Sleep apnea is a medical condition where breathing repeatedly stops and starts during sleep. This interruption can range from partial airway blockage to complete cessation of airflow, leading to reduced oxygen levels in the body. While present in the general population, sleep apnea is prevalent within the military community, affecting approximately 1 in 20 service members in 2013, with prevalence increasing annually. This article explores physical, psychological, and operational factors within military service that contribute to sleep apnea among service members.
Physical Factors and Service-Related Injuries
Physical factors and service-related injuries play a role in the development of sleep apnea among military personnel. Obesity is a risk factor for obstructive sleep apnea (OSA), where excess weight can narrow the airways and increase resistance to breathing during sleep. Although the military has height and weight standards, weight gain can still occur due to lifestyle changes, injuries limiting physical activity, or stress, contributing to this increased risk. A 10% increase in body weight can elevate the risk of OSA.
Traumatic Brain Injury (TBI) and head or neck injuries are also contributors. TBI, a common injury in military populations, can directly affect the brain’s control over breathing, leading to central sleep apnea (CSA) where the brain fails to send proper signals to the breathing muscles. While TBI is more often linked to CSA, these injuries can also contribute to sleep disturbances that exacerbate obstructive patterns.
Chronic pain, a common issue among service members, can disrupt sleep architecture and contribute to sleep-disordered breathing. Pain can cause frequent awakenings and prevent restorative sleep, which can lead to muscle relaxation in the throat and subsequent airway collapse typical of OSA. Studies show that chronic pain is highly prevalent in veterans with OSA, with some reports indicating its presence in nearly 70% of individuals. This bidirectional relationship means pain worsens sleep, and poor sleep can intensify pain perception.
Pre-existing conditions, such as a deviated septum or enlarged tonsils, can become more problematic under the stressors of military life. While not directly caused by service, the physical demands and environmental factors can exacerbate these anatomical predispositions, making individuals more susceptible to airway obstruction during sleep.
Psychological Impact and Stress
The psychological impact of military service and chronic stress influences the incidence of sleep apnea. Post-Traumatic Stress Disorder (PTSD) is linked to sleep apnea, with some studies showing a substantial increase in the probability of obstructive sleep apnea as PTSD severity rises. PTSD can lead to hyperarousal, making it difficult to relax and fall asleep, and frequently causes nightmares, which fragment sleep. This fragmented sleep and constant vigilance disrupt the normal sleep cycle, potentially leading to both central and obstructive sleep apnea.
Anxiety and depression, common mental health challenges in the military, also disrupt sleep and can alter breathing patterns. These conditions can exacerbate sleep apnea symptoms by making it harder to initiate and maintain sleep, creating a cycle where poor sleep worsens mental health, and vice versa. For instance, a veteran with depression or anxiety may find it difficult to relax during sleep, leading to more frequent awakenings and potentially contributing to sleep-disordered breathing.
Chronic stress, inherent in military environments, triggers physiological changes which can disrupt sleep patterns and worsen sleep apnea symptoms. This sustained stress contributes to a state of heightened alertness, even during attempted sleep, preventing the deep, restorative sleep necessary for proper physiological function and airway muscle tone. The interplay between mental health conditions and sleep disturbances creates a complex environment conducive to sleep apnea.
Operational Environment and Lifestyle
The operational environment and specific lifestyle factors within the military contribute to the risk of sleep apnea. Irregular sleep schedules, shift work, and prolonged duty hours are common, leading to chronic sleep deprivation and disruption of the body’s circadian rhythm. This constant disruption impairs respiratory control and can weaken upper airway muscles, making them more prone to collapse during sleep. Service members often learn to “sleep when they can,” resulting in short, non-restorative naps rather than sustained deep sleep, which is crucial for overall health.
Deployment conditions present challenges that exacerbate sleep issues. Noisy barracks, extreme temperatures, limited personal space, and the constant need for vigilance hinder restorative sleep. The unpredictable nature of military operations, including sudden alerts or travel across multiple time zones, further disrupts sleep cycles, contributing to sleep fragmentation. Such environments can make it difficult to achieve the necessary sleep quality, even when time is available.
Physical demands and chronic fatigue associated with military roles can also contribute to sleep apnea. Extreme physical exertion can lead to muscle relaxation during sleep, potentially worsening obstructive sleep apnea. This fatigue, combined with the other stressors, can reduce the body’s ability to maintain an open airway throughout the night. Carrying heavy loads and engaging in strenuous activities can cause muscle strain, further impacting the muscles involved in breathing.
Dietary and lifestyle changes in military life can indirectly increase sleep apnea risk. During deployments, diets may shift towards high-calorie, less nutritious options, which can contribute to weight gain. This weight gain increases the risk for obesity, a factor in obstructive sleep apnea. The cumulative effect of these environmental and lifestyle elements creates a heightened susceptibility to sleep-disordered breathing among military personnel.