Get Some Sleep!
By Debbie Vyskocil, BCN
Published in Proceedings, a publication of the U.S. Naval Institute.
From 1968 to 1969, I served in Vietnam as a team leader with the elite Marine Special Operations unit, 1st Force Reconnaissance Company. Our teams operated deep within enemy controlled territory. Covert close-in observation, prisoner acquisitions, ambushes and other direct-action missions were our specialized focus. Fitness and mental alertness were fundamental to our success… Our missions were typically four–six days in duration, often in heavily vegetated jungle terrain. Operating in and amongst enemy troop concentrations required utmost acuity and mental focus. These missions were extremely taxing as sleep was difficult to impossible. The longer on patrol the more challenging it became to focus and maintain mental concentration. Upon return to base, we would sleep for extended periods of time; the necessity for sound sleep and recuperation was vital. Sleep and its recuperative effects are absolutely fundamental to competent performance, not only in combat scenarios but in virtually all callings.
—Major C.L. Lowder, USMC (Retired), recipient of the Silver Star medal
One common thread weaves through studies on the performance and health of officers, troops, veterans, and civilians: without sleep, functioning and health erode. The National Institutes of Health (NIH) has found that 62 percent of Americans have symptoms of insomnia and 50 percent of service members have clinically significant sleep problems.
How many hours did you sleep last night? How many times did you wake up? How long did it take to fall back to sleep? Each of these variables affects the amount of recharging your body and brain receive and your performance. On average, how many hours did you sleep each night last month? You most likely sleep less during a mission, but that also is when you need all your resources and your highest cognitive functioning.
The National Sleep Foundation recommends seven to nine hours of sleep per night for adults. According to recent research on military personnel, 32 percent get five hours or less sleep per night. 32 percent get between five and six hours. This leaves just a third of service members getting enough sleep to function at their highest level. Sleep problems are one of the most frequent reasons that military personnel seek mental health help on active duty and are the number one cause for veterans seeking help.
As Major Lowder noted, sleep deprivation has an acute impact on individuals and teams. He understood that, as a result of sleep deprivation during their missions, his team would be slower, their cognitive decision making would be delayed, and their reflexes would be diminished—all detrimental to a highly skilled special operations team on a critical mission.
Performance/Operational Readiness
If you are sleep deprived for a couple of nights do you feel a beat off? Veterans and active-duty service members cite several concerns related to too little sleep. In a simulated combat study in which Army officers received three hours of sleep during a 53-hour exercise, participants experienced severe impairments in vigilance, reaction time, attention, memory, and reasoning, and they reported depressed moods.1 NIH recognizes that these challenges, along with controlling emotions and problem solving, are directly correlated to sleep deprivation.
Research shows chronic sleep challenges—defined as six hours or less sleep per night over an extended period of time—have the same impact as two nights of total sleep deprivation. After being awake for 24 hours straight, an individual’s performance decreases to a level equivalent to that observed at a blood alcohol level of 0.10 percent.2 You don’t want your team members driving their cars while intoxicated. Do you want them conning a ship or submarine, flying an F-35, or conducting a hostage rescue mission in that condition? Adding to the risk, self-reported sleepiness ratings suggest people are largely unaware of their increasing cognitive deficits, which may explain why the impact of chronic sleep challenges on waking cognitive functions often is assumed to be zero. It also may be why service members often don’t ask for a break. “No, I’m good.” In many military units, going without sleep or very little sleep also is considered a sign of toughness. “You can sleep when the deployment is over!” This attitude is unhealthy, leads to suboptimal performance, and can be dangerous.
