Army drills down on health of its force, finds it needs more sleep

The Army has just finished its first ever base-by-base study on the health of service members. Among the findings: an alarming number of soldiers are sleep deprived, mostly for reasons that have nothing to do with military deployments.

The Army surgeon general’s inaugural Health of the Force Report was built almost entirely from information the service already had in existing databases but had never been analyzed in a way that let officials scrutinize various health indicators of entire populations of soldiers in various spots around the country.

Several data points raised concern among Army public health officials: only about 15 percent of soldiers are getting the 7-to-8 hours of sleep per night most adults require, compared to a 70 percent rate in the broader American public. The 32 percent of soldiers who smoke or use smokeless tobacco is 14 percentage points higher than the general population. Bone and muscle injuries are happening at higher rates than in previous eras. And despite the Army’s high physical fitness standards, 13 percent of soldiers were classified as obese.

Officials in the surgeon general’s office see those findings as useful not just for pointing out broad health concerns, many of which the Army has been keeping a close eye on for the past several years, but also because they strongly suggest the Army’s medical professionals can’t implement the needed remedies without the help of a host of other officials, including base commanders, individual unit leaders and other organizations like the military’s commissary system.

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“We realized we had to do something different. The average soldier is only a patient in our medical system for about 100 minutes every year,” said Col. Deydre Teyhen, the Army’s assistant deputy chief of staff for public health. “If Army medicine wants to get better health readiness across the force, we have to find ways to influence the other 525,500 minutes. We think this report gives the rest of our Army leaders a way to do that.”

For some measures of public health, the report found wide variances between different installations and Army medical officials are urging local commanders to use the data to implement practices that have shown to have a positive health impact where they’ve already been tried.

For instance, at Fort Bliss, Texas, the tobacco use rate is just 19 percent compared to an overall Army average of 32 percent, due in part to local officials’ response to previous public health studies showing that moving smoking areas further from buildings cuts tobacco use.

At Fort Campbell, Kentucky, officials improved their nutrition score just by changing the location of the dining facility’s salad bar.

“They moved it so that you couldn’t get to the rest of the food without walking past the healthier options,” Teyhen said. “That alone increased salad sales by 24 percent. No one had to tell these soldiers, ‘Eat your greens’ or put a big poster up. It’s the same philosophy grocery stores use for product placement, but we’re using it for good. That same facility moved their desserts 10 feet further away, and dessert sales went down 16.8 percent.”

Other factors that affect broad swaths of the Army’s population are trickier, because they’re more culturally ingrained and traditionally have not been thought of in health and readiness terms.

Sleep is a prime example.

Army health officials worry that a warrior ethos has trained commanders over many generations to dramatically undervalue the importance of a consistent good night’s rest. But the study suggests that most soldiers’ chronic sleep deprivation has very little to do with deployment demands or warfighting: even at their home stations, most soldiers stay up too late as a matter of choice.

“It’s an epidemic problem. We are sleeping much worse than the average American. It has impacts on performance, on weight, on stress levels, on behavioral health conditions and on our relationships,” Teyhen said. “The Navy sailors who were captured by Iran were impacted by sleep deprivation as one of the leading factors that took them off course. It leads to car accidents, it leads to errors in decision making. The need for sleep just can’t be understated.”

Barbara Agen Ryan, a registered nurse who led training and education during the study, said the surgeon general’s office hopes the new report will begin to change local commanders’ attitudes on topics such as sleep, because the report points to numerous scientific studies that show connections between health and human performance.

One data point raised in the report: people who routinely get fewer than 7 hours of sleep per night are about as impaired as someone who’s consumed the legal driving limit for alcohol.

“We think we’ve packaged the information in a way that it’s so deep and rich in science and it’s not just an abstract recommendation,” Ryan said. “Because of that, we think commanders can have a lot of confidence in what we’re delivering. I think the confidence has grown because we’re trying to meet leaders at the individual and unit level with data and reports that are very evidence-based.”

Teyhen said some commanders have already made changes, including by directing their troops to “bank” sleep in advance of missions during which they’ll have to conduct their duties with little or no rest.

“We have to be able to perform while we’re sleep-deprived while we’re in a war zone. We have to train to that just like we train for everything else, but it shouldn’t be our normal way of life,” she said. “Our best example probably is at Fort Carson, where they started reverse-cycle physical training. They do PT at the end of the day instead of in the morning. Not only do they get more sleep, it allowed soldiers to help get the kids ready for school and spend some time with the family before everybody went out the door. It’s been a huge success, not only for the families but for the soldiers, because we know that being sleep deprived by four hours decreases your maximum bench press by 20 pounds. If we want to get the most out of unit PT, doing that at a time when they’re not sleep deprived is the way to do it. We’re seeing pockets of success and I think it’s going to continue to grow.”

Other health challenges the report identified, like higher rates of musculoskeletal injuries during basic training are likely a reflection of broader changes in American society: the incoming pool of recruits is less physically fit and has poorer dietary habits than their counterparts from a few decades ago.

Still, individual Army leaders have plenty of opportunities to change that behavior, said Dr. Amy Millikan Bell, a medical adviser to the project, particularly when the challenges are put in terms of military readiness.

“Part of the culture change is translating our medical information and knowledge of what’s good and bad for us into how that impacts readiness,” she said. “When you talk to commanders in that way and tell them how it impacts soldiers, it’s very different than telling them that the national prevention standards say X, Y or Z. We have to start the conversations where we can link culture into the discussion about health, because behavior change happens at a cultural level.”