TWO. Epidemiology of Sleep Problems in the Military

This chapter specifically informs our first research question: What are the correlates and consequences of sleep problems among servicemembers in the post-deployment period? In this chapter, we provide background on the nature and consequences of sleep problems in military populations, with a specific focus on the post-deployed context, given that this has been identified as a high-risk period for sleep problems among active-duty servicemembers and veterans.

As discussed in relation to our conceptual model, which is presented later in this chapter, sleep problems that may be initiated in the deployed environment may perpetuate into the post-deployed environment and have a lasting impact on servicemember health and readiness. For this reason, a better understanding of how factors across all aspects of the deployment cycle may contribute to long-term sleep problems can help to inform policy and programmatic efforts to prevent and reduce these consequences. The conceptual framework presented here provides a useful lens for viewing sleep-related problems in the military context. Our literature review also highlights how most studies focus on sleep-related problems rather than on promoting healthy sleep. In that regard, the conceptual framework may be a useful heuristic for identifying and ultimately modifying sleep-related thoughts and behaviors that perpetuate sleep problems long after a servicemember returns from deployment.

To answer our first research question, we summarize the results of our literature review of military sleep studies published since the beginning of combat operations as part of Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND), including longitudinal and cross-sectional studies on prevalence, risk factors and correlates, and consequences of sleep problems in the post-deployment period. Although sleep research with military samples is burgeoning, the majority of the research targets civilians, who differ from military populations in several ways (e.g., age, gender, combat experience). In most instances, we could not directly compare civilian sleep studies with those that used military samples and therefore are cautious in making any comparisons regarding the prevalence of sleep problems in military and civilian populations. Still, we reference the civilian work to highlight gaps in the military research. We include comments from our key informant interviews and working group meeting to support the military literature search, where appropriate, and provide substantiating front-line knowledge to interpret these empirical findings. These methods are described in more detail in Appendixes G and H. Finally, we also addressed the first research question by developing and administering a sleep survey to the Deployment Life Study servicemember cohort. That effort and its results are discussed in Chapter Three.

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