Field studies reveal a profound effect on moral reasoning, as well. Studies at Walter Reed Army Institute of Research found that sleep deprivation disrupts the ventromedial prefrontal regions of the brain, which are critical to making judgments and decisions. When sleep deprived, people may experience greater difficulty integrating emotion and cognition to guide moral judgments, causing them to choose courses of action different from those that they normally would.3
The consequences of cognitive functioning impairment are most frightening for those in high-risk situations with small margins of error. Deployed Army personnel getting six or fewer hours of sleep per night reported more accidents, mistakes, and decreased ability to do their jobs. Sleep deprivation is linked to devastating accidents, such as nuclear accidents, the Exxon Valdez oil spill, and the Challenger space shuttle explosion.4,5
Impact on Memory
Short-term memories are converted to long-term during sleep. Memory is imperative to job performance and interpersonal functioning. Information, data, and critical details need to be stored in long-term memory for future retrieval. Without quality sleep memories can be lost. A young Marine who had just returned from deployment expressed concern that at age 23, he could not remember the names of people he met. He had been sleep deprived for months and would lay in bed for a minimum of two hours each night prior to sleep onset. Sleep protects memories from being forgotten and makes them easier to access; it almost doubles our chances of remembering previously recalled material.
Physical Health Effects
Along with performance considerations, there are physical and mental health effects from sleep deprivation. A retired Army major with an inability to sleep more than four hours each night recently required electric shock to his heart due to atrial fibrillation, a direct result of sleep issues, according to his cardiologist. He currently is on medication, occasionally needs emergency medical care, and may require surgery.
Sleep problems are the cause of or contribute to many diagnosed health conditions such as hypertension and cardiovascular disease, asthma, obesity, pain, fertility problems, diabetes, cancer, and even mortality.6,7,8 A study of military personnel showed a correlation between physical health conditions and short sleep duration, nightmares, and sleep disorders.9 A recent study of 54,279 people between the ages of 20 and 89 over a period of 11 years found those with just three symptoms of insomnia had greater than three times the risk of developing heart failure compared to those with no insomnia symptoms.
Mental Health Effects
In a 2007 study of 10,000 people, those with insomnia were five times as likely to develop depression as those without. Substantial evidence from both military and civilian studies suggests sleep issues can be a cause of or early symptom of mental health challenges including depression, post-traumatic stress disorder (PTSD), anxiety disorders (e.g., panic disorder, obsessive-compulsive disorder), substance abuse, and suicide.
In a study of 15,204 service members from all military branches, predeployment insomnia was the most prevalent mental health diagnosis—ahead of new-onset PTSD, anxiety, and depression diagnosed post-deployment.10 Post-deployment soldiers who average fewer than six hours sleep per night were more than three times likely to have attempted suicide than those with adequate sleep.11 Coupled with civilian research, this suggests that sleep problems are an independent predictor of suicidality.
So What Can You Do?
1. Learning to sleep at will, quickly, is imperative when only a short amount of time is allotted between missions. An Army colonel who served in Iraq tells me 20-minute naps were key to her maintaining optimal performance. Her father, a Marine major, successfully used this method throughout his service in Vietnam.
2. Ask those who are in the room when you sleep if you snore or stop breathing. If the answer is yes, see your doctor. You could have sleep apnea, which is common and easily treated, but it does not go away on its own. Apnea can lead to atrial fibrillation.
3. To ease yourself to sleep, create a scenario of something non-stressful as your “go to” thought when you lie down. It can be as simple as happy thoughts of holding your baby girl, camping with your grandfather when you were young, or fishing with your brother. The primary reason for people not falling asleep is the constant chatter of their thoughts. What you are thinking about when you fall asleep often is what you think about when you wake up during the night and can be the first thought when you awake in the morning. For example, if you are worrying about how you are going to pay your mortgage when you fall asleep, when you wake during the night your mortgage fears will likely be back. Replacing anxious thoughts with calming thoughts can lead to better sleep more quickly
4. Mentally list the U.S. states alphabetically along with their capitals, or try four-square breathing—inhale for four counts, hold for four, exhale for four, and wait for four, simply focusing on your breath.
5. If these tips don’t work, seek medical help. Don’t let sleep deprivation or insomnia go untreated for too long. It’s not a matter of just toughening up!
