Sleep Apnea in the Military: A Growing Health Concern for Veterans

💡 Key Takeaways

• Rising Incidence: Sleep apnea is a growing concern among military veterans, with the rate of those being diagnosed increasing by 11% per year according to the Veterans Health Administration in 2019.
• Higher Risk Factors: Veterans are 3-4 times more likely to be diagnosed with sleep apnea compared to the general population. Contributing factors include PTSD, traumatic brain injuries, and chronic stress, which are common experiences in military service.
• Multiple Causes: Sleep apnea in veterans is not solely linked to age or existing health conditions. It is often associated with unique military experiences such as irregular sleep cycles, chronic stress, and traumatic events, which can trigger or exacerbate the condition.
• Associated Health Risks: Untreated sleep apnea in veterans can lead to a host of other medical conditions, including cardiovascular diseases, diabetes, and high blood pressure. Timely diagnosis and treatment are crucial for preventing these complications.
• Treatment and Support: The VA provides various treatment options, including CPAP therapy and lifestyle changes, to help manage sleep apnea in veterans. Qualifying veterans may also be eligible for disability benefits related to this condition.

Military service requires sacrifice at a level that many civilians cannot fully comprehend. When you first took that oath, you offered up your time, your safety, and potentially even your life for the sake of the nation you swore to protect. Unfortunately, too many of our service members come back with life-altering changes to their physical health and mental well-being.

Sometimes, it takes years for the full impact on your health to become known. In the last decade, we’ve even seen evidence of this in the sleep apnea community. Reports show that sleep apnea in the military is a growing problem, with potentially millions of veterans affected, even after years spent recovering from potential triggers, including PTSD, physical injuries, and chronic stress.

In 2019, the Veterans Health Administration reported more than 1.3 million diagnosed cases of sleep apnea in veterans across the US. At that time, this number represented a 44% increase in cases from a previous report in 2015– an increase of 11% per year.

The number of veterans with sleep apnea has only increased as our former service members continue to age. However, more recent data on diagnosed cases has not yet been publicly released. Following the trends described in the 2019 report, estimates suggest that over 1.5 million veterans have been diagnosed with sleep apnea.

Service members have seen an increased risk for sleep apnea in recent years, especially compared to the general population. After examining the number of confirmed cases, it seems veterans are between 3-4 times more likely to be diagnosed with sleep apnea.

By 2019, there were 18.2 million veterans in the United States. Based on the VHA report released that same year, more than 7% had been diagnosed with sleep apnea. Less than 2% of Americans (about 6 million) had received the same diagnosis.

Sleep apnea is most prevalent in older, chronically ill individuals. However, VA sleep disorder reports show a growing number of young, relatively healthy veterans with sleep apnea.

Diagnostic trends suggest a link between sleep apnea and military service that has less to do with aging or the VA’s unique healthcare system and more to do with environmental conditions or experiences often associated with military service.

The unique causes of sleep apnea in veterans are believed to be a combination of the following:

• Post Traumatic Stress Disorder
• Traumatic Brain Injuries
• Chronic Stress
• Irregular Sleep Cycles
• Underlying Illnesses

In the past few years, scientists have documented alarming numbers of service members with PTSD and sleep apnea. While this relationship is still not fully understood, it is thought that PTSD causes physical changes to the body and brain, which increase your susceptibility to sleep apnea.

In 2015, a Veteran PTSD Clinic partnered with the University of California to explore this trend further. After examining 195 veterans who served in Afghanistan and/or Iraq, researchers found that nearly 70% had a high risk for sleep apnea.

Their results suggested that veterans with PTSD had a higher risk, even with a normal BMI and blood pressure. For every ten points scored on the PTSD Checklist, participants had a 40% increased likelihood of being considered “high risk” for having sleep apnea.

Health experts have known for decades that a brain injury can cause sleep apnea. Research suggests that even experiencing a mild TBI makes you 25% more likely to develop sleep apnea afterward, which is by far the most common form of brain injury in military service members.

The link between veterans and sleep apnea is unsurprising, given their increased risk for blast injuries. Blast TBIs are a type of injury that occurs almost exclusively in military settings. Service members who have sustained any type of TBI are more likely to develop sleep apnea than those who have not.

