If I don’t die from lack of rest: Sleep and the military

Military service has always been accompanied by lack of sleep, particularly in wartime for those on the front lines. It’s not just the stress of service that makes it difficult to sleep, though of course that’s a factor—it’s the interruption of mortars and bombs, the expectation of reporting early for duty, the tasks that need to be completed when not actively on duty, the endless small details of life on the edge of a conflict. Along with that lack of rest has come a corresponding deployment of stimulants, with the military sometimes at the forefront of developing stimulant medications and other drugs, with World War Two being rather a banner era for the use of amphetamines among the armed forces, particularly for pilots.

As many as 70 percent of active duty military sleep for less than six hours daily, despite the recommendation that adults sleep for seven to nine hours daily in order to remain healthy and functional. Not sleeping has serious short and long term health implications. It’s not just about impaired decision making, slow reaction times, irritability, and, in some studies, questionable judgement in fast moving situations involving critical moral decisions. Do you shoot or do you hold fire? Is a civilian a risk or not? How do you handle a situation where you need to make a snap judgement that could cost lives of civilians or your fellow soldiers?

In the long term, sleep deprivation is associated with heart and circulatory problems, diabetes, depression, and stroke. There’s a suggestion that it may also increase the risk of certain tumours and cancers, which is a rather troubling thought. There’s a reason that in the civilian world, attitudes toward shift work are changing, and the notion that shifts known to necessitate abbreviated sleeping schedules are okay is starting to decline. Workplaces are realising that employees are more functional, efficient, and safe when they’re getting enough sleep, which is a particular concern in industrial settings, where you don’t want people with inadequate sleep operating heavy machinery and performing complex tasks. It’s one reason why there have been such major reforms to intern hours in medical training, for example, as there are legitimate concerns about allowing young doctors to practice medicine while exhausted—regulatory authorities began to realise that perhaps this was not such a good idea.

Yet in the military, sleep deprivation continues to be tolerated as a simple cost of running an armed force. It’s not just a part of the culture in the sense that people accept it and don’t take any particular action to address it. In some cases, it’s an active source of pride, with individual soldiers competing to see who’s most functional with minimal rest. Military culture is a complicated and unfamiliar world for many civilians, and the competitive nature of some soldiers in some settings can be difficult to understand. This is not a culture where people readily admit what they perceive as weakness, which makes it hard for people to admit that they need sleep and that their ability to make decisions is seriously impaired by lack of rest.

The military isn’t adequately addressing its sleep problem, though it may not be resorting to the ready use of stimulants as much as it once did. But the culture of not taking adequate measures to protect soldiers from lack of sleep reflects a larger problem with military culture and health care—in some ways, it’s a preview of the neglect veterans will experience when they return from service and enter the VA system. Active duty military often struggle with lack of sleep and many people are not aware of how seriously inadequate sleep can affect their lives—they may not link emotional and physical symptoms with sleep deprivation, for example, or they may be reluctant to report them to military doctors for fear of being taken off duty or penalised for being ‘weak.’

Medical advances, especially in emergency and trauma medicine, often emerge from within the military. Governments have substantial financial and other resources to sink into developing effective treatments for soldiers with a variety of injuries—it’s the government that developed effective first-line treatments to use in the field, it’s the government that worked on programs to make a variety of serious traumatic injuries survivable, it’s the government that’s pioneering treatments for traumatic brain injuries and limb loss, two common issues emerging in Iraq and Afghanistan. Yet, the military can’t address one of the most fundamental problems facing a huge majority of soldiers in a variety of settings, from ships to the front line to bases: Sleep.

Needing sleep is hardly evidence of weakness. It’s a reflection of the human condition and the limits of the human body, and while the military often challenges people to push their bodies to the limit, this is a dangerous limit to push. A government that positions itself as wanting to care for its soldiers and provide health care support in return for their service must address the imperative for sleep while still acknowledging that being on active duty often means a requirement for 24/7 availability. That requirement doesn’t have to translate into the kind of shift work that promotes poor sleep, though, and it doesn’t need to be balanced out by the cultivation of bad habits among soldiers who treat sleep deprivation, at times, as a badge of honour.

Image: U.S. Army, Flickr