Sleep problems are a manifestation of other health conditions. For this reason, resolving them cannot be put off.
By Dr. Melissa Lim, Chief Medical Officer and Co-Founder, Somnology and Patrick Yam, CEO and Co-Founder, Somnology
Veterans are more likely to have one or more chronic illnesses than their civilian counterparts, such as Type 2 diabetes or hypertension. They’re also more likely to suffer from sleep disorders — especially if they have one or more chronic illnesses.
Yet while there is greater awareness of the sleep disorders stemming from PTSD, there is less awareness among veterans of the relationship between sleep health and chronic disease. As a 2019 study of insomnia in military veterans noted, “sleep is often ignored as a core health behavior, rarely addressed within biopsychosocial assessments or routine primary care visits, and generally not integrated into chronic disease management programs.”
This needs to change. Veterans need greater access to sleep solutions so they can avoid flare-ups and the exacerbation of existing chronic conditions, while keeping future comorbidities from manifesting.
Understanding the Challenges to Optimal Sleep
So why aren’t more veterans receiving treatment for their sleep disorders? And why aren’t providers putting sleep health in the forefront of treatment plans?
To answer these questions, we should consider both the culture of the military as well as the insidious nature of sleep disorders. One study noted that irregular schedules and ongoing physical, social, and emotional demands during military deployments can trigger the onset of initial sleep difficulties. Deployment to a war region, for example, requires frequent travel across multiple time zones that is disruptive to one’s natural circadian rhythm—the cyclical 24-hour period of human biological activity.
But unlike a flare-up of diabetes linked with consuming too much sugar in a two-hour period, poor sleep quality doesn’t necessarily trigger the acute exacerbation of a chronic illness. Therefore, the urgency of addressing these conditions is minimized. When the correlation between a disorder such as persistent insomnia and poor long-term health outcomes isn’t apparent, help isn’t sought.
Compounding this issue is the media’s tendency to focus on sleep as a wellness goal for optimal health rather than a healthcare necessity. We see countless articles on sleep retreats and wellness centers that offer sleep analysis, and countless articles with simple, everyday advice (e.g., “avoid screens after 8 p.m.,” or “take deep breaths, and count to four”).
By the same token, many popular wearable sleep tracking applications provide limited insight into sleep patterns, and cannot diagnose deeper clinical issues such as sleep apnea.
While undergoing a sleep study at a sleep center is a more comprehensive option, this approach requires a huge time commitment on the part of the patient of up to 12 hours per session, not including transportation. Plus, most sleep studies only measure one night of sleep, which may be insufficient for properly diagnosing a disorder.
Moving Toward Better Sleep
Healthcare providers and veterans, along with most U.S. citizens, need to reframe thinking around sleep health as a biological necessity – one that is intertwined with our physical, mental, and emotional health.
For healthcare providers, this means focusing on interventions, care plans, and treatments that center on improving sleep. It also means asking more comprehensive questions about sleeplessness, when veterans complain of insomnia, exhaustion, or feelings of depression.
Veterans will also benefit from sleep-diagnostic tools that are more comprehensive than everyday wearables, and offer insight, coupled with clinical guidance on the next steps a veteran can take.
Finally, we need to make sleep studies more accessible to all veterans — not just individuals in affluent communities. Many of our men and women who retire from active duty move to rural areas located 100 miles or more from certified sleep centers. If they have seemingly minor problems, such as insomnia, they may put off treatment continually. This makes them more vulnerable to complications stemming from comorbidities such as heart disease or diabetes.
Fortunately, we’re starting to see some progress. In 2019, the U.S. Department of Veterans Affairs conducted a pilot study of 1,000 veterans ages 20 to 89, whereupon they utilized comprehensive, software-as-a-service-based sleep solution provided by Somnology.
Veterans were given advanced, wearable home monitoring equipment, which tracked individual sleeping patterns, and uploaded data insights into a virtual sleep lab. In the lab, specialists would analyze the data and arrange follow-up consultations via telehealth. During the consultation, physicians would address concerns and help patients weigh treatment options.
This approach has helped individuals understand their diagnoses and led to more effective treatment opportunities. Having a dedicated sleep specialist, accessible via telehealth, improved patient engagement in their care.
It also helped the VA save approximately 50% in sleep-diagnostic test costs.
While this is just one small example of the success of a more comprehensive approach, it is an important one for those who suffer from chronic illnesses. By putting sleep quality first, and not viewing it as less essential than other health metrics, we’ll help veterans improve their quality of life, and extend their long-term mortality.