Veteran and Military Healthcare

Sleep Disorders

There are a number of veterans who have returned from combat in Iraq and Afghanistan who have been exposed to traumatic or stressful events. Among the 229,000 OIF/OEF combat veterans who have sought VA medical care since 2002, approximately 17% of them have reported symptoms consistent with a diagnosis of PTSD1. Sleep disturbances are a very common negative consequence of combat exposure. 52% of combat veterans with PTSD experience nightmares and 90% of combat veterans diagnosed with PTSD experience difficulties initiating and maintaining sleep2.

Sleep disorders and increased rates of difficulty initiating and maintaining sleep are common in patients suffering from bipolar disorder, substance abuse, major depression, panic disorder, and chronic pain disorders3-4. Sleep disturbances following a recent exposure to a traumatic event can predict the later development of PTSD5-6. For many combat veterans, the rapid progression of disease is directly correlated with sleep dysfunction disrupted circadian cycles.

Normal patterns of sleep and waking are regulated by neurotransmitters which alter electrical activity in specific areas of the brain. A loss of coordinated activity between sleep-active and wake-active neurons disrupts the circadian rhythm of the sleep-wake cycle and of autonomic nervous system activity during the transitions between sleep and waking. Disturbances in sleep patterns resulting from circadian phase shifts and disordered autonomic function are associated with imbalances in neurotransmitters which modulate these activities. Chronic stress, anxiety , depression, and chronic pain increase amino acid turnover, depleting the body of the vital chemicals needed to achieve and maintain normal sleep phases. In many patients, adjustments to dietary intake of specific nutrients is not sufficient or a safe way to sustain the increased turnover rate of specific amino acids. Drugs designed to manipulate the neurotransmitters involved in sleep function often fail over time due to the lack of available substrate needed to manufacture the necessary chemicals.

The nutritional requirements of most interest to patients with sleep disorders associated with fibromyalgia, depression, and PTSD are nutrients which function as neurotransmitters or precursors of neurotransmitters that modulate circadian effects on the sleep-wake cycle and autonomic nervous system activity7. As precursors of serotonin and acetylcholine, tryptophan and choline are especially important to these patients as is glutamate which functions not only as a neurotransmitter but also as a precursor of GABA. Rx only medical foods designed for the clinical dietary management of sleep disorders related to depression and anxiety are a viable and sustainable option for physicians to utilize in clinical practice to provide patients with the neurotransmitter precursors required for the maintenance of normal sleep cycles.

  1. Hoge CW, Castro CA, Messer SC, McGurk 0, Cotting OJ, Koffman RL: Combat duty in Iraq and Afghanistan. mental health problems, and barriers to care. N Engl J Med 2004; 351: 13-22.
  2. Gellis, et al. :Predictors of sleep disturbances in OIF/OEF veterans reporting trauma, Military Medicine 2010
  3. Roth, et al. :Sleep Problems, comorbid mental disorders, and role functioning in the national survey replication. Biological Psychiatry 2006
  4. Smith, et al.: how do sleep disturbance and chronic pain inter relate? Sleep Med rev. 2004
  5. Kroen D, et al, Sleep complaints as early predictors of PTSD. AM j Psychiatry 2002
  6. Mellman TA, et al. REM sleep and the ealry development of PTSD. Am J Psychiatry 2002
  7. Boivin DB. Influence of sleep-wake and circadian rhythm disturbances in psychiatric disorders. J Psychiatry Neurosci 2000