Military members and sleep problems

This article discusses the importance of sleep for members of the military, especially post-deployment.

Improving the quality and quantity of U.S. military members' sleep following deployment could help reduce other health problems, including depression and post-traumatic stress disorder, according to a new RAND Corporation study.

However, a lack of consistent and transparent sleep-related policies may impede efforts to promote sleep health among service members, researchers say.

"The U.S. military has shifted from combat operations in Iraq and Afghanistan toward helping service members and veterans reintegrate into noncombat roles," said Wendy Troxel, co-leader of the study and a behavioral scientist at RAND, a nonprofit research organization. "One issue that is often overlooked once military men and women return home is that of persistent sleep problems, because in many ways such problems are viewed as endemic to military culture."

Sleep disturbances are a common reaction to stress and are linked to a host of physical and mental health problems. Sleep problems often follow a chronic course, persisting long after service members return home from combat, with consequences for their reintegration and the readiness and resiliency of the force, researchers say.

The RAND report is the first comprehensive review of sleep-related policies and programs across the U.S. Department of Defense, examining the frequency of sleep disorders and factors that contribute to the problem. A survey of nearly 2,000 service members from all branches of the U.S. military found sleep problems had negative effects on mental health, daytime functioning and perceived operational readiness.

"Military policies on prevention of sleep problems are lacking, and medical policies focus on treating mental disorders that are often linked with sleep problems, instead of sleep itself," said Regina Shih, project co-leader and a senior social scientist at RAND. "We know that sleep problems may precede the onset of mental disorders."

While there may be stigma about seeking sleep treatment, it may be lower than the stigma associated with seeking help for mental health problems. Researchers say this suggests sleep could be a gateway to improving psychological health and readiness in service members.

Researchers say that historically, military cultural attitudes have tended to discount the importance of sleep. For example, service members noted that depriving oneself of sleep is often seen as a badge of honor and acknowledging the need for sleep can be seen as a sign of weakness.

The study recommends widespread education and awareness programs within the Defense Department as one means of shifting these cultural attitudes. In operational contexts, the military emphasizes mission first and the need for sleep may be sacrificed for operational demands. Policies are needed to educate service members and leaders about the importance of sleep, including awareness on the importance of sleep for resilience.

Leaders are not always sure how to develop and execute sleep plans that can balance circadian rhythms with the realities of operational environments, or how to allow for adequate recovery periods after extended sleep deprivation in order to optimize force readiness.

The RAND study presents 16 policy recommendations to help the military improve the prevention, identification and treatment of sleep problems in service members. Those policies fall under four broad categories: prevention of sleep problems; increasing identification and diagnosis of sleep problems; ways to clinically manage sleep disorders and promote sleep health; and ways to improve sleep in training and operational contexts.

The report can be found online at:http://www.rand.org/pubs/research_reports/RR739.html

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Study claims exercise reduces epilepsy risk in men

Consistent and vigorous exercise, such as during military training, is shown to reduce risk of later developing epilepsy for men.

New research suggests that men who exercise vigorously as young adults may reduce their risk of developing epilepsy later in life. The study is published in the September 4, 2013, online issue of Neurology, the medical journal of the American Academy of Neurology. Epilepsy is a brain disease that causes repeated seizures over time.

"There are a host of ways exercise has been shown to benefit the brain and reduce the risk of brain diseases," said study author Elinor Ben-Menachem, PhD, MD, with the University of Gothenburg in Sweden and an associate member of the American Academy of Neurology. "This is the first study in humans to show that exercise may also reduce the risk of epilepsy, which can be disabling and life-threatening."

For the study, 1.17 million Swedish men were given cycle tests that measured cardiovascular fitness when they enlisted for mandatory military service at age 18. The participants were then assessed for epilepsy for an average of 25 years. During follow-up, 6,796 men were diagnosed with epilepsy.

The study found that men who had a high level of fitness were 79 percent less likely to develop epilepsy than those with low fitness levels and 36 percent less likely to develop epilepsy than those with medium fitness levels.

The proportion of men with high fitness who developed epilepsy in the study was 0.48% (2,381 out of 496,973 with high fitness). The proportion of men with medium fitness who developed epilepsy was 0.62 percent (3,913 out of 629,876 with medium fitness). The proportion of men with low fitness who developed epilepsy was 1.09 percent (502 out of 46,230 with low fitness).

