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Cultural Barriers to Sleep Health

Numerous studies have identified military cultural attitudes and beliefs about sleep as a critical barrier to implementing and enforcing healthy sleep practices (Kennedy, 2009; Miller and Shattuck, 2005; Mysliwiec, McGraw, et al., 2013; Brown, Caldwell, and Chandler, 2013). For example, Brown, Caldwell, and Chandler (2013) noted that "the operational community treats the need for sleep as a resource to be rationed in the best times, and as a sign of weakness in the worst." The perspectives of our inter-

Figure 6.1. Barriers to Promoting Healthy Sleep Among Servicemembers

Barriers to Promoting Healthy Sleep Among Servicemembers

viewees and the expert working group participants supported this finding, suggesting that cultural attitudes about sleep can serve as significant barriers to promoting sleep health (through prevention, treatment, and identification, as shown at the bottom of Figure 6.1). Both groups indicated that a servicemember's ability to perform with little or no sleep has traditionally been viewed as a "badge of honor" within the military rather than a risk or a problem. They also pointed to potential stigma associated with expressing a need for more sleep, which may deter servicemembers from self-identifying or seeking help before a sleep problem becomes chronic and debilitating. At the operational level, the military culture emphasizes mission first, and a need for sleep is perceived as secondary to that goal or, perhaps, even a sign of weakness.

Sleep May Be Viewed as a Luxury Rather Than a Biological Need

Interviewees and working group participants across all the Services, particularly those who engaged in military operations, indicated that resistance to recognizing the importance of sleep is deeply embedded in military culture. They noted that prioritizing sleep can be met with such sentiments as "You're not being macho enough," "Toughen up," "Suck it up," or "Sleep is for the weak." In essence, sleep is considered a "luxury" that generally falls low on the list of servicemembers' priorities, especially in a high-OPTEMPO setting. Further, some noted that these attitudes and beliefs are difficult to modify because of institutional resistance to change. These perspectives suggest that cultural attitudes toward sleep may compound or exacerbate other, more tangible— and often unavoidable—operational or environmental barriers to servicemember sleep, as discussed later in this chapter.

While the cultural attitudes surrounding sleep in the military generally seemed less than positive, these attitudes tended to vary by military branch or occupational field and rank. For example, some interviewees and working group participants felt that aviators tend to be more rigid about how much rest and sleep they get during their crew days and that this was less common in the ground or surface fleet forces. One Marine Corps operational staff member stated,

In a perfect world we'd follow the model that's done by the air side. There's not anything that's even kind of close, even halfway . . . for the ground or the shore.

Expectations regarding sleep also seemed to vary by rank. Some interviewees and working group participants suggested that senior military personnel or leadership may have an exceedingly difficult time prioritizing sleep:

As a senior person, I wasn't going to be the first person to go to bed. You want to be at the table, you want to be part of the discussion, and a lot of these discussions are happening well into the evening.

These perspectives are supported in the literature, which suggests that leadership is often required to work extended hours (Harrison and Horne, 2000). A survey of Army infantry officers found that "an overwhelming majority of respondents reported that their superior slept significantly less than needed" (Miller, Shattuck, and Matsangas, 2011). Indeed, many in our sample described the pressures on commanders to avoid sleep and suggested that commanders may be the most sleep-deprived servicemembers.[1]

Many interviewees and working group participants were hopeful that increasing recognition of the value of sleep, in both society as a whole and in the military, would lead to a cultural shift in how sleep is prioritized. Specifically, some felt that military attitudes toward sleep are improving, partly because of increasing media attention on the consequences of insufficient or poor sleep and greater public awareness of the importance of sleep for optimal health and functioning.

  • [1] See Shay (1998) for a detailed discussion of the challenges facing military leadership not only in encouraging others to prioritize sleep but also in allocating sufficient time for sleep for themselves.
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