Combat exposure, post-traumatic stress symptoms, and health-related behaviors: the role of sleep continuity and duration

Study Objectives Aggression, substance misuse, and other health risk behaviors are common among combat veterans. We examined whether sleep quality and quantity predict the association between combat exposure, post-traumatic stress symptoms, and adverse health-related behaviors. Methods Soldiers (N = 2420) from a brigade combat team completed surveys assessing combat experiences, and psychological and behavioral health factors, approximately 3 months following deployment to Afghanistan in 2011. Results Respondents were 93.5% male; 73% were age 18-29 years old. The response rate was 80% (3076/3832); 94% (2876/3076) of the soldiers who attended the recruitment briefings consented to participate in this research. Complete data were available across the variables used in this study for up to 2420 soldiers. Sleep continuity disturbance accounted for the association of combat exposure with post-traumatic stress symptoms and aggression, alcohol use, and risky behavior. Moreover, for soldiers who reported sleep duration of <6 hr per day, the indirect association of combat exposure and post-traumatic stress on aggression, alcohol use, risky behavior, and opioid use was strongest. Conclusions This study is the first to model sleep problems as a predictor of the association between combat exposure and post-traumatic stress symptoms and frequently reported health-related behavior problems. Sleep disturbance is highly prevalent among Warfighters. While not fully preventable in operational contexts, these problems can be effectively mitigated postdeployment with appropriate policy and intervention resources. Improving the sleep characteristics of combat-exposed soldiers following deployment should reduce subsequent post-traumatic stress and related health compromising behavior, thereby enhancing force readiness.