The results were lessened only slightly after considering genetic factors and a prior history of traumatic brain injury, stroke or diabetes.

"Exercise may affect epilepsy risk in two ways. It may protect the brain and create stronger brain reserve, or it may simply be that people who are fit early in life tend to also be fit later in life, which in turn affects disease risk," Ben-Menachem said.

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Veterans with PTSD have less nightmares after sleep apnea treatment

A study shows that veterans who have PTSD have fewer nightmares after receiving sleep apnea treatment.

For military veterans suffering from post-traumatic stress disorder and sleep apnea, treatment with continuous positive airway pressure, or CPAP, reduces their nightmares, a new study finds.

Researchers reviewed the medical records of U.S. veterans who had been treated in a VA medical center sleep clinic between 2011 and 2012. The investigators looked at the average number of nightmares per week before treatment and up to six months after CPAP was prescribed for the veterans.

The use of CPAP led to a significant reduction in the number of nightmares, which was most connected to how well veterans complied with the treatment.

"Patients with PTSD get more motivated to use CPAP once they get restful sleep without frequent nightmares, and their compliance improves," principal investigator Dr. Sadeka Tamanna, medical director of the sleep disorders laboratory at G.V. (Sonny) VA Medical Center in Jackson, Miss., said in an American Academy of Sleep Medicine news release.

The findings were recently published online in the journal Sleep and presented at the annual meeting of the Associated Professional Sleep Societies, in Baltimore.

"One out of six veterans suffers from PTSD, which affects their personal, social and productive life," Tamanna said. "Nightmares are one of the major symptoms that affect their daily life, and prevalence of [sleep apnea] is also high among PTSD patients and can trigger their nightmares."

CPAP, which is a common treatment for sleep apnea, helps keep the airway open by providing a stream of air through a mask that is worn during sleep. PTSD symptoms such as nightmares usually start soon after a traumatic event but may not show up until months or years later, according to the National Center for PTSD of the U.S. Department of Veterans Affairs.

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Identifying conditions contributing to concussions and brain damage

A new computer model claims to help reduce concussions and brain injury in athletes and soldiers.

Concussions can occur in sports and in combat, but health experts do not know precisely which jolts, collisions and awkward head movements during these activities pose the greatest risks to the brain. To find out, Johns Hopkins engineers have developed a powerful new computer-based process that helps identify the dangerous conditions that lead to concussion-related brain injuries. This approach could lead to new medical treatment options and some sports rule changes to reduce brain trauma among players.

The research comes at a time when greater attention is being paid to assessing and preventing the head injuries sustained by both soldiers and athletes. Some kinds of head injuries are difficult to see with standard diagnostic imaging but can have serious long-term consequences. Concussions, once dismissed as a short-term nuisance, have more recently been linked to serious brain disorders.

"Concussion-related injuries can develop even when nothing has physically touched the head, and no damage is apparent on the skin," said K. T. Ramesh, the Alonzo G. Decker Jr. Professor of Science and Engineering who led the research at Johns Hopkins. "Think about a soldier who is knocked down by the blast wave of an explosion, or a football player reeling after a major collision. The person may show some loss of cognitive function, but you may not immediately see anything in a CT-scan or MRI that tells you exactly where and how much damage has been done to the brain. You don't know what happened to the brain, so how do you figure out how to treat the patient?"

To help doctors answer this question, Ramesh led a team that used a powerful technique called diffusion tensor imaging, together with a computer model of the head, to identify injured axons, which are tiny but important fibers that carry information from one brain cell to another. These axons are concentrated in a kind of brain tissue known as "white matter," and they appear to be injured during the so-called mild traumatic brain injury associated with concussions. Ramesh's team has shown that the axons are injured most easily by strong rotations of the head, and the researchers' process can calculate which parts of the brain are most likely to be injured during a specific event.

The team described its new technique in the Jan. 8 edition of the Journal of Neurotrauma. The lead author, Rika M. Wright, played a major role in the research while completing her doctoral studies in Johns Hopkins' Whiting School of Engineering, supervised by Ramesh. Wright is now a postdoctoral research fellow at Carnegie Mellon University. Ramesh is continuing to conduct research using the technique at Johns Hopkins with support from the National Institutes of Health.