Stress is more than an emotional experience. It also changes your body by triggering the release of stress hormones like cortisol. These changes become more damaging when you are placed under a lot of stress for a long time, a common problem in veterans.

A 2013 study published in the journal Psychoneuroendocrinology found that veterans previously deployed to a war zone showed an increased stress response even if they didn’t have PTSD.

The impacts of chronic stress on the development of sleep apnea are not totally understood. Sleep apnea causes heightened cortisol levels on its own. However, increased stress hormones have been linked to poorer health outcomes and may even cause inflammation. Experts suspect both of these factors could play a role in triggering sleep apnea in the military and civilians.

Between unpredictable sleep schedules on deployment and the development of insomnia after returning home, being in the military pretty much guarantees poor sleep. While having PTSD makes it harder to sleep, sleep health can be impacted no matter what you experience during your service. And it can stay that way for a long, long time.

According to a report on insomnia in the military, many veterans who served in the Korean, Vietnam, and Gulf Wars have reported decades of sleep disturbances following those first years of service. Meanwhile, about 66% of Iraqi and Afgan War veterans struggle with insomnia.

Experts suspect that there is a hidden link between insomnia and sleep apnea in veterans. Obstructive Sleep Apnea is seen in 30-40% of chronic insomnia cases, and it is believed that sleep deprivation likely worsens existing cases of sleep apnea.

When you think of the military, you probably think of a soldier in peak health. But, it’s been well documented that veterans tend to struggle with their physical and mental health after getting home.

Sometimes, these issues arise within weeks or even days after returning, while others may not appear until decades later. Studies show that even younger vets are impacted by this trend. 44% of recent service members are obese, five points over the national average for Americans under 45.

Below are some common health conditions that can trigger sleep apnea in veterans.

• Substance Use Disorder: SUD is associated with an increased risk for sleep apnea.
• Chronic Obstructive Pulmonary Disease: Sleep apnea occurs in about 15% of COPD cases.
• Parkinson’s Disease: Sleep apnea can occur in up to 40% of people with Parkinson’s.
• Cancer: People with cancer have a high chance of developing sleep apnea.
• Heart Failure: Your risk of sleep apnea is very high if you have heart failure.
• Type II Diabetes: Diabetes can lead to sleep apnea.

Over time, sleep apnea takes a toll on your body. Like the general population, veterans with sleep apnea have an increased risk of developing other chronic illnesses due to this sleep disorder. Without proper treatment, sleep apnea creates extra stress, leads to chronic inflammation, and advances aging.

Untreated sleep apnea is associated with the following medical conditions:

• Death
• Cardiovascular Disease
• Heart Conditions
• Stroke
• High Blood Pressure
• Diabetes

Some veterans do qualify for VA disability due to their sleep apnea. However, you must prove that this sleep disorder resulted from your military service. The VA will then calculate your amount of disability pay depending on the severity of your condition.

Veterans are at a high risk for sleep disorders due to the long-lasting impacts of military service, particularly PTSD and brain injury. Common sleep disorders in veterans include:

• Insomnia
• Nightmares
• Sleep Apnea
• Periodic Limb Movement Disorders
• Restless Leg Syndrome

A 2019 Veterans Health Administration report stated that over 1.3 million veterans were diagnosed with sleep apnea. That number has only increased since then, and given the prevalence of undiagnosed sleep apnea, there are likely millions of veterans with this condition.

Veterans are more likely to have sleep apnea due to their increased likelihood of having PTSD, physical injury, chronic stress, and other chronic conditions that are known to increase the risk for sleep-disordered breathing.

Like many other chronic sleep disorders, there is a high prevalence of sleep apnea in the military. While this is often attributed to PTSD and brain injuries, it can also affect service members who have experienced chronic stress, insomnia, or other underlying health conditions.

Despite the growing number of veterans with sleep apnea, there is good news! Your VA provider can help you manage this condition through CPAP therapy, lifestyle changes, and other treatment alternatives. For more information on managing your sleep apnea, check out our blog!