Sleep advice for veterans and military service members with PTSD

PTSD can be debilitating for America’s veterans and military men and women.

On Monday, June 27, PTSD Awareness Day — and on every day of the year, for that matter — it’s important for all Americans to recognize that up to 30% of service members experience some sort of post-traumatic stress from their experiences during wartime or deployments or from other traumatic events, such as sexual and physical assault.

Dr. Yuval Neria, a Columbia University professor of medical psychology and PTSD expert, told Fox News Digital in an interview that PTSD sufferers often find difficulty falling asleep due to anxiety, agitation and hyper-vigilance. 

They also may experience chronic nightmares.

“Nightmares are really a common symptom of PTSD,” said Neria. “People are terrified by their nightmares and always very ambivalent about whether to fall asleep or not because they know that they may meet their demons,” he also said.

RAND Corporation senior behavioral scientist and sleep expert Dr. Wendy Troxel agreed that nightmares, along with feeling “chronically vigilant” and experiencing flashbacks, are among the hallmark symptoms of PTSD.

“There’s even some evidence that sleep disturbances can predict the onset of post-traumatic stress disorder,” she said in an interview with Fox News Digital.

Troxel led a 2015 RAND Corporation study that found that only 37% of veterans achieve adequate sleep — while more than half reported some sort of sleep disturbance.

“Sleep problems are really debilitating,” she said. “They affect every aspect of your mental and physical well-being.”

“It makes it very hard to perform at your work, particularly among [the] sort of high-demand, high-risk occupations that our military [members are] involved with,” Troxel also said. 

Jen Satterly, a SJen Satterly, a St. Louis-based certified health coach and respected authority on PTSD, has worked closely with combat veterans and others who have dealt with PTSD issues. 

Satterly worked alongside many special ops combat forces in the field and today helps veteran couples and others address their PTSD issues head-on, along with her husband, Tom Satterly, a highly decorated combat veteran whose story was portrayed in the Oscar-winning 2001 film “Black Hawk Down,” about the 1993 battle in Somalia. 

Jen Satterly described a time when she was embedded with special forces and got “probably two hours of sleep a night. Two to four hours [of sleep] was pretty common” for them, she said.

“And I literally thought I had cancer” at one point, she said. She remembered having to tell the teams one night before a mission, “I can’t go — I’m really, really sick. There’s something wrong with me.”

Her hair was falling out, she felt nauseous and she’d lost a lot of weight, she said. “So I have personally noticed the side effects of a lack of sleep and how much it physically impacted me.” She said that some members of the forces had been keeping that schedule for as long as 20 years. 

Satterly said there is a great deal of stress connected to the work they do — “the stress on the body and mind is intense,” she said. 

Add a lack of sleep to the mix — and “everything is affected,” she said.  

Some military members will return from overseas after months of service and they’re somehow, within just a couple of days, expected by others in society to be back in the regular flow of daily life, she said.

“PTSD will include nightmares,” she said. But it’s not just that: It’s about the quiet time right before sleep, she said. 

“That’s when the visions come back; that’s when the nightmares come back.” It is why, she said, that some individuals turn to drinking or to taking pills — “to avoid those memories.”  

“When I talk to guys who have reached out for help, one of the first things I’ll ask them is, ‘How do you sleep?’ And every single time, they’ll tell me, ‘You know, I sleep for two hours a night or four hours a night, but then I’m up at 3 a.m. and I can’t go back to sleep.’”

Addiction often enters the picture, she said, because these brave, struggling individuals — who did or are still doing so much for our nation — are trying to self-medicate their way out of the difficult issues they’re experiencing.

For veterans and active duty service members who recognize they may have PTSD symptoms or who want to try to ward it off completely — and for their loved ones and other family members going through these issues right alongside them — here are five expert tips on how to get better sleep. 

1. Establish a routine to promote sleepiness

The best way to get into the groove of consistent sleep is to maintain a regular sleep-wake schedule.

“Our bodies and our brains simply work better when we have predictable, reliable routines,” said Wendy Troxel. “And the best place to start with that is having a regular wake-up routine.”

Troxel advised beginning by waking up at the same time every day followed by immediate exposure to sunlight.

“That’s a very powerful cue to set our internal biological clocks, otherwise known as our circadian rhythms.”

Neria, an Israeli military veteran, said people should avoid taking naps during the day in order to promote sleepiness at night.

The psychologist also mentioned the importance of daily exercise, since physical activity will exert energy as well as improve mental health.

2. Avoid alcohol, especially at night

Imbibing a few alcoholic beverages at night may make people feel sleepy at first — but alcohol is not a sleep aid.

“It is a sedative,” Troxel said. “Sedation is not sleep.”

Excessive alcohol, which the body must process during the night, will actually cause fragmented sleep — which disturbs REM sleep.

REM, or rapid eye movement, is the part of sleep most associated with emotional processing, learning and memory consolidation.

“So, by disrupting and fragmenting sleep, particularly REM sleep, this can further disrupt one’s ability to emotionally regulate, which can exacerbate any other mental health symptoms,” said Troxel.

Neria added that people with PTSD already have “great difficulty” achieving REM sleep due to disturbances such as nightmares.

3. Get up for a bit if struggling to fall asleep

For those who are tossing and turning and waiting for sleep to kick in, getting out of bed for a short time may help.

“Go to a chair in the room or go to a separate room and do something that’s relaxing but distracting,” Troxel said. That way, “you can actually get your body and your brain sleepy again so that you’re able to fall back to sleep.”

The key is to avoid stimulation from light or aggressive activity — so busying your brain with reading a book, listening to music or engaging in deep breathing could help, especially if a nightmare was the culprit in disrupting your sleep. 

“Those types of self-soothing strategies can be really helpful, and you do that until you’re ready to return to bed,” said Troxel.

4. Know when to seek treatment — and know that help is out there

It might be time to seek medical treatment if sleep problems persist for more than three nights a week for longer than a month, noted Troxel.

“Better to nip it in the bud sooner rather than later, because the more chronic it becomes, the more debilitating it can become,” she said.

She assured those suffering from PTSD that they should not feel shame in asking for help.

“The goal is to improve your sleep so that you can improve your stress resilience and ultimately optimize your performance,” she said. “There is help out there.”

Troxel also stressed that the most effective treatments don’t come in the form of a pill.

Instead, behavioral treatment like cognitive behavioral therapy is recommended by the U.S. Department of Veterans Affairs as treatment for veterans with insomnia; it can help lessen the intensity of nightmares.

Neria confirmed that the more progress made in treatment, the less hyper-vigilant, anxious and depressed PTSD sufferers tend to become. His most recent research has leveraged horse-assisted therapy through the Man O’ War project, specifically catered to treat PTSD.

“Don’t delay treatment. Don’t avoid treatment,” he said. 

5. Consider these related pieces of advice for better sleep

Consider taking natural supplements such as magnesium and melatonin, said Jen Satterly of All Secure Foundation; it’s always wise to check with your doctor first. “Work on your gut health for better sleep as well,” she said.

Don’t drink caffeine at least 8 to 10 hours before bed. 

Also, consider reducing or removing energy drinks from your diet. 

Use meditation or sleep-assist apps such as Calm to help relax into sleep, “without having the TV on,” she said, “which can keep you awake in the long run.” 

Check with your doctor to see if you should have your hormone levels tested.