance ("Can't turn off, always alert")
• Nightmares (combat, IED blasts, firefights)
• Sleeping with weapons ("Can't sleep without rifle nearby")
• Environmental noise (generators, mortars, alarms)

3. Post-Deployment

• Adjustment back to normal (brain still in combat mode)
• Nightmares persist for months/years
• Startling awake at every sound
• Insomnia from anxiety

4. Physical Conditions

• Sleep apnea (50% higher in military vs. civilians)
• TBI (traumatic brain injury) → sleep disruption
• Chronic pain → can't get comfortable

5. Cultural Factors

• "Sleep is weakness" mentality
• Work through exhaustion (mission first)
• Energy drinks normalized (Monster, Rip-Its = standard breakfast)

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Sleep Issues Red Flags (When to Get Help)

Normal vs. Problem Sleep

Normal (acceptable):

• 7-9 hours sleep most nights
• Fall asleep within 30 minutes
• Wake refreshed
• Occasional bad night (1-2x/month)

PROBLEM (needs attention):

• <6 hours sleep regularly
• Take >1 hour to fall asleep (nightly)
• Wake 3+ times per night
• Wake exhausted (even after 8 hours)
• Microsleeps during day (nodding off at desk, while driving)
• Need energy drinks to function
• Sleep issues >3 months

Critical Warning Signs (Seek Help IMMEDIATELY)

Dangerous symptoms:

• ❗ Fall asleep while driving (even once)
• ❗ Microsleep during duty (safety-critical job)
• ❗ Hallucinations from sleep deprivation
• ❗ Suicidal thoughts related to exhaustion
• ❗ Relationship/job problems from irritability
• ❗ Self-medicating with alcohol to sleep

Action: Call Military OneSource (800-342-9647) or base Mental Health clinic TODAY

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Common Military Sleep Disorders

Insomnia (Most Common)

Symptoms:

• Can't fall asleep (racing thoughts)
• Wake at 3 AM, can't fall back asleep
• Never feel rested

Causes in military:

• PTSD/anxiety
• Stress (work, family, money)
• Shift work
• Caffeine overuse (drinking Monster at 4 PM)

Treatment:

• CBT-I (Cognitive Behavioral Therapy for Insomnia) - BEST, no meds
• Sleep hygiene changes
• Medication (short-term only)

Sleep Apnea (Very Common in Military)

Symptoms:

• Loud snoring
• Gasping/choking during sleep
• Morning headaches
• Daytime exhaustion (even after 8 hours sleep)
• Falling asleep during meetings

Causes:

• Obesity (common after leaving active fitness culture)
• Neck circumference >17" (men), >16" (women)
• Genetics

Treatment:

• CPAP machine (TRICARE covers 100%)
• Weight loss (often cures mild apnea)
• Dental appliance
• Surgery (severe cases)

VA disability rating: 30-50% (if service-connected)

PTSD-Related Nightmares

Symptoms:

• Recurring nightmares (combat, IED, firefights)
• Wake in panic/sweat
• Avoid sleep (fear of nightmares)
• Sleep <4 hours/night

Treatment:

• Prazosin (medication, reduces nightmares - 60-80% effective)
• CPT (Cognitive Processing Therapy)
• EMDR (Eye Movement Desensitization and Reprocessing)
• Image Rehearsal Therapy

Circadian Rhythm Disorder (Shift Work)

Symptoms:

• Can't sleep when you need to (after night shift)
• Exhausted during day shift
• Never feel rested

Treatment:

• Melatonin (timed doses)
• Light therapy (bright light during "day" shift)
• Blackout curtains + sleep mask
• Schedule consistency (same sleep time even on days off)

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Treatment Options (All Free via TRICARE)

Sleep Study (Polysomnography)

What it is:

• Overnight stay at sleep clinic
• Monitors: brain waves, breathing, heart rate, oxygen levels, movements

Diagnoses:

• Sleep apnea
• Restless leg syndrome
• Narcolepsy
• Periodic limb movement disorder

Cost: $0 (TRICARE covers)

How to get:

• Primary care referral
• Or call Sleep Medicine clinic directly

CBT-I (Cognitive Behavioral Therapy for Insomnia)

What it is:

• 6-8 week program
• Change thoughts/behaviors around sleep
• No medication

Techniques:

• Sleep restriction (paradox: sleep less to sleep better)
• Stimulus control ("Bed is for sleep only, not Netflix")
• Cognitive restructuring ("I won't die if I don't sleep tonight")

Effectiveness: 70-80% success rate (better than medication long-term)

Cost: $0 (TRICARE covers)

How to get:

• Referral to behavioral health
• Or online CBT-I program (free via Military OneSource)

CPAP Machine (For Sleep Apnea)

What it is:

• Mask that blows air into nose/mouth
• Keeps airway open during sleep

Effectiveness: 90-95% improvement in symptoms

Cost: $0 (TRICARE covers machine + supplies)

How to get:

• Sleep study first (diagnoses sleep apnea)
• Prescription for CPAP
• Supplies replaced every 6-12 months

