There is a high rate of sleep-related disorders among veterans and active-duty military. Returning military personnel experience sleep dysfunction secondary to physical injury as well as post-traumatic stress disorder (PTSD). It is not out of the ordinary for abnormal sleep patterns to persist long after deployment has ended.

Obstructive sleep apnea (OSA), caused by obstructed breathing during sleep, has increased substantially in recent years and is considered the most prevalent of sleep dysfunctions among veterans. Of concern is that sleep dysfunction for any reason may increase the symptoms and risk for PTSD.

Military deployment in itself may be a risk factor for a sleep disorder. The rate of disability related to OSA has increased, and the cause remains unclear. Dr. Mohammad Al-Ajam, a physician specializing in sleep medicine at Brooklyn Veterans Hospital in New York, said of sleep apnea among veterans, "The connection to veterans is that OSA afflicts men more frequently than women, especially those who are in middle age and moving from an active to a sedentary life…exposure to chemical and dust could be factors…We don’t have cause and effect linkage yet."

Associations for OSA have been found with increased risk for mood and anxiety disorders, and there were very strong associations with PTSD and major depressive disorder. These associations were found even after accounting for increased weight and obesity. Obesity is a primary factor among civilians having OSA, but this does not always seem to be the case with military and veterans.

A comorbid diagnosis of PTSD impacts compliance with treatments for OSA. A study found that having PTSD was more likely to result in decreased compliance with using breathing systems designed to treat OSA at night.

Previously deployed veterans have sleep dysfunctions that do not fit into diagnostic criteria for sleep dysfunctions that are applied to civilian populations.

"For any disease, if you can’t characterize it, then it doesn’t lend itself to appropriate diagnosis, treatment and research to improve it," were the concerns expressed by Army Col. Vincent Mysliwiec, a doctor specializing in sleep medicine at Madigan Army Medical Center in Tacoma, Washington.

Col. Mysliwiec and his medical team found that sleep dysfunction rates are high among enlisted personnel and the dysfunctions can persist long after deployment. He characterizes a set of symptoms that are unique to those exposed to major trauma, such as deployed military. The symptoms include sleep dreams or nightmares that include vocalizations, somnambulism, combative behaviors, such that bed partners are at risk for injuries, and other sleep functions. The cluster of symptoms are called disruptive nocturnal behaviors (DNB).

Col. Mysliwiec and his research team propose a new diagnostic category, Trauma Sleep Disorder (TSD), to better diagnose and treat the unique sleep dysfunctions that are presenting among veterans and active-duty military personnel. Col. Mysliwiec described TSD for the Stars and Stripes military news organization as, "an overdrive phenomenon…sparking powerful surges from the sympathetic nervous system, the same mechanisms that govern fight-or-flight reflex."

Disrupted sleep secondary to traumatic brain injury impacts quality of life. Even in the absence of injury; sleep problems impact functioning during the day. The risk of disordered breathing and trauma-related sleep disorders warrants further research in order to assure optimum care for those having served our country.