As Major Lowder’s team learned in Vietnam, sufficient quality sleep is key to mission success and staying alive in a dangerous environment. To function properly, you must protect yourself from the ill effects of sleep deprivation. As a leader, you must take into account the sleep needs of your Sailors and Marines to ensure their health and safety and your unit’s mission success.
1. Harris R Lieberman, Gaston P. Bathalon, Christina M. Falco, F. Matthew Kramer, Charles A. Morgan, and Philip Niro, “Severe Decrements in Cognition Function and Mood Induced by Sleep Loss, Heat, Dehydration, and Under nutrition During Simulated Combat,” Biological Psychiatry, vol. 57, no. 4, (15 February 2005), 422–429.
2. Drew Dawson, and Kathryn Reid, “Fatigue, Alcohol and Performance Impairment,” Nature, vol. 388, no. 6639, (17 July 1997), 235.
3. William D.S. Killgore, PhD; Desiree B. Killgore, MS, CCC-SLP; Lisa M. Day, MSW et al. “The Effects of 53 Hours of Sleep Deprivation on Moral Judgment,” Sleep, vol. 30, no. 3 (March 2007), 345-352.
4. Christopher Drake, Timothy Roehrs, Naomi Breslau, Eric Johnson, Catherine Jefferson, Holly Scofield, and Thomas Roth, “The 10-Year Risk of Verified Motor Vehicle Crashes in Relation to Physiologic Sleepiness,” Sleep, vol. 33, no. 6 (June 2010), 745–752.
5. Merrill M. Mitler, Mary A. Carskadon, Charles A. Czeisler, William C. Dement, David F. Dinges, and R. Curtis Graeber, “Catastrophes, Sleep, and Public Policy: Consensus Report,” Sleep, vol. 11, no. 1 (February 1988), 100–109.
6. Lena Mallon, Jan-Erik Broman, and Jerker Hetta,
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“High Incidence of Diabetes in Men with Sleep Complaints or Short Sleep Duration: A 12-Year Follow-Up Study of a Middle-Aged Population,” Diabetes Care, vol. 28, no. 11, (November 2005), 2762–2767.
7. Daniel F. Kripke, Lawrence Garfinkel, Deborah L. Wingard, Melville R. Klauber, and Matthew R. Marler, “Mortality Associated with Sleep Duration and Insomnia,” Archives of General Psychiatry, vol. 59, no. 2 (February 2002), 131–136.
8. L. Gallicchio, and Bindu Kalesan, “Sleep Duration and Mortality: A Systematic Review and Meta-analysis,” Journal of Sleep Research, vol. 18, no. 2 (June 2009), 148–158.
9. Vincent Mysliwiec, Leigh McGraw, Roslyn Pierce, Patrick Smith, Brandon Trapp, and Bernard Roth, “Sleep Disorders and Associated Medical Comorbidities in Active Duty Military Personnel,” Sleep, vol. 36, no. 2 (February 2013), 167–174.
10. P. Gehrman; AD Seelig; IG Jacobson; EJ Boyko; TI Hooper; GD Gackstetter; CD Ulmer; TC Smith; for the Millennium Cohort Study Team, “Predeployment Sleep Duration and Insomnia Symptoms as Risk Factors for New-Onset Mental Health Disorders Following Military Deployment,” Sleep, vol. 36, no. 7 (July 2013), 1009-1018.
11. David D. Luxton, David Greenburg, Jenny Ryan, Alexander Niven, Gary Wheeler, and Vincent Mysliwiec, “Prevalence and Impact of Short Sleep Duration in Redeployed OIF Soldiers,” Sleep, vol. 34, no. 9 (September 2011), 1189–1195.
President of Optimal Edge Performance, Ms. Vyskocil is board certified in neurofeedback. She merges neuroscience with leadership training to cultivate resilience and optimal functioning. Designing training protocols based on the brain and body’s response to challenges, she is an expert on the impact of sleep and stressors on performance and health.