Beyond its use in evaluating combat and sports-related injuries, the work could have wider applications, such as detecting axonal damage among patients who have received head injuries in vehicle accidents or serious falls. "This is the kind of injury that may take weeks to manifest," Ramesh said. "By the time you assess the symptoms, it may be too late for some kinds of treatment to be helpful. But if you can tell right away what happened to the brain and where the injury is likely to have occurred, you may be able to get a crucial head-start on the treatment."

Armed with this knowledge, Ramesh and his colleagues want to use their new technology to examine athletes, particularly football and hockey players, who are tackled or struck during games in ways that inflict that violent side-to-side motion on the head. In the recent journal article, the authors point out that many professional sports games are recorded in high-definition video from multiple angles. This, they write, could allow researchers to reconstruct the motions involved in sport collisions that lead to the most serious head injuries.

The authors also noted that some sports teams equip their players' helmets or mouth guards with instruments that can measure the acceleration of the head during an impact. Such data, entered into the researchers' computer model, could help determine the likely location of brain damage. These results, combined with neuropsychological tests, could be used to guide the athlete's treatment and rehabilitation, the authors said, and to help a sports team decide when an athlete should be allowed to resume playing. This strategy also may help reduce the risk to athletes arising from a degenerative disease linked to repeated concussions.

More research, testing and validation must be conducted before the computer model can become useful in a clinical setting. This will include animal experiments and the correlation of data from event reconstruction to make sure the model accurately identifies brain injuries.

Ideally, Ramesh would like to collect digital brain images from soldiers and athletes before they enter combat or join highly physical sports activities. "We would then be able to track a high-risk population and keep records detailing what types of head injuries they experience," he said. "Then, we could look at how their brains may have changed since the original images were collected. This will also help guide the physicians and health professionals who provide treatment after critical events."

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Up to 85% of US Military has Sleep Disorder

Research into the US Military shows that up to 85% of military personnel has some form of a sleep disorder.

Eighty-five percent of U.S. military study participants had a clinically relevant sleep disorder, researchers say.

Lead author Dr. Vincent Mysliwiec, chief of Pulmonary, Critical Care and Sleep Medicine at Madigan Army Medical Center in Tacoma, Wash., said 51 percent of had obstructive sleep apnea followed by 25 percent with insomnia.

The study involved an analysis of 725 diagnostic polysomnograms -- used to diagnose sleep problems -- performed in 2010 at Madigan Army Medical Center.

Study subjects were active duty military personnel from the U.S. Army, Air Force and Navy, comprising mostly men -- 93.2 percent -- and 85 percent were combat veterans. Sleep disorder diagnoses were adjudicated by a board certified sleep medicine physician.

The study, published in the journal Sleep, found the participants' mean self-reported home sleep duration was only 5.74 hours per night, and 41.8 percent reported sleeping 5 hours or less per night.

Individual sleep needs vary, but most adults need about 7 to 8 hours of nightly sleep to feel alert and well-rested during the day.

"While sleep deprivation is part of the military culture, the high prevalence of short sleep duration in military personnel with sleep disorders was surprising," Mysliwiec said in a statement. "The potential risk of increased accidents as well as long-term clinical consequences of both short sleep duration and a sleep disorder in our population is unknown." UPI

FACTS & FIGURES

Over 500,000 U.S. troops deployed to Afghanistan and Iraq since 2001 suffer from PTSD. All Voices

Every day about 22 veterans in the United States kill themselves, a rate that is about 20 percent higher than the Department of Veterans Affairs’ 2007 estimate, according to two-year study by a VA researcher. Washington Post

The U.S. military has been struggling to deal with the suicide crisis since numbers began rising in 2004. In 2012, the average was nearly one soldier suicide a day. NPR

The number of unemployed veterans rose above 800,000 in January, a spike that raises concerns about the long-term viability of efforts to find jobs for former military personnel. Stars and Stripes

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18 AND UNDER

For Pediatricians in the Military, Duty Always Calls

Left, Kalim Bhatti For The New York Times; right, Evelyn Hockstein For The New York Times

Dr. Eve Kimball, left, was the first female intern in the Army. Her daughter, Maj. Catherine Kimball-Eayrs, at Walter Reed Army Medical Center.

By PERRI KLASS, M.D.

