Megan Brooks

June 16, 2016

DENVER — A new study finds that spouses of military service members experience significant sleep disturbances, which has the potential to affect the health and psychosocial functioning of the entire military family.

"These results are important because we know very little about sleep problems among military spouses," principal investigator Wendy Troxel, PhD, senior behavioral and social scientist at the RAND Corp, Pittsburgh, Pennsylvania, said in a statement.

"Promoting sleep health may be an important strategy for enhancing military families' adjustment in the postdeployment period. This is particularly relevant given that the past 14 years of protracted overseas combat have exacted an unprecedented toll on US service members and their families," Dr Troxel added.

She presented the study here June 12 at SLEEP 2016: 30th Anniversary Meeting of the Associated Professional Sleep Societies.

"We previously reported in a large RAND report that service members have very high rates of sleep disturbances," Dr Troxel noted in an interview with Medscape Medical News. "This is the first time we are looking at sleep disturbances in the spouses, which we think is really important because sleep is such an important contributor to health and functioning and the overall resilience of military families."

As part of the Deployment Life Study group, 1480 female spouses of military service members completed self-report instruments related to sleep, physical health, marital satisfaction, and depression.

Forty-four percent of spouses reported sleeping fewer than 6 hours per night, more than half (54%) reported daytime impairment due to sleep problems, and 62% reported experiencing daytime fatigue at least one to two times per week, Dr Troxel reported.

Sleep problems, including poorer sleep quality, shorter sleep duration, and greater daytime dysfunction, were associated with poorer self-rated health, lower marital satisfaction, and greater depressive symptoms. "This was true after we statistically controlled for a host of other variables that are known to correlate with these outcomes," Dr Troxel said.

Spouses of currently or previously deployed service members reported poorer sleep quality and more fatigue than spouses of service members who had never deployed.

Dr Troxel emphasized that sleep problems in military service members and their spouses are not solely attributable to deployment.

"There are other characteristics of military life, including unpredictable work schedules, threatening training environments, high job demands, and frequent residential moves, that can really impact stress levels in the family and sleep. Successfully identifying sleep problems is important as we now have evidence-based behavioral treatments that are now the frontline recommended treatment but remain underutilized," Dr Troxel told Medscape Medical News.

This study is "interesting" because no one has really looked at sleep in spouses of service men, Philip Gehrman, PhD, CBSM, from the Department of Psychiatry, University of Pennsylvania, Philadelphia, and member of the Penn Sleep Center, noted in an interview with Medscape Medical News.

"And the findings make sense. All the normal responsibilities that a lot of women have, the military adds another whole level on top," added Dr Gehrman, who wasn't involved in the study.

He also noted that sleep problems often go unrecognized in the military and in the general population because people don't bring up the topic and primary care physicians don't ask. "A lot of people with sleep problems just keep it to themselves," Dr Gehrman said.

A related study presented at the conference shows that insomnia is common in female veterans, again largely unbeknownst to their physicians.

The researchers, led by Kimberly Babson, PhD, from the Veterans Affairs Palo Alto Health Care System, Menlo Park, California, did a cross-sectional study of 6247 female veterans using Veterans Affairs primary care facilities. Overall, 47.5% reported symptoms of insomnia that led to functional impairment, but less than 1% had a diagnosis of a sleep disorder based on their medical record, Dr Babson reported.

Dr Gehrman said he's "not surprised" that insomnia symptoms fly under the radar, noting that underdiagnosis is a "huge issue."

Sleep disorders are important to recognize, he said, "because we have effective behavioral treatments but a lot of people just aren't getting it." Access to cognitive-behavioral therapies is also an issue. "If you're looking at 10% to 15% rate of insomnia in the general population, you would need probably several hundred people who could provide that treatment in Philadelphia alone," Dr Gehrman commented.

The study was supported by RAND National Defense Research Institute; Office of the Surgeon General, US Army, and the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury; and the National Heart, Lung, and Blood Institute.

SLEEP 2016: 30th Anniversary Meeting of the Associated Professional Sleep Societies. Abstracts 1015 and 0776. Presented June 12, 2016.

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