Medical and Treatment Systems Barriers to Promoting Sleep Health

Resistance to Treatment Seeking

A common theme in interviews and the expert working group suggested that negative attitudes toward sleep in the military may contribute to servicemembers' reluctance to admit or seek treatment for sleep problems. This unwillingness could be associated with a fear of negative career consequences, particularly in the case of serious sleep problems requiring intensive treatment. According to one medical staff member,

If [a servicemember] is identified with a sleep disorder of some type, they may be concerned that it may interfere with their career and their ability to stay in the [Service] if they have sleep apnea or narcolepsy.

More generally, stigma associated with help-seeking for mental health problems that are frequently comorbid with sleep problems (Ramchand, Acosta, et al., 2011) may serve as a barrier to identifying and treating sleep problems. Servicemember concerns may include the implications for his or her career or a perceived change in respect from peers. Clinical screening forms are often oriented around mental health disorders. For this reason, a sleep-related diagnosis could be considered as solely a mental health diagnosis and perhaps carry an equivalent amount of stigma from the servicemember's perspective.

Nevertheless, the level of stigma characteristic of sleep problems, alone, appears to be lower than that associated with depression, PTSD, or other mental health issues. Thus, servicemembers may be more likely to seek help for sleep problems than for these mental health disorders:

I don't get the sense that there's a stigma involved with being referred for sleep, similar to what there would be for a PTSD. . . . It may be that they get sent for evaluation for primary sleep disorder, but the real issue is their PTSD, and they just get referred under the guise of the sleep disorder, but the heart of the problem could be the mood disorder [sic].