Total VeteranSleep Problems After Military Service: Insomnia, Sleep Apnoea and What Works
Over half of post-9/11 veterans entering VA care met the criteria for insomnia disorder. Here is why sleep stays broken after service and what fixes it.
- 57.2% of 5,552 post-9/11 veterans enrolling in VA care met criteria for insomnia disorder, against about 30% of all adults.
- Among those with PTSD, the insomnia rate reached 93.3%.
- In a 2010 Army sleep clinic sample, 51.2% had obstructive sleep apnoea.
- CBT-I is the first-line insomnia treatment and improves sleep in 7 out of 10 people who complete it.
- The NHS recommends 7 to 9 hours for adults; the CDC recommends 7 or more for ages 18 to 60.
Sleep problems are one of the most common health issues veterans carry out of service. In a study of 5,552 post-9/11 veterans enrolling in VA health care, 57 percent met the criteria for insomnia disorder, against roughly 30 percent of the general adult population. Obstructive sleep apnoea is also common. Both are treatable. The first-line treatment for insomnia is cognitive behavioural therapy for insomnia (CBT-I), which the NHS and the VA both offer, and sleep apnoea responds to treatment such as a CPAP machine, which the NHS supplies free when needed.
How common sleep problems are in service and after
| Study | Who was studied | Key findings |
|---|---|---|
| Mysliwiec et al., Sleep (2013) | 725 active-duty personnel referred for overnight sleep studies at Madigan Army Medical Center, 2010 | 85.1% had a clinically relevant sleep disorder: 51.2% obstructive sleep apnoea, 24.7% insomnia. Average home sleep was 5.74 hours a night and 41.8% reported 5 hours or less. |
| Colvonen et al., Sleep (2020) | 5,552 post-9/11 veterans newly enrolling in VA health care | 57.2% met criteria for insomnia disorder. Rates rose to 93.3% among those with PTSD, 77.7% with traumatic brain injury and 69.6% with chronic pain. |
| RAND Corporation research brief (2015) | Review of more than 100 Department of Defense, VA and service policies | Sleep problems are a primary complaint after deployment. Some operational manuals stated that four hours a night for a week would not affect performance, which the authors say contradicts strong scientific evidence. |
The Madigan figures come from people already referred for a sleep study, so they describe a group with suspected problems. The VA figures cover every newly enrolling post-9/11 veteran in the sample, which makes the 57 percent figure a strong indicator of how widespread insomnia is after service. Military.com's report on the VA study notes the rate held across age, sex, race and service branch.
Why sleep does not reset at discharge
The RAND review found that military culture often treats sleep loss as a "badge of honor", and that personnel may under-report sleep symptoms after deployment. Years of short sleep, shift work and early starts can build patterns that continue into civilian life. Several other factors keep them going:
- PTSD. The VA's National Center for PTSD states that almost everyone with PTSD also has trouble sleeping. Insomnia and nightmares are both PTSD symptoms.
- Sleep apnoea. The same source notes that sleep apnoea is common in people with PTSD, particularly veterans, and that treating it with CPAP may help PTSD treatment.
- Pain and injury. Seven in ten veterans with chronic pain in the VA study met insomnia criteria.
- Caffeine, alcohol and screens. Habits that helped you function on duty work against sleep at home. The NHS advises avoiding caffeine and alcohol within 6 hours of bed.
How much sleep you need: UK and US guidance
| UK (NHS) | US (CDC and VA) | |
|---|---|---|
| Adult sleep need | 7 to 9 hours on average | 7 or more hours for ages 18 to 60; 7 to 9 hours for ages 61 to 64; 7 to 8 hours for 65 and over |
| First treatment for insomnia | CBT from your GP, face to face or through an online self-help programme | CBT-I, usually six sessions, in person, by video, online or with the CBT-i Coach app |
| Sleeping pills | Rarely prescribed; a few days, or weeks at most | Often recommended for 2 to 4 weeks only |
| Sleep apnoea treatment | Lifestyle changes, CPAP (free on the NHS if needed), mouth devices | Assessment and treatment through VA or private health care |
| Veteran-specific route | Op COURAGE (England) for mental health needs linked to service | VA primary care, mental health services and Vet Centers |
Sources: NHS insomnia guidance, CDC: About Sleep and the National Center for PTSD sleep guidance.
Build the routine back
Cohorts help you rebuild daily structure with a plan of the day, a coach and a peer who keeps you honest.
Insomnia: what works
CBT-I targets the thoughts and behaviours that keep you from sleeping. It runs as a short structured course with a therapist, online or through an app, and you keep a sleep diary throughout. According to the National Center for PTSD, CBT-I improves sleep in 7 out of 10 people who complete it and also reduces how many nightmares people have. It is recommended over medication, which works quickly but temporarily.
In England, NICE recommended the Sleepio app in May 2022 as a six-week digital CBT programme for insomnia, after trial evidence showed it was more effective than sleeping pills (Pharmaceutical Journal report). Access through the NHS varies by area, so ask your GP what is available locally.
Steps both health services recommend
- Get up at the same time every day, including weekends.
- Go to bed only when you feel sleepy.
- Keep the bedroom dark, quiet and cool.
- Put screens away before bed; the CDC suggests at least 30 minutes.
- Skip caffeine in the afternoon and evening, and avoid big meals and alcohol before bed.
- Exercise during the day; the NHS advises finishing at least 4 hours before bed.
See your GP or VA provider if changing habits has not helped, if the problem has lasted months, or if tiredness is affecting work, driving or relationships.
Sleep apnoea: when snoring is more than snoring
The NHS describes the signs as breathing that stops and starts during sleep, gasping or choking noises, loud snoring and frequent waking, followed by daytime exhaustion, poor concentration, mood swings and morning headaches. A partner often notices first, so take them to the appointment if you can. Risk factors include obesity, a large neck, alcohol, smoking and sleeping on your back.
In the UK, you may need to tell the DVLA, and if excessive sleepiness has been confirmed you must not drive until it is under control. Treatment ranges from weight loss and cutting alcohol to a CPAP machine, a mouthguard-style device or surgery. CPAP works best when used every night.
Free tools and services
| Service | Country | What it is |
|---|---|---|
| Insomnia Coach (VA app) | US (works anywhere) | Self-guided app based on CBT-I, with a weekly training plan, sleep diary and 17 tools. Built for everyone, including veterans and service members. |
| CBT-i Coach (VA app) | US (works anywhere) | Companion app for people doing CBT-I with a health provider. |
| NHS GP | UK | Free assessment, CBT for insomnia face to face or through an online self-help programme, and assessment for sleep apnoea. |
| Op COURAGE | England | NHS veterans' mental health service, open to self-referral, covering mental health problems and psychological trauma that often disrupt sleep. |
| Vet Centers | US | No-cost counselling for eligible veterans, service members and families, including for PTSD. The 24-hour call line is 1-877-927-8387. |
Poor sleep and trauma often travel together. If you are also dealing with intrusive memories or guilt, read our guides to PTSD and complex PTSD and moral injury.
UK: call Samaritans free on 116 123, day or night. The Combat Stress 24-hour helpline for veterans is 0800 138 1619 (text 07537 173683). In England, call NHS 111 and select the mental health option, or contact Op COURAGE, the NHS mental health service for veterans. Call 999 if a life is at risk. US: contact the Veterans Crisis Line: dial 988 then press 1, text 838255, or chat online. From Europe, including the UK, the line takes calls on +1 844-702-5495.
What to do this week
- Set one fixed wake-up time and keep it for 14 days, weekends included.
- Keep a sleep diary for two weeks to take to your GP or VA provider.
- Ask a partner whether you snore