Published: April 12, 2010

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In the mid-1960s, Dr. Eve Kimball was the first female intern in the Army. She started her residency in pediatrics at Madigan Army Medical Center in Tacoma, Wash., while her husband did his residency there in internal medicine. She was honorably discharged after one year for disability — she was pregnant with their first child — and has worked as a civilian pediatrician in practices that serve military families.

Dr. Kimball’s second daughter, Maj. Catherine Kimball-Eayrs, is now chief of outpatient pediatrics at Walter Reed Army Medical Center. When I met her in March, she was pregnant, in her fatigues, with her own third child.

“I was really glad that she chose the military for her training,” her mother said. “I think she got better training — and is having a better experience now — than she would have in a civilian residency.”

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New Treatment May Help Soldiers, Athletes, Others Rebound from Traumatic Brain Injuries

A new treatment has been found for traumatic brain injury which may be helpful for soldiers, athletes, and others.

A potential new treatment for traumatic brain injury (TBI), which affects thousands of soldiers, auto accident victims, athletes and others each year, has shown promise in laboratory research, scientists are reporting. TBI can occur in individuals who experience a violent blow to the head that makes the brain collide with the inside of the skull, a gunshot injury or exposure to a nearby explosion. The report on TBI, which currently cannot be treated and may result in permanent brain damage or death, appears in the journal ACS Nano.

Thomas Kent, James Tour and colleagues explain that TBI disrupts the supply of oxygen-rich blood to the brain. With the brain so oxygen-needy -- accounting for only 2 percent of a person's weight, but claiming 20 percent of the body's oxygen supply -- even a mild injury, such as a concussion, can have serious consequences. Reduced blood flow and resuscitation result in a build-up of free-radicals, which can kill brain cells. Despite years of far-ranging efforts, no effective treatment has emerged for TBI. That's why the scientists tried a new approach, based on nanoparticles so small that 1000 would fit across the width of a human hair.

They describe development and successful laboratory tests of nanoparticles, called PEG-HCCs. In laboratory rats, the nanoparticles acted like antioxidants, rapidly restoring blood flow to the brain following resuscitation after TBI. "This finding is of major importance for improving patient health under clinically relevant conditions during resuscitative care, and it has direct implications for the current [TBI] war-fighter victims in the Afghanistan and Middle East theaters," they say.

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NFL and MIlitary work together to gather Concussion Data

How can the military and the NFL improve helmets and improve the number of people who seek treatment for concussions? Working together is a promising start.

The National Football League, worried about the impact of head injuries, plans to follow the military’s lead by putting high-tech sensors in players’ helmets to gather data on concussions that could benefit both organizations.

The Army has been putting blast sensors in its helmets since 2007 and will eventually deploy 45,000 of the devices to monitor head injuries suffered by soldiers in blasts by improvised bombs in Afghanistan.

NFL spokesman Brian McCarthy said in an e-mail this week that the league is testing a range of helmet sensors that it hopes to install in players’ helmets to gather data on the causes of concussions. Information gathered from the testing is being evaluated by doctors and engineers and shared with the military, he said.

The goal is to prevent concussions — or at least minimize the severity — and reduce the stigma of seeking treatment for head injuries.

NFL Commissioner Roger Goodell met with Gen. Ray T. Odierno, the Army’s chief of staff, in May. Since then, NFL players, coaches and medical personnel have held two meetings at the Pentagon with military leaders.

Last week, Minnesota Vikings coach Leslie Frazier, New York Jets assistant special teams coach and Army veteran Ben Kotwica and former coaches Bill Cowher and Eric Mangini talked about brain injuries and concussions with U.S. troops at Forward Operating Base Arian in Afghanistan’s Ghazni province, McCarthy said.

The NFL is planning more meetings between players and soldiers to talk about the issue later this year.

“There is a tremendous amount of respect between the NFL and military communities, and we are working together to break down some of the stigma around reporting a head injury,” McCarthy said.

A soldier may not listen when his commanding officer tells him that he needs to take head injuries seriously, but perhaps he’ll listen if one of his NFL heroes says so, he said.

“Similarly, our players may not want to listen to medical personnel and coaches deliver the message, but perhaps they’ll listen to a Special Ops soldier who has seen significant combat action,” he said.

Studies have found that about 60 percent of former NFL players have suffered concussions and about 33 percent report having at least three. The military has reported nearly 230,000 cases of traumatic brain injury among the more than 2 million Americans who have been deployed to Iraq and Afghanistan.

