Sleep is one of the most important aspects of health and force readiness that is often overlooked, but not at Walter Reed National Military Medical Center’s Sleep Disorders Center.

Regular and healthy sleep patterns are responsible for restoring our physical, emotional and mental systems. When those systems are forced to go with a lack of healing sleep, it can have drastic effects on the human body.

“If you’re tired of being tired and struggling to remember things or stay awake in meetings or even while driving, schedule a sleep study instead of drinking another coffee or energy drink and feel what it’s like to actually sleep,” said Raymond Irvine, acting clinical coordinator for Walter Reed’s sleep center.

Sleep disorders take numerous forms, with both physical and psychological causes. Obstructive Sleep Apnea (OSA), considered one of the most common sleep-related ailments, is characterized by interruptions in breathing during sleep due to some physical issue that blocks the airway, such as the airway collapsing, or a condition in the nose. Narcolepsy is a neurological disorder that inhibits the brain’s ability to control the sleep cycle, which can lead to excess sleepiness during the day, or even cause sudden bouts of sleep. On the other hand, nightmare disorder or Post Traumatic Stress Disorder (PTSD) are mental health conditions that can severely disrupt normal sleep patterns, leading to insomnia, frequent awakening, and persistent sleep disturbances.

Loss of sleep can lead to more significant effects than just being frequently tired. Sleep loss is attributable to serious physical health issues. Fatigue can lead to a lack of attention, which increases the possibility of accidents. A body suffering from sleep deprivation weakens, reducing its ability to resist infection and increasing the likelihood of illness. Findings even indicate that sleep loss (especially related to OSA) can increase the risk of heart disease and potentially contribute to the development of cancer.

In addition to the physical effects caused by sleep deprivation, it can also lead to debilitating mental and cognitive decline. Conditions like short temper, or being easily agitated are common, and more serious effects are possible or even likely. Memory loss, trouble concentrating or focusing on tasks and impaired decision making frequently develop, which can be especially disruptive for active duty service members.

A cross-sectional study performed on active duty service members at Walter Reed’s sleep center between 2014 to 2017 revealed several disturbing finds related to insomnia. The levels of functional impairment caused by sleep loss are likely much higher than most people would consider. Forty-four percent of those tested during the study indicated they suffered from clinical insomnia, with more than 80 percent demonstrating functional impairment. Females participating in the study demonstrated they were more likely than men to meet the criteria for clinical insomnia by more than 15 percent and showed pronounced indications of functional impairment.

Walter Reed’s Sleep Disorders Center provides several facilities to assist service members in overcoming sleep related issues.

“We have a 12-bed lab, whereas many sleep labs can only accommodate four or maybe six beds,” said Irvine. “We run five nights a week, and on each of those nights we can fill all 12 beds.”

The center employs a staff of approximately 20 personnel, most of whom are certified sleep experts. There are several active duty Fellows (physicians who have completed medical school and residency who are pursuing additional training in a specialty area), five part-time active duty staff physicians that share time in other clinics, and two on-staff physicians, including Dr. Bernadette Villarreal. As a military reservist, Villarreal brings a direct familiarity and understanding of the sleep-related issues that active service members face on a regular basis.

“I think one of the things that sets us apart here is the fact that we are a center that can provide things like multiple sleep latency tests, or MSLTs, for our service members who are being considered for a diagnosis of narcolepsy or idiopathic hypersomnia,” said Villarreal. “Our service members must go to an accredited center like Walter Reed because there have been studies that look at rates of incorrect diagnoses for these service members and we’ve found that on occasion, when they are sent elsewhere, they’re getting a diagnosis that doesn’t accurately reflect what they have. So, it’s now criteria for some of the branches for service members to come here so we can adequately assess what is going on and retest them if needed. I think that is one thing that sets us apart.”

A typical sleep study can take approximately 30-60 days, depending on the nature of the sleep disorder. The treatment usually involves initially meeting one-on-one with a doctor or, in the case of pre-screened patients suffering from OSA, joining an intake group of patients starting their treatments together. The next step is to schedule the initial sleep study so the staff can observe the patients as they sleep and determine the causes of the issues they are dealing with.

The overnight stay involves sleep observation, which is followed by an office appointment to discuss the results and to begin implementing a treatment plan. Some sleep issues, like OSA, involve the need for external devices, such as the Continuous Positive Airway Pressure machine, or CPAP, which is currently regarded as the “gold standard” for treating sleep apnea issues. The CPAP device involves wearing a mask throughout the night that pushes pressurized air through the sleeper’s nose and/or mouth allowing them to breathe normally. The sleep center can provide a variety of CPAP machines to help their patients find the exact right choice to address their specific issue.

Another option for OSA available is a small therapy device implanted near the collarbone that sends out a pulse when it detects the patient’s tongue blocking the airway. Walter Reed’s sleep center was the first facility in Maryland to offer this option, and more patients are electing this procedure instead of relying on the masks required by CPAP equipment. It is important to note, however, that patients considering this procedure must meet certain criteria and are required to have failed with the CPAP equipment first.

While CPAP and the implant offer relief from the physical sources of sleep loss, the psychological causes require more nuanced treatments. Medications can be effective when treating nightmare disorders. There is also a form of cognitive-behavioral treatment called Imagery Rehearsal Therapy (IRT). IRT is designed to assist people experiencing nightmares, especially those stemming from some form of trauma, in managing their “bad dreams” and literally changing the narrative of the dream to something more positive or at least less frightening.

Treating PTSD depends on the symptoms, and their underlying causes. Medication is an option, especially if the disorder manifests in nightmares. There are also other forms of Cognitive Behavioral Therapies that can assist in suppressing or reducing the overwhelming effects of PTSD.

Whatever the cause of someone’s sleep issues, Walter Reed’s Sleep Disorders Center is well provisioned to identify the source of the problem and provide some form of relief. The most important step is beginning the process.

“Don’t be afraid to get your sleep tested,” said Irvine. “It will be the easiest medical test you ever do. It’s not something you should be afraid of, and if you’re experiencing sleep loss it’s something you should address because it’s going to improve your quality of life across the board.”