Insomnia and the Military: Addressing the Causes and Effects

People who are connected to the military are especially vulnerable to sleep problems. This includes service members, veterans, and their families. What does the research tell us about insomnia? And what can we do about it?¹

The data

Studies conducted over 20 years provide important information about insomnia in the military:¹

• Between 2000 and 2009, the Department of Defense (DoD) documented a 19-fold increase in insomnia disorder in service members.
• Insomnia diagnoses increased across all branches of the military.
• Insomnia rates in the Army were consistently higher than in the other branches. In fact, soldiers in the Army were diagnosed with insomnia twice as often as members of any other branch.
• Rates were higher for service members over the age of 40, as well as female and non-Hispanic Black service members.

Military families

It's not just service members who struggle with sleep problems. Military spouses report getting less sleep than spouses of civilians. About 44 percent of military spouses reported getting 6 hours of sleep or less per night. And they reported poor sleep quality overall. Military spouses may not serve active duty, but they face many of the same stressors. These include:²

• Frequent moving
• Fear of their spouse being deployed
• The everyday challenges of military service

The impact of poor sleep on the military

Chronic sleep problems have daytime impacts on most people. Many of us are familiar with feeling grumpy and fatigued, and avoiding events or tasks as a result of poor sleep. Research has more specifically looked at the impact of poor sleep in the military. Data suggests that insomnia decreases the readiness of our military forces by:¹

• Impairing cognitive performance
• Increasing risk of injury
• Impairing decision making
• Slowing reaction time
• Reducing physical endurance

Again, military families are also impacted by disrupted sleep. About half of the military spouses in one study reported at least "a little" daytime impairment due to sleep problems. And a third reported fatigue at least 3 to 4 times a week.²

Treatment options

The most recent version of treatment guidelines was adopted by the DoD and Veterans Affairs (VA) in 2019. Based on all of the available data, the DoD and VA recommend behavioral treatments for people with insomnia. These include cognitive behavioral therapy for insomnia (CBTI) and brief behavioral treatment for insomnia (BBTI). They advise against only prescribing medicine for insomnia disorder, noting several risks and limited success.³

Despite these guidelines, people with insomnia don't always receive the recommended treatment. One study showed that 54 percent of service members received behavioral treatment versus 73 percent who received medicine. Older service members were less likely to receive treatment overall.¹

How to get treatment

The DoD and VA invested a lot of time, money, and expertise into treating insomnia. Thousands of clinicians have been trained to work with insomnia. I have been involved in training these clinicians, and I recommend that military-connected people with insomnia:

• Tell your healthcare provider about your sleep problems. Don't assume your sleep problems are just something you have to live with. Tell your provider how your sleep problems are affecting your everyday life.
• Request evidence-based treatment. Healthcare providers within the DoD and the VA have been trained to provide the most effective insomnia treatments. CBTI is likely available through the behavioral health or sleep medicine departments. BBTI is becoming increasingly available through primary care.
• Online resources are available, too. Check out the VA's Veterans' Health Library for information and resources created specifically for military-connected people.