Military officials who have briefed Goodell on the Army’s helmet sensors say their devices are slightly different than those being tested by the NFL, which are looking only at the forces generated by blows to the head.

The Army’s sensors detect blunt force trauma to the head, acceleration of helmet and shock waves generated by explosions, said Lt. Col. Frank Lozano, who oversees the military helmet sensor program and was among those who spoke to Goodell.

The Army’s sensors have recorded data from 200 events, including 30 IED attacks and accidents such as falls and vehicle crashes, he said.

The sensors start recording any time a soldier’s helmet is involved in an impact that generates a force in excess of 150 Newton, a measure of force. Scientists estimate that a boxer’s punch can generate thousands of Newtons, but a smaller force is still capable of causing an injury.

The Army recently started deploying its third-generation helmet sensor, made by defense contractor BAE Systems, Lozano said.

Helmets containing the two-ounce sensors are being issued to troops headed for Afghanistan’s most hostile areas, he said.

The immediate benefit of a helmet sensor is detecting whether a soldier has been through a traumatic event, since some people who suffer concussions are unaware they have been injured, Lozano said. It’s far too common, for athletes and troops alike, to try to shake off the symptoms and keep going.

“Our system has an antenna that allows the helmet sensor to contact a field service representative and say, ‘I’ve been in a traumatic event,’” he said. “It will alert them to contact the unit and say, ‘One of your sensors went off. I need the sensor, and we need to examine the soldier.”

Some soldiers have come through events that set off their sensors without experiencing concussions — a sign that people’s brains can react differently to traumatic events, he said.

“What we are trying to do is collect the data and correlate it with soldier medical records in conjunction with the medical community and correlate that information over lots of different events so we can develop a more systematic software tool that can predict when an event may lead to traumatic brain injury,” Lozano said.

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Brain Injuries from Blasts in Combat Similar to Football Impacts

In an advance that may someday provide health benefits for soldiers and athletes, a team of researchers has discovered a mechanism that could be the cause of traumatic brain injuries (TBI) in blast-exposed soldiers.

The breakthrough study, published recently in the journal Science Translational Medicine, finds that the brain injuries suffered by soldiers from improvised explosive devices (IEDs) are due to the head rotation or motion from the blast wind.

The research team created a blast neurotrauma mouse model that controlled head motion during blast exposure. The study showed that the brain injuries observed in mice exposed to blasts -- equivalent to battlefield exposures -- are identical to the brain injuries suffered by soldiers from military blasts, such as IEDs, when the heads were allowed to move.

However, when the head motions were restrained, there were no brain injuries or other neurological effects in the mice.

The researchers also compared brain tissue samples from four soldiers with known blast exposure and/or concussive injury with brain tissue samples from three amateur American football players and a professional wrestler with histories of repetitive concussive injuries. In addition, they compared the brain tissue samples to those from a control group of four young men without a history of blast exposure, concussive injury or neurological disease.

The results showed that the brain damage in blast-exposed veterans is similar to the brain injuries observed in football players who have sustained repetitive concussive head injuries. This result is a significant finding because it demonstrates a common link between what has previously been believed to be two disparate injury mechanisms.

The three-year-long study, believed to be the first and only research effort that has clearly identified an injury mechanism from the direct effects of blasts, involved 35 researchers from 14 university research centers, medical schools, hospitals or other centers.

The research team was led by Lee Goldstein, a medical doctor and associate professor at Boston University School of Medicine (BUSM) and Boston University College of Engineering, and Ann McKee, a medical doctor, professor at BUSM and director of the Neuropathology Service for the Veterans Affairs New England Healthcare System. It included William Moss, a physicist in B Division at Lawrence Livermore National Laboratory.

In addition to Boston University, the Veterans Affairs Boston Healthcare System and LLNL, among the other institutions participating in the study were New York Medical College, Harvard Medical School, Massachusetts General Hospital, Emerson Hospital (Concord, Mass.), the Veteran Affairs Medical Center (White River Junction, Vt.), and the University of Massachusetts, Lowell.

As a co-author of the paper, Moss contributed to the sections describing the blast characteristics and the discussion leading to the conclusion that blast-induced head motion was the predominant brain injury mechanism. He also showed that the experimentally produced blast waves were similar -- in amplitude and duration -- to military exposures.

