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What Are the Barriers to Achieving Healthy Sleep for Servicemembers?

As noted in Chapter Six, even with the best evidenced-based best practices and programs to prevent and treat sleep problems in servicemembers and codified policies related to sleep, cultural, environmental and operational, and individual (knowledge-related) barriers across the military context may impede efforts to promote sleep health in servicemember populations; medical and treatment systems barriers may also impede such efforts.

An ongoing challenge is that military cultural attitudes have historically tended to discount the importance of sleep. These cultural attitudes can serve as significant barriers to implementing healthy sleep practices across the continuum of sleep health, including prevention, identification, and clinical management, and across operational and medical system contexts. 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. In operational contexts, the military emphasizes mission first, and the need for sleep may be perceived as a sign of weakness. Manpower limitations can also compound the operational demands faced by military leaders and servicemembers; even where sleep policies are in place, leaders may not have sufficient manpower to allow for proper sleep—an issue that is particularly salient, given the high OPTEMPO of recent years. Above and beyond operational barriers, operational settings are barriers themselves because they are often uncomfortable, noisy, and otherwise challenging environments. And sleep policies, even when implemented, may be interpreted as guidance secondary to operational demands.

Our research suggested that a lack of knowledge about the importance of sleep behaviors was a barrier to recognizing and addressing sleep problems. Such 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 how to identify and manage sleep problems, as well as how to develop and implement a sleep plan.

Finally, the military medical and treatment systems experience challenges because of a lack of adequate screening tools, procedures, and systems for detecting sleep problems in military contexts. In addition, both continuity of care and sleep provider and clinic shortages were noted as barriers to promoting sleep health in servicemember populations.

Understanding these barriers is critical to making well-informed and robust policy recommendations related to the prevention, identification, and clinical management of sleep problems and the promotion of sleep health in both operational and training settings.

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