Service members can break a bad sleep cycle

BRADLEY AIR NATIONAL GUARD BASE - East Granby, Conn. -- Believe it or not, there is something to counting sheep when a stressful day turns into a sleepless night. What happens though when counting sheep doesn't seem to be working?

Endless nights of tossing and turning, frequent waking or even waking up early can translate to just having a tough time sleeping. However, insomnia has a wide breadth and you may be suffering from it without even knowing.

According to the Mayo Clinic online, insomnia is a sleep disorder that makes falling asleep, staying asleep or accomplishing either difficult.

Cindy Hould, one of the Connecticut National Guard's military and family life consultants, agrees, but characterizes it a bit differently.

"Insomnia is the disturbance in the quality or the amount of sleep," said Hould. "It really has to do with how efficient you are at sleeping."

This means it is not necessarily the quantity of sleep, but the quality of sleep, said Hould.
Oddly enough, said Hould, people who do yoga and are able to enter a restorative state when relaxed can have better sleep with less hours of sleep. They are increasing the quality of their sleep.

Now this doesn't this mean we should be engaging in yoga at every staff meeting to breed a culture of meditating among our Soldiers and Airmen. As Hould points out, there are many different techniques to help combat sleeplessness.

This was the subject of her "Insomnia" discussion on June 17, 2014, as part of the Lunch and Learn series. This series offers poignant strategies to deal with various wellness issues while Guardsmen have their lunch. For this particular one, Hould discussed the ins and outs of insomnia and how to cope to approximately 16 Guardsmen at Bradley Air National Guard Base, East Granby, Connecticut.

What causes insomnia and some the effects?

As a licensed marriage and family therapist, Hould sees service members for sleep therapy treatment and the majority of her clients experience routine waking during the middle of the night usually after returning home from a deployment.

This can be attributed to the military life style, said Hould. Travelling through different time zones, late night work shifts, erratic schedules, staying busy to avoid boredom and even tinnitus can all contribute to sleep disturbances and insomnia.

Moreover, "Over 50 percent of combat veterans experience sleep disturbance and just as many report intrusive trauma-related thoughts while attempting to initiate sleep," said Dr. Aaron Martin, a clinical health psychology postdoctoral-resident at the Veterans Affairs Connecticut Healthcare System. Quoting a study done in the 1990s, Martin continued to explain that insomnia can also be a major symptom of an underlying medical condition such as depression and PTSD.

Martin is one of the resources that Hould uses to assist service members with their sleep disturbances and insomnia.

"It is difficult to answer the question of whether or not insomnia exacerbates PTSD or depressive symptoms because we use sleep disturbances themselves to diagnosis both conditions," said Martin.

The other two forms of insomnia are difficulty falling asleep and early morning awakening which Hould said, "is the ability to fall asleep and sleep through most of the night but awake a couple of hours before your alarm and not be able to fall back asleep." 

Some of the effects or issues that may come from insomnia or sleep disturbances are tiredness, irritability, difficulty concentrating, impaired ability to handle stress, less production overall and a lowered immune system.

"Your cognitive thought process starts to decline as your brain compensates just to keep your body awake," said Hould.

"When you look at the importance of the military mission, failure is never an option. So, the importance of being awake, aware, cognitive and ready to complete the mission is essential. Good sleep habits are a function of what we do," said Lt. Col. Walt Levantovich, chief of safety for the 103rd Airlift Wing.

Knowledge of what insomnia or sleep disturbances are and how to identify them is only half of the battle to individual mission readiness. The other half is about changing those bad habits.

Practicing good sleep hygiene

A bad habit is like a soft chair, easy to get into, hard to get out of. The same adage applies to the cycle of sleeplessness and getting a better night's sleep. Like all bad habits, the best way to break free is to start a new good habit that replaces it. This is the crux of practicing good sleep hygiene.

In general, there are some tips to reshaping your body's and mind's sleeping habits. Hould suggests the following:
  • Exercise in the morning or early afternoon. When you exercise in the evening, it wakes up your body and gets the body metabolizing food which in turn gives you energy.
  • Set the "Body Clock." This means trying to go to bed the same time every night even if you can't fall asleep right away.
  • Avoid naps. Napping will interfere with your nightly sleep cycle.
  • Forego the nightcap. If you drink alcohol to fall asleep, when the alcohol metabolizes, the body has a surge of energy and can wake you in the middle of the night.
  • Nicotine is a stimulant--avoid it. As is caffeine. Avoid ingesting caffeine four to six hours before sleeping.
  • Reserve bed time for sleeping; do not bring the laptop to bed to get work done.
  • In line with working from bed, do not use tablets or phones in bed. The light of the screen stimulates the eyes and brain.
  • Turn the face of the clock so you can't see it.
  • The perfect sleeping temperature is 68 degrees Fahrenheit.
  • Lastly, shower or bathe before bed to help relax the muscles.

Now, if none of these tricks or tips work, Hould recommends setting a meeting with a cognitive behavioral therapist. According to Hould, therapy is more effective over the long term than prescription medication. Realistically, it will take about four to eight sessions with a therapists to begin changing your sleeping habits.

"In the military, people want results quickly, but it's like training. You have to invest in it as if you were preparing for a deployment," said Hould.

Seeing a therapist for sleep disturbances does not make you "crazy"
Seeking help is not a sign of weakness. The message is very clear and has been the buzz for quite some time in the military. The military and the Veteran's Administration have set aside millions of dollars nationwide for programs designed to aid military members and service-connected or returning veterans.

For anyone who is serious about tackling their insomnia, Hould has a cognition exercise that she said has seen be very effective.

The key is to put the worries out of your mind, said Hould. There is a negative feedback loop for those who can't get to sleep due to their worries.

As more and more thoughts about planning and fixing the problems of the day fill your mind, you get amped, which keeps you awake, which adds fuel to the worries and thoughts, and stress then feeds back into the arousal which continues to keep you awake.

"So you want to replace your thoughts with meaningless thoughts," said Hould. "There really is something to counting sheep--it will block those worries from your mind."

Another way to empty the mind is to write it all down. This allows someone to project their thoughts onto the paper which translates into taking out the trash, said Hould.

"Spend 15 minutes writing down all of your worries and thoughts at the end of the work day, or several hours before bed," said Hould. If you write everything down before right before bed, you reinvest those thoughts to your consciousness.

This technique is just one of the many that cognitive behavioral therapists can offer someone suffering from insomnia and sleep disturbances. Another tool that Hould recommends, especially if a military member is serious about seeing a therapist for his or her insomnia is the Sleep Diary by the National Sleep Foundation.

This tool, when filled out and brought to your cognitive behavioral therapist, will assist the therapist in structuring a plan to combat sleeplessness.

The bottom line is mission readiness in the military. How prepared and effective we are at doing our job can sometimes be the difference between success and failure, or sustaining an injury versus returning safely. Sleep is an important function of being human and an important part of mission readiness.

For Flying Yankees looking for more information about insomnia or sleep disturbances, please contact the wing's director of psychological health, Lynn Biella. She will have the resources available to best suit your needs. Additionally, veterans may reach out directly to Dr. Aaron Martin to participate in his sleep skills group that is scheduled for July 23, 2014, he can be reached at 203-932-5711, ext. 2302. Lastly, any Guardsmen in Connecticut may also reach out to Cindy Hould by email, cindy.hould@ahsg.us, or by phone, 860-593-7786.

The sleep diary can be found through the National Sleep Foundation at their website.