Moss and other members of the research team believe that once a person has undergone a blast exposure, it may still be possible some day to stem some of the effects of the brain damage in the days and weeks after such an explosion.

"A medical solution may be more practical than an engineering or physics-based solution," Moss said. "Because the brain injuries don't appear immediately upon exposure -- and take time to develop -- this suggests there may be a way to medically intervene with drugs or other therapies that could inhibit or prevent the damage from occurring," Moss said.

Moss has been studying the causes of -- and ways to mitigate -- TBI in soldiers for more than five years.

Last year, Moss and colleague Mike King, an LLNL mechanical engineer, concluded a one-year study that found that soldiers using military helmets one size larger and with thicker pads could reduce the severity of TBI from blunt and ballistic impacts. Their research was funded by the U.S. Army and the Joint IED Defeat Organization.

In an article published in September 2009 in Physical Review Letters, Moss and King found that non-lethal blasts may induce sufficient skull rippling to generate potentially damaging forces in the brain without a head impact.

First lady announces new program to help people with traumatic brain injuries

A local doctor was among those asked to be with Michelle Obama today in Richmond, Virginia, as she announced a new program to help the troops coming home from the wars in the Middle East.

Dr. Paul Harch joined the first lady to talk about how medical schools can do research and train new doctors to better care for veterans needs, especially with brain injury.

The White House is recognizing the importance of brain research, such as the research being done here in New Orleans, as beneficial to the health of the men and women who fought in Iraq and Afghanistan.

"The mental health challenges many of our troops face once they return home," Michelle Obama said from the podium in Richmond Wednesday afternoon.

For 20 years now, Medical Watch has been following the research of two LSU Health Sciences Center doctors, emergency medicine specialist Dr. Paul Harch, director of the LSUHSC New Orleans Hyperbaric Medicine and Wound Care Department, and Dr. Keith Van Meter, the chief of the section of emergency medicine.

They have worked on projects to help patients with brain injury healing through hyperbaric oxygen treatments. They have treated near drowning victims, such as a California man who spent nearly a half hour at the bottom of the Mississippi River and has no brain damage, and many others with strokes, traumatic brain injury, and those with some mental disabilities and brain defects from birth.

A few years ago, the doctors began studies on veterans coming home from the Middle East, those who had post traumatic stress disorder from war and those whose brains were injured from explosions.

They testified in front of the Congressional House Armed Services Committee and reported to the Department of Defense on their oxygen treatment studies for injured soldiers.

Young marine Jake Mathers was in the pilot study when he came home with brain damage from a suicide bomber explosion and PTSD.

"You forget where you put your cell phone. Like 10 times a day you can't find your car keys. You can't really do anything productive without screwing it up a couple of times," he said before the treatments in February 2009.

After the oxygen treatments (HBOT), his health changed.

"My sleep is better. I'm sleeping longer. I'm not dreaming about mean and angry things constantly. My memory, I don't even have a memory problem anymore. I don't have headaches at all any more," said Mathers back in 2009 after HBOT treatments.

Read more: http://www.wwltv.com/news/First-lady-announces-new-program-to-help-traumatic-brain-injuries-137151843.html

Post-Traumatic Sleep Disorders

Although one may understand the prevalence of horrifying dreams in our returning soldiers, the specific sleep disorders falling upon them seem to be unique to their own combat experience.

A recent study shows that the specific traumatic experience a soldier faces causes the variety of sleep disorder he or she is fated for if that soldier has post-traumatic stress disorder (PTSD) or traumatic brain injury (TBI). Our nation's defenders find themselves overwhelmed by insomnia and sleep apnea, occurring in regards to their trigger.

Published in the journal Chest, this study oversaw 261 patients with either PTSD, TBI, or both. Even though the initial study was created to determine the prevalence of sleep disorders in these patients, in order to find specific correlations with these increased sleep disorder rates, clinical variables were incorporated and assessed.

The findings were as such:

• 71% showed sleep fragmentation (inability to sleep through the night)
• 87% showed hypersomnia (excessive sleepiness, usually during the day)

Further diagnostic sleep studies were performed on around 80% of patients:

• 56% diagnosed with obstructive sleep apnea (OSA)
• 49% diagnosed with insomnia

Now particularly interesting in regards to physical injury, those with blunt trauma had twice as much OSA while those with blast injuries experienced almost 25% more insomnia cases.

