How Pharmacists Can Combat the Military's Top Health Problem

What is the No. 1 disorder seen among deployed soldiers?

While many may guess that it’s post-traumatic stress disorder (PTSD), sleep problems are actually the most common health issue in the military, according to Lt. Col. Kate E. Van Arman.

Among 300,000 military members who suffer a traumatic brain injury (TBI), 97% reported some form of a sleep problem, most commonly insomnia. In addition, 34% said they had sleep apnea, and half of them said they experienced fragmented sleep, according to Lt. Col. Van Arman, who recently gave a presentation on sleep disorders among military patients with mild TBI.

Lt. Col. Van Arman noted that many of her findings also relate to soldiers without TBI, the Army News Service reported.

Pharmacist Counseling Points for Sleep-Deprived Soldiers

Jeannette Y. Wick, RPh, MBA, previously wrote about several suggestions that pharmacists can make to patients with sleep problems. For example, pharmacists can counsel patients that weight loss may help improve sleep problems, especially sleep apnea. In addition, sleeping on your side instead of your back can help reduce snoring.

Wick also pointed out that some patients might benefit from long-term intranasal topical steroids, continuous positive airway pressure, or a customized oral dental appliance.

Pharmacists may also want to counsel soldiers to steer clear of more than 400 mg of caffeine a day, as it can disrupt sleep and lead to mood deterioration. Pharmacists can also remind their patients to try not to drink caffeinated beverages 6 hours before bedtime.

Sleep Deprivation: A Persistent Health Problem in the Military

Sleep problems may be more severe for those in the military for a variety of reasons, and the consequences of soldiers’ lack of sleep can be especially concerning.

Army Surgeon General Lt. Gen. Patricia Horoho stated that fewer than 6 hours of sleep for 6 days in a row is the equivalent of having a .08% blood alcohol level.

“We never will allow a soldier in our formation with a .08% alcohol level, but we allow [sleep deprivation] every day [in soldiers who have] to make those complex decisions,” Horoho was quoted in The Army News Service report.

One-third of the US military sleeps fewer than 5 hours per night and two-thirds sleeps fewer than 6 hours, according to Lt. Col. Van Arman. Deployed soldiers, especially those in combat arms branches, sleep just 3 hours a night on average.

One reason why soldiers may be more likely to be sleep-deprived is the fact that staff duty sometimes requires an individual to stay up for 24 hours. Other times, soldiers are punished by having to complete extra duties until midnight, Lt. Col. Van Arman noted.

In addition, military members’ sleep may be fitful due to noise or weather conditions.

Lt. Col. Van Arman put soldiers’ level of fragmented sleep in context by noting that an average person may wake up 3 to 5 times in 1 night, but a particular army specialist with mild TBI woke up 529 times in a single night in a sleep lab.

Health Consequences from Sleep Deprivation

Lt. Col. Van Arman has seen a great deal of soldiers in their 20s visit the pharmacy for medication to treat erectile dysfunction (ED). She surmised that their low testosterone levels—which should have been around 500 ng/dL, but were instead around 200 ng/dL—were affected by their lack of sleep.

“Once you get better sleep, your testosterone levels are going to go up, and your ED issues will improve,” she has told soldiers, according to The Army News Service report.

Military members may also be at increased risk of cardiovascular disease (CVD) because of their sleeping problems.

One sleep study showed that soldiers who were told they would be randomly awakened in the night had elevated cortisol levels, which have been linked with CVD. Other soldiers in the study who were told they would get a good night’s sleep but be awakened at 6 a.m. did not have the same constantly high cortisol levels, and neither did those who were told they would be awakened once every 3 hours.

Lt. Col. Van Arman noted that soldiers are often confronted with situations where they need to react quickly, even during the night, so they have to have a “quick reaction force brain.”

Military pharmacists can play a large role in reminding their military colleagues about the vital need for sleep and educating them about the risks of CVD.

“Pharmacists can help patients and other members of the health care team appreciate the importance of [CVD and metabolic health],” Wick previously wrote for Pharmacy Times. “As our understanding of the mechanisms underlying both becomes clearer, we will have more opportunities to tailor care to specific targets. Until then, we need to help patients sleep as soundly as possible and address CVD conditions, as well.”

Previous research has shown that short sleepers are more likely to be overweight, which is another CVD risk factor. Patients with sleep apnea also may experience blood pressure surges that contribute to plaque rupture.

Another recent study suggested that poor sleep is associated with less motivation, reduced overall functioning, and amplified emotional responses to neutral or mildly negative events.