Adjustment period: 2-4 weeks (feels weird at first, stick with it)

Medications (Short-Term Only)

Prescription sleep meds:

• Ambien (zolpidem)
• Lunesta (eszopiclone)
• Trazodone (off-label for sleep)

Pros:

• Work fast (fall asleep within 30 minutes)

Cons:

• Dependency risk (body stops making natural sleep chemicals)
• Tolerance (need higher doses over time)
• Grogginess next day
• Not long-term solution

Military concern: Flight status, weapon qualification can be affected

Recommendation: Use ONLY for 2-4 weeks while doing CBT-I

Melatonin (Over-the-Counter)

What it is:

• Natural hormone that regulates sleep/wake cycle
• Supplement available at GNC, Vitamin Shoppe, Amazon

Dose: 0.5-3 mg (start low)

Timing: 1-2 hours before desired sleep time

Effectiveness:

• Good for: Jet lag, shift work, deployment return (circadian rhythm adjustment)
• Not good for: PTSD nightmares, sleep apnea

Cost: $5-$15/month

Military-friendly: No side effects, no flight restrictions

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Sleep Hygiene (Foundation for Better Sleep)

Do's

1. Consistent schedule:

• Same bedtime/wake time (even weekends)
• Trains body's circadian rhythm

2. Dark, cool, quiet bedroom:

• Blackout curtains
• 65-68°F temperature
• White noise machine (blocks barracks noise)

3. Wind-down routine (30-60 min before bed):

• Read (not on phone)
• Shower
• Stretching
• Avoid screens (blue light disrupts melatonin)

4. Exercise (but not before bed):

• 30+ minutes daily
• Not within 3 hours of sleep

5. Limit caffeine:

• No caffeine after 2 PM
• Cut energy drinks (500mg+ caffeine = terrible for sleep)

Don'ts

1. No screens in bed:

• Blue light = destroys sleep drive
• Use "Night Shift" mode if you must use phone

2. Don't lie awake in bed:

• If not asleep in 20 minutes, get up
• Do quiet activity until sleepy
• Return to bed

3. Don't nap >30 minutes:

• Short naps (20-30 min) = okay
• Long naps (1-2 hours) = destroys nighttime sleep

4. Don't drink alcohol to sleep:

• Falls asleep faster but RUINS sleep quality
• Wake at 3 AM when alcohol wears off

5. Don't watch clock:

• "It's 2 AM, I only have 4 hours left!" = anxiety
• Turn clock away from bed

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Energy Drink Trap (Why You're Exhausted)

The Vicious Cycle

1. Poor sleep → Exhausted
2. Drink 2-3 Monsters (500mg+ caffeine)
3. Caffeine lasts 6+ hours in body
4. Can't sleep that night
5. Repeat

Breaking the Cycle

Week 1: Cut caffeine after 12 PM

• Hard, you'll be tired
• Sleep improves slightly

Week 2: Cut to 1 energy drink (morning only)

• Replace afternoon caffeine with water, walk

Week 3: Switch to coffee (less caffeine)

• 1 cup coffee = 100mg caffeine
• 1 Monster = 300mg caffeine

Week 4: Normal sleep returning

• Fall asleep faster
• Sleep deeper
• Wake refreshed (no more energy drinks needed!)

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When Sleep Issues Become VA Claims

Service-Connected Sleep Disorders

Can claim:

• Sleep apnea (if developed during service OR worsened by service)
• Insomnia secondary to PTSD
• Nightmares (part of PTSD claim)
• Circadian rhythm disorder (shift work)

VA ratings:

• Sleep apnea with CPAP: 50% ($1,075/month)
• Sleep apnea without CPAP: 30% ($524/month)
• Insomnia (secondary to PTSD): Included in PTSD rating

How to document:

• Medical records (sleep study results)
• Sleep clinic visits
• CPAP prescription
• Statement: How sleep issues started/worsened during service

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Action Steps

This Week:

1. ✅ Track sleep (how many hours, quality, how you feel)
2. ✅ Cut caffeine after 2 PM
3. ✅ Set consistent bedtime (even if you can't fall asleep, be in bed)

If Issues Persist 2+ Weeks:

1. ✅ Call Military OneSource: 800-342-9647 (free sleep coaching)
2. ✅ Schedule appointment with primary care
3. ✅ Ask for sleep study referral (if snoring, gasping, exhaustion despite sleep)

If Serious (falling asleep while driving, suicidal thoughts):

1. ✅ Call Military OneSource: 800-342-9647 (24/7)
2. ✅ Go to Emergency Room or Mental Health clinic (same day)

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Related Guides

• PTSD Symptoms, Treatment & VA Disability
• TBI and Headaches in Military
• VA Disability Claims Step-by-Step

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Remember: Sleep isn't weakness. Chronic sleep deprivation DESTROYS health, relationships, and careers. You wouldn't drive a vehicle with no brakes - don't operate your body with no sleep. Treatment is FREE via TRICARE. Get help. Your mission effectiveness depends on it.