DENVER – Sleep problems and their host of deleterious physical and psychosocial consequences are pervasive among the civilian female spouses of U.S. military service members, according to the first large study to examine the issue.
“Our findings suggest that if we’re trying to promote the resilience and adjustment of military spouses and their families – particularly in light of 14 years of protracted overseas combat, where many families are experiencing deployment – sleep might be a really important target,” Wendy M. Troxel, PhD, said while presenting the study results at the annual meeting of the Associated Professional Sleep Societies.
Bruce Jancin/Frontline Medical News
Dr. Wendy M. Troxel
The study population consisted of a nationally representative group of 1,805 female civilian spouses of military service members. Forty-four percent reported short sleep duration, meaning 6 hours or less per night. Another 18% got 5 hours or less. The Centers for Disease Control and Prevention and the American Academy of Sleep Medicine recommend 7 hours or more, noted Dr. Troxel, senior behavioral and social scientist at RAND Corporation in Pittsburgh.
More than half (54%) of military spouses reported that their sleep problems contributed to daytime impairment, such as intolerance of their spouse or children, frequent crying, or suboptimal performance at work or chores. One-third of the spouses reported feeling daytime fatigue three or more times per week, and another 29% experienced daytime fatigue one or two days per week.
As has been observed in other studies, sleep problems in military spouses were associated with psychosocial impairment. In linear regression analyses, the spouses with poor sleep quality, daytime impairment, and/or fatigue had significantly more depressive symptoms on the Patient Health Questionnaire–8, lower marital satisfaction, and poor self-rated health. Women with shorter sleep duration had more depressive symptoms and poorer self-rated health, but not lower marital satisfaction.
The spouses of services members currently deployed in combat zones had significantly worse sleep quality as measured on the Pittsburgh Sleep Quality Index compared with spouses of previously or never-deployed service members. But for the other outcomes of interest – sleep duration, daytime impairment, and fatigue – there were no differences based upon deployment status.
“This shows that it’s not just about the stress of combat deployment, it’s also about the stresses of everyday military life. Military families experience a great deal of stress that could lead to sleep disturbances whether or not a service member has been deployed: frequent residential moves, very long and unpredictable work hours, demanding jobs, threatening training environments,” Dr. Troxel said. “I think we need to be thinking about sleep as an important health indicator of military families in general across the deployment cycle.”
The study results are a call to action, she added.
“These findings highlight the importance of targeted screening, prevention, and intervention methods for military spouses. And primary care is where most people present with sleep problems,” Dr. Troxel said.
There are formal screening instruments for sleep problems, but in her view they really need to be better validated for use in primary care before widespread adoption.
“Simply having providers ask three quick questions about their patients’ sleep and daytime function is a good, practical approach: How’s the quality of your sleep? How much do you sleep on average? Do you have enough energy during the daytime to get through your day-to-day functioning? That’s informative enough to indicate the utility of moving on to longer screening tools or to referral for evidence-based treatments,” she said.
Dr. Troxel noted successful intervention in sleep problems in civilian spouses is a priority for reasons beyond their personal well-being. “Civilian spouses are most often the primary caretakers for service members who return from war with either invisible mental health wounds or physical health wounds,” she said. “And we’re expecting to have need for a lot of caretakers.”
The RAND National Defense Research Institute, the Office of the Surgeon General, the U.S. Army, and the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury funded the study.