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Untangling Sleep Problems When You Have PTSD

Army veteran Raquel Rojas with her daughter, Jennifer. Raquel blamed PTSD for her sleep problems, but later found out she had sleep apnea.
Army veteran Raquel Rojas with her daughter, Jennifer. Raquel blamed PTSD for her sleep problems, but later found out she had sleep apnea.

Army veteran Raquel Rojas had a rude awakening. One night while she was visiting her daughter in Brooklyn, New York, she was jolted by her daughter’s pleas to breathe. Raquel was unaware she had been gasping for air in the middle of the night.

“My daughter was tugging at me to make sure I could catch my breath,” Raquel said. “I was startled by my daughter’s reaction, but I finally knew there was something going on.”

A sleep study at the VA back in Florida confirmed obstructive sleep apnea, a condition in which a person repeatedly stops and starts breathing while they sleep. Until that visit, Raquel had blamed post-traumatic stress disorder (PTSD) for her sleeplessness.

“I went to stay with my daughter because PTSD was affecting me in many ways, and she didn’t want me to be alone.” Raquel had attempted suicide in the past and received care for PTSD and her mental health. The flashbacks and nightmares had been more bothersome than the obstructed airway and had obscured the full picture of her sleep problems.

“I would only sleep two or three hours, then I would wake up and stay awake,” Raquel said, adding that her reentry to civilian life had been turbulent.

“I was all over the place while I was active duty as an 88 Mike. I did transportation and was in Iraq in 2003 and 2004. I spent time at Camp Anaconda, which was nicknamed ‘Mortaritaville’ because we were constantly under attack.”

After 24 years in the Army, Raquel separated from the military and moved to Florida, spending part of the year in Puerto Rico, where she was born.

“I didn’t know many veterans on the island at first,” Raquel said. “But then I got involved in Wounded Warrior Project activities.”

A Wounded Warrior Project® (WWP) Project Odyssey mental health workshop focused on women veterans and a peer support group in Puerto Rico helped connect her to resources.

“The Wounded Warrior Project team has been very helpful – I know now that I can reach out for help.”

Sleep Deprivation, USA

Sleepless nights are a frequent problem for veterans and civilians in this country. The National Institutes of Health (NIH) reports that 50 to 70 million Americans have sleep disorders and that 1 in 3 adults do not get enough sleep to protect their health.

For veterans, layers of physical and psychological issues can compound health problems and lead to sleep disturbances. It can be difficult to tease out the causes or even differentiate the cause from the effect. Some veterans get by on little sleep and consider this their post-service new normal.

In WWP’s Annual Warrior Survey, 78% of the warriors WWP serves reported having sleep problems. More revealing, 90% of them screened positive for sleep issues, whether or not they consider it a problem.

Lack of sleep can show up as little quantity of sleep or not getting enough quality sleep (not progressing to the next sleep stage), flashbacks, night terrors, and insomnia. In some cases, traumatic brain injury (TBI), and the structural changes in the brain that TBI causes, can aggravate sleep problems.

Regardless of the underlying causes, experts recommend addressing sleep problems before they affect other areas of your health. Giving your mind a rest is important to your healing. While you sleep, a process called glymphatic clearance removes debris from your brain, helping to restore brain function.

This restorative function is one of several important jobs our brains perform while we rest. Getting enough quantity of sleep, as well as quality of sleep, helps our bodies get the full benefit of each stage of the sleep cycle.

Addressing physical obstacles to sleep sometimes uncovers underlying mental health issues and vice versa.

“Sometimes people are afraid to get to sleep,” said Ashley Ross, Warrior Care Network deputy director at WWP. “You can have a physical problem like sleep apnea addressed and realize now other sleep problems come to light. Treating both the physical sleep issue and the depression or PTSD works better for the veteran.”

“One of the biggest things warriors need to know is that recognizing and preventing stressors has a positive impact on mental health issues,” Ashley said.

That prevention includes healthy sleep.

