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Healthy sleep for healing

Sleep is an important factor in health. In addition to aiding in the healing of the body after injury, studies suggest that sleep can help boost the immune system, prevent disease, and ease depression. (U.S. Army photo by Lt. Col. John Hall) Sleep is an important factor in health. In addition to aiding in the healing of the body after injury, studies suggest that sleep can help boost the immune system, prevent disease, and ease depression. (U.S. Army photo by Lt. Col. John Hall)

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Traumatic Brain Injury

Sleep is an important factor in health. In addition to aiding in the healing of the body after injury, studies suggest that sleep can help boost the immune system, prevent disease, and ease depression. Yet a common complaint among service members and veterans with traumatic brain injury is difficulty sleeping. Many people with brain injuries also experience sleep disorders.

Sleep disorders and sleep disturbances are two different things.

A concussion and a sleep disorder can present with similar symptoms such as irritability, headaches, anxiety, and inability to focus. Treatment of TBI starts with the treatment of sleep to help determine which symptoms are related to poor sleep and which are injury related.

“For instance, something like short-term memory is very impacted by sleep loss,” said Dr. Janna Mantua principal investigator studying sleep at Walter Reed Army Institute of Research. “Ruling out sleep disorders that might be undetected is really critical.”

For those with a TBI, sleep disturbances or poor sleep can actually slow recovery and worsen symptoms, according to DVBIC officials. Those who are not getting adequate sleep report more pain, irritability, memory loss and functional problems.

Mantua said historically people with brain injuries were kept awake to monitor symptoms, but that is no longer the guidance. “The general recommendation is the opposite: to rest, to stay in the dark, to not look at any screens,” she said.

Sleep can be sabotaged by choosing to sleep at the wrong time, getting too much screen time before bed, or self-medicating. “A Better Night Sleep” podcast, produced by the Defense Health Agency, gives practical tips on sleep disorders and information on the evidence-based treatments that really work.

“The number one nonprescription drug people are taking to help them get to sleep at night is a beer or a glass of wine, or other kinds of alcohol,” said Dr. Julie Kinn, research psychologist at DHA. “But then, you’re putting a lot of sugar into your body, you’re going to metabolize it in a few hours and need to get up and go to the bathroom, and then you’re going to be wide awake. Plus drinking alcohol doesn’t help you learn other good ways of getting to sleep like meditating, purposefully relaxing or turning of all your screens, etc.”

Patients and healthcare providers have access to resources for learning healthy sleep habits. The Defense and Veterans Brain Injury Center recently released a Sleep Interactive Provider Training to teach military providers the evaluation and management of sleep disturbances following concussion in a deployed and non-deployed primary-care setting. The interactive training introduces the “Management of Sleep Disturbances Following Concussion/Mild TBI Clinical Recommendation” and companion clinical support tool. DVBIC also provides guidance to help primary care managers assess and manage sleep disturbances associated with concussion, including specific recommendations for managing symptoms of insomnia, circadian rhythm sleep-wake disorder, and obstructive sleep apnea. The healthy sleep fact sheet offers tips and exercises for patients to help get a better night sleep.

Mantua encourages anyone with sleeping difficulties to speak to your doctor. “We know how to treat bad sleep. Sometimes it takes people a long time to get there – for instance insomnia is difficult to treat – but we know treatments that work.”

Listen to the full interview on the TBI Family Podcast.

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Diagnoses of Traumatic Brain Injury Not Clearly Associated with Deployment, Active Component, U.S. Armed Forces, 2001 – 2016

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4/4/2017
Traumatic Brain Injury (TBI) is structural alteration of the brain or physiological disruption of brain function caused by an external force.  TBI, particularly mild TBI or concussion, is the most common traumatic injury in the U.S. military. This analysis provides the estimated rates of incident TBIs among service members before their first-ever deployment as well as separately among service members during deployments/ after deployments. It also mentions factors that may explain why the TBI incidence rates among the previously deployed were higher than those of the never-deployed group. Moreover, it describes the demographic and military traits of service members diagnosed as TBI cases (before/after deployment). Categorization of person time during surveillance period included four categories: Group 1 (Never deployed/TBI before first-ever deployment), Group 2 (Currently deployed or within 30 days of return), Group 3 (previously deployed but not currently deployed nor within 30 days of return) and Censored after Diagnosis of TBI. From 2001-2016, 276,858 active component service members received first-time diagnoses of TBI. The crude overall incidence rate of TBI among deployed service members was 1.5 times that of service members assigned to Group 1 and 1.2 times that of service members in Group 3 during the surveillance period.  Total TBI cases by group were Group 1 42.8%, Group 2 13.2% and Group 3 44.0%. Incidence rates by group (per 100,000 person-years) were Group 1 1,141.3, Group 2 1,690.5, and Group 3 1,451.2. Learn more at www.Health.mil/MSMR and see fact sheets at www.Health.mil/AFHSB

