Assessing Sleep and Its Benefits in Combat Veterans

Abstract

Research Question: Does the delivery of Boot Campaign¿s existing novel, holistic virtual Resilience and Recovery program that teaches skills on the highest yield components of resilience in the veteran family population result in an increase in overall well-being and specifically an increase in quality and/or quantity of sleep? What are the most salient components of sleep that still need to be addressed and what is the best format in which to address these in order to construct a virtual program to address these and continue treatment for veterans all across the United States and eventually, internationally?

Background and Significance: It is widely documented that a disproportionate number of U.S. military veterans suffer from invisible wounds of war, such as posttraumatic stress disorder (PTSD), chronic pain, and traumatic brain injury (TBI). Sequelae can result in disruption in daily life, including suffering from negative emotional responses, memory processing problems, disrupted social relationships and decreased physical fitness. Because many veterans living with PTSD and TBI experience drastic disturbances in their sleep habits, they can experience difficulty with processing memories, have flashbacks of traumatic events, and can have irrational emotional responses to small disruptions in their daily lives and social relationships. A lack of sleep can also result in decreased testosterone levels, contributing to lower muscle mass, slower metabolism and uneven body fat distribution, and overall decreased self-confidence. In concert with the impact from other invisible wounds of war, veterans can experience significantly lower quality of life. There is also evidence to suggest a correlation between insomnia and suicidality, which remains a problem that plagues the military and veteran community.

Materials and Methods: Our objective was to identify if Boot Campaign¿s already existing holistic Resilience and Recovery virtual program addressing overall improvement in our veterans¿ lifestyle, emotional well-being and social relationships is sufficient to address sleep concerns. De-identified standardized self-report measure data provided by Boot Campaign was analyzed from veterans who completed this program. Our subject population was taken from veterans who are enrolled in Boot Campaign¿s Resilience and Recovery Program. All participants were former members of the United States Armed Services who have been diagnosed with PTSD and TBI, and who also reported co-occurring insomnia. Inclusion criteria for de-identified subjects included that the participant was a US military veteran, aged 20-70, who is a proficient English speaker diagnosed with PTSD and mild-to-moderate TBI, and who also reported co-occurring insomnia. Exclusion criteria included those in acute crisis, those with severe psychopathology or severe brain injury, and those who were unable to access virtual technology. We collected data through the standardized, self-reporting Pittsburg Sleep Quality Index (PSQI) questionnaire for each participant both pre- and post-training. We then used a paired t-test to analyze changes in the rate of improvement of each of the above components in the veterans undergoing training. These groups were assessed for their rates of improvement at two different time points (baseline and post-training). Significant results were assessed using a p-value = 0.05.

Results: Our analysis of the results from the currently existing Resilience and Recovery Virtual Program identified that while successful in multiple areas of wellness, the comparison of pre- and post-training sleep shows less of an improvement in our population. Although we identified an improvement of mean scores of the Pittsburgh Sleep Quality Index (PSQI), these results were largely not statistically significant. The results of this data analysis support our hypothesis that the currently existing Resilience and Recovery program, while improving overall veteran well-being in a variety of areas, is not sufficiently addressing sleep as a very important independent factor. As such, this research project assisted with the design and development of a novel Virtual Sleep Program (VSP) for veterans.

Conclusion: Upon completion and implementation of the Virtual Sleep Program, we anticipate that veterans will experience an increase in self-reported overall well-being and quality of life, including decreases in stress, improved social relationships, improved sleep quality and/or quantity, and improved physical and emotional health. We hope this will help improve relationships and possibly stress levels in those surrounding the veterans, including adult family members, caregivers, physicians, and friends.