“Sleep helps restorative body-mind functions and when you improve sleep, you’re better able to manage your mental health,” Ashley said. “If your ability to function is impaired, your coping skills are affected, too, making daily issues seem more challenging. Getting a good night’s rest is key for everyone, especially veterans with PTSD, and WWP is here to help.”

How Wounded Warrior Project Helps if PTSD is Impacting Your Sleep

A comprehensive approach helps the veteran and their partner. A range of services, from VA benefits to novel treatment, can be tapped into through WWP.

Benefits Services

WWP Benefits Services assists warriors with review and appeals of the benefits they have earned. That may include medical and mental health services through VA providers. To supplement those services, WWP programs helps warriors approach sleep problems – whether from physical or mental issues – from various angles.

Physical Health and Wellness

A WWP physical health and wellness coach might help a veteran identify habits within their control that can improve their sleep. Sleep hygiene, which includes behavioral details like limiting screen time, using a facial mask, getting curtains that block light, eating several hours before bedtime, and watching liquid intake can provide immediate improvements before tackling other issues.

Project Odyssey

If the problem persists, WWP warriors have access to other solutions designed to address mental health and spilling over to all areas of well-being, including sleep. Some examples include Project Odyssey®, a 12-week, goal-focused, mental health program that begins with an in-person week of adventure-based learning. The variety of approaches is intended to empower veterans to take control of their overall health.

Warrior Care Network

Warrior Care Network, for instance, can help address both physical and psychological causes of sleep problems. It is an outpatient treatment program that makes world-class care at four academic medical centers accessible to warriors at no cost to them.

Through two- to three-week intensive outpatient programs, Warrior Care Network provides care tailored to each veteran and family member. It integrates behavioral health care, rehabilitative medicine, wellness, nutrition, mindfulness training, and family support. It is designed to provide clinical care along with wraparound support to ensure each veteran is getting the best treatment.

The program is interdisciplinary – warriors get a full evaluation before their treatment starts.

“Veterans can get very targeted therapy that will help them,” Ashley said. “If they have problems with sleep or pain or nutritional issues or substance use, Warrior Care Network providers will set up a program to address those issues at one location.”

Warrior Care Network also helps to match veterans to a local provider when they return home, so that they receive follow-up care. Another aspect of the comprehensive program is that family support members are included and can participate in educational sessions and activities. WWP covers all costs for veterans and their partners.

Getting Support During Hard Times 

For veterans like Raquel, having a network of support via family, fellow veterans, and organizations like WWP offers peace of mind and treatment options during challenging times.

“The COVID-19 pandemic was bad for me,” Raquel said. “I felt isolated. At this point in my life, I’ve been struggling for such a long time. If there’s something that can be done, I want to do it.”

Raquel now sees that there are others who also need support. “What I do to improve my health might also help another soldier,” she said. “We were fit for duty in order to join the Army and serve our country, and we come back with all this stuff going on. When I left on deployments, I was fit for duty. Now I have diabetes, hearing aids from all the explosions, PTSD, and sleep apnea.” 

Having spent time with other veterans through WWP, Raquel knows she is not alone. She also realizes that by improving her health, she can be one of the warriors carrying another veteran off the battlefield – like the WWP logo illustrates.

Connecting to Resources

Reaching out for help is a first step.

“There are phenomenal PTSD and depression therapies to help people treat their psychological needs, as well as their physical issues,” Ashley said. “You might have a diagnosis but that doesn’t mean you can’t get help for it and enjoy better health. Treating sleep disorders, with or without psychological issues, is about hope.”

WWP programs help warriors with complex issues reach out for help and find multiple solutions to sleep problems and other combat-related and non-combat-related conditions. Learn more about how WWP helps warriors and caregivers through mental health programs and PTSD treatment options at #CombatStigma.

About Wounded Warrior Project
Since 2003, Wounded Warrior Project® (WWP) has been meeting the growing needs of warriors, their families, and caregivers — helping them achieve their highest ambition. Learn more.

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