Disseminate Positive Messaging About Sleep as an Operational Imperative to Increase Awareness and Reduce Cultural Barriers
One potential way to change how sleep is viewed is to change the terminology used to discuss it. Using the analogy of "heat casualties" that result from insufficient hydration in the presence of high temperatures, the military can refer to individuals whose performance suffers from insufficient sleep as "sleep casualties." This use of terminology emphasizes the point that sleep-related performance decline does not reflect weakness or a lack of discipline but, rather, a failure to meet a basic biological need. When sleep is viewed as an imperative and not as a deterrent through educational campaigns and broader public awareness, cultural and stigma barriers may slowly disintegrate. These messages about the value of sleep as a component of readiness (e.g., "operational sleep") should be incorporated into all levels of Professional Military Education curriculums to present the ideas early and often in servicemembers' careers. In addition, key informants suggested referring to sleep as another vital sign, just as blood pressure, pulse and respiratory rates, and body temperature are vital signs. The VA has used "Pain as the 5th Vital Sign" in its toolkit for conducting pain assessments, and the same could be applied to sleep (VA, 2000).
Table 7.2 shows where the recommendations discussed above fit within the continuum of sleep health promotion that runs from prevention to identification, clinical management, training, and operations. As the table shows, most of the recommendations are specific to one of the four categories. However, two of them—disseminate positive messaging about sleep and increase servicemember and line leader education about health—cut across all four categories, while one of them—develop provider education programs—cuts across the first three categories.