Traumatic Brain Injury (TBI) is structural alteration of the brain or physiological disruption of brain function caused by an external force. TBI, particularly mild TBI or concussion, is the most common traumatic injury in the U.S. military. This analysis provides the estimated rates of incident TBIs among service members before their first-ever deployment as well as separately among service members during deployments/ after deployments. It also mentions factors that may explain why the TBI incidence rates among the previously deployed were higher than those of the never-deployed group. Moreover, it describes the demographic and military traits of service members diagnosed as TBI cases (before/after deployment).

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Obstructive Sleep Apnea Diagnosis Treatment Guide Active Duty U.S. Military

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3/13/2017
This infographic provides information on Obstructive sleep apnea (OSA) diagnosis and treatment of active duty U.S. Armed Forces to help primary care providers screen high-risk individuals and encourage patients to explore OSA treatment options for managing this burden of disease. The data comes from an analysis of sleep apnea conducted from 2004 through 2016.  With appropriate diagnosis and treatment of OSA, this growing health concern for military populations can be effectively managed. OSA symptoms include snoring, gasping for breath during sleep, headaches, insomnia and daytime fatigue. During the surveillance period, OSA were highest in those aged 40 years or older, male non-Hispanic  black, obese, army service members, married, had more than one prior deployment or had completed 18 years or more of service.  The incidence rate among individuals aged 40 years or older was more than 3-fold higher in 2015 compared to 2004. Individuals serving 18 or more years had a 3-fold higher incidence rate of OSA in 2015, compared to 2004. The 12-year incidence rate in service members serving 18 years or more was more than 2-fold higher than those with 11-17 years of service.  Improved screening, referral, and treatment have been recommended for individuals who may suffer from post-traumatic stress disorder (PTSD) and depression, in which OSA-associated fatigue and poor sleep quality can exacerbate symptoms.  Additionally, the STOP-BANG questionnaire for sleep apnea may help primary care providers to screen high-risk individuals and identify those whose symptoms warrant further evaluation. Individuals who suffer from OSA have increased rates of cardiovascular disease, chronic fatigue, motor vehicle accidents, cognitive impairment, and post-traumatic stress disorder.  Learn more about OSA and treatment options for managing this burden of disease by visiting Health.Mil/AFHSB

This infographic provides information on Obstructive sleep apnea (OSA) diagnosis and treatment of active duty U.S. Armed Forces to help primary care providers screen high-risk individuals and encourage patients to explore OSA treatment options for managing this burden of disease.

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Schedule Your Power Nap

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3/13/2017
Need to recharge? Don't lean on caffeine -- a power nap will boost your memory, cognitive skills, creativity and energy level.

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Obstructive Sleep Apnea Rates by Service, U.S. Armed Forces

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This infographic documents an increase in the incidence of Obstructive sleep apnea (OSA) diagnoses and associated attrition among U.S. service members over a 12-year surveillance period from 2004-2015. It also examines time to separation from military service after an incident of OSA diagnosis. Here are key facts about the OSA incidence rates by service: •	Rates of OSA were lowest in young service members, white non-Hispanics, Marines, air crew, and in those with less than five-years of service or no prior deployments. •	The category of pilots/ air crew consistently had the lowest OSA incidence rates, compared to all other occupations •	The annual incidence rates for the Army rose steadily from 2008 to 2015 and were higher during this period than the rates of the other services  The high percentage of cases diagnosed prior to separation from service is a concern because OSA as a large health and economic burden for the armed services is a treatable and partially preventable disease. For more information on OSA, appropriate screening and prevention strategies to improve both individual health and mission performance, visit Health.mil/AFHSB

This infographic documents an increase in the incidence of Obstructive sleep apnea (OSA) diagnoses and associated attrition among U.S. service members over a 12-year surveillance period from 2004-2015. It also examines time to separation from military service after an incident of OSA diagnosis.

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Armed Forces Health Surveillance Branch
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