The study authors, doctors from the Walter Reed Army Medical Center in Washington, DC, warn that, "an increased awareness of the high prevalence of sleep disorders in combat veterans is critical given the chronicity of these disorders, and extension beyond the military healthcare system."

Read more: http://www.dailyrx.com/news-article/obstructive-sleep-apnea-insomnia-tbi-and-ptsd-16163.html

Migraine, headaches a growing problem for the military

Army Spec. David Hunt made it through a year of deployment in central Iraq largely unscathed. But two years after returning to the United States, he faces medical retirement from the military.

As Hunt, 37, describes it, there’s “really not any place” for him in the Army because of chronic migraine, the condition that has plagued him ever since an off-duty auto accident in 2006.

He has fought the symptoms (nausea, vomiting, sensitivity to light) through deployments to the Arizona-Mexico border as well as Iraq. He recalls one particularly bad migraine hitting while he was alone and on guard in Arizona, and he vomited while seeking shelter from the harsh sun. “I did everything I could to just sit up and keep watch,” he said.

Hunt isn’t alone. Over the past decade, migraine and headache have become a significant problem for U.S. armed forces. A 2008 Defense Department report said diagnoses of migraine increased across all branches of the military between 2001 and 2007. Another, more recent study found that, among nearly 1,000 soldiers evacuated from Iraq and Afghanistan because of some form of headache between 2004 and 2009, two-thirds did not return to duty. “Headaches represent a significant cause of unit attrition in personnel deployed in military operations,” the study concluded.

The stress and physical demands of serving in combat areas can trigger head pain, according to experts, and concussions and head traumas increase the likelihood that service members will later develop debilitating headaches and migraines.

Growing recognition has positioned headache and migraine among such issues as post-traumatic stress disorder as a military health concern, and the Defense Department is funding millions of dollars in research. Scientists are evaluating new treatments and therapies that could benefit not only military personnel but also civilians, the estimated 6 percent of men and 18 percent of women who have at least one migraine a year.

A 2009 study of more than 1.2 million U.S. participants in the Iraqi and Afghan military actions found the number who received a diagnosis of migraine increased 40 percent after a tour of duty.

The post-deployment diagnosis was especially common among those who had experienced concussion, anxiety or depression. Ten percent of men and 20 percent of women who had a concussion subsequently got their first migraine diagnosis.

More than 6 percent of men and more than 16 percent of women with a history of anxiety or depression while in the war zone then developed migraine.

Anxiety and depression continue to be issues post-deployment and are frequently linked to migraine symptoms, as is post-traumatic stress disorder. Together, these problems dramatically reduce the quality of life: According to Lt. Col. Jay Erickson, a physician at the Madigan Army Medical Center in Tacoma, Wash., one in three service members with migraine is moderately or severely disabled by the condition post-deployment as determined by the widely used Migraine Disability Assessment test.

Read more: http://bangordailynews.com/2011/11/10/health/migraine-headaches-a-growing-problem-for-the-military/

Headaches Take Toll on Soldiers

Headaches, a virtually universal human complaint at one time or another, are among the top reasons for medical evacuation of military personnel from Iraq and Afghanistan, and for ongoing depletion of active-duty ranks in those countries, according to research led by Johns Hopkins specialists. Just one-third of soldiers sent home because of headaches return to duty in either place, the research shows.

“Everyone gets headaches, and there are generally physical or psychological stressors that contribute to them,” says study leader Steven P. Cohen, M.D., an associate professor of anesthesiology and critical care medicine at the Johns Hopkins University School of Medicine and a colonel in the U.S. Army Reserves. “War amplifies all stressors, which may be why headaches take such a great toll in soldiers overseas.”

The findings, published online in Cephalalgia, the journal of the International Headache Society, highlight one of the fastest-growing causes of medical evacuations from the two prolonged military conflicts. They are a significant and worrisome contributor to the depletion of military units overseas, Cohen says.

Overall, neurological illness is one of the top three causes of non-combat-related loss of unit strength in Operations Iraqi Freedom and Enduring Freedom, and headaches are the most common neurological complaint in the war zones. Cohen and his team found that post-concussion headaches and migraines were the most common forms of headache requiring evacuation. Physical trauma led to almost half of the debilitating headaches, they determined.

Read more: http://www.newswise.com/articles/headaches-take-toll-on-soldiers