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What Are the Barriers to Achieving Healthy Sleep for Servicemembers?

Even with evidenced-based practices and programs to prevent and treat sleep problems in servicemembers and codified policies related to sleep in place, we found cultural, operational, knowledge-related, and medical system barriers across the military context that may impede efforts to promote sleep health and treat sleep disorders in service-member populations (as discussed in Chapter Six).

Expert panel attendees and interviewees highlighted the importance of military culture as a potential barrier to the promotion of healthy sleep practices. Specifically, they suggested that military cultural attitudes have historically tended to undermine the importance of sleep, which serves as an ongoing challenge to the adoption and implementation of effective sleep policies and programs. For instance, stigma associated with expressing a greater need for sleep may deter servicemembers from self-identifying or seeking help before a sleep problem becomes chronic and debilitating. Screening for sleep disturbances within military contexts is also limited, with sleep being perceived as a low institutional priority in military communities or simply "behind other areas" of war-related health issues.

Operational environments themselves are often barriers to healthy sleep, because of noise, crowded conditions, and the need for vigilance in threatening settings. Furthermore, we found that sleep policies are generally interpreted as "guidance" in operational contexts and, thus, secondary to operational demands. Although efforts to promote healthy sleep behaviors are important, such efforts must be carefully balanced against the realities of the dynamic, high-risk, and demanding military environment. Also, even where sleep policies are in place, leaders may not have sufficient manpower to allow for proper sleep—threats that are particularly salient given the high OPTEMPO of recent years. However, recent efforts to promote healthy sleep by optimizing crew shift schedules have shown that such strategies actually promote performance. Thus, perceived "trade-offs" may be balanced by improvements in servicemember performance and overall satisfaction.

Our qualitative research informed by expert panel attendees and interviewees suggested that the lack of knowledge about the importance of sleep behaviors and sleep-related policies was a barrier to recognizing and addressing sleep problems. This lack of knowledge or awareness is partly the result of limited education and training among leadership about the importance of sleep and the lack of a centralized DoD-wide resource on sleep policies. A centralized DoD repository could supplement some Service-specific websites that do provide sleep resources1 to include guidance on the identification and management of sleep problems, as well as how to develop and implement at sleep plan.

Finally, medical and treatment system challenges create barriers. There is a lack of adequate screening tools, procedures, and systems for detecting sleep problems in military contexts. In addition, both continuity of care and shortages in the number of sleep providers and clinics were noted as barriers to promoting sleep health in service-member populations during our interviews and focus groups.

Understanding these barriers is critical to making well-informed and robust policy recommendations related to preventing, identifying, and clinically managing sleep problems and promoting sleep health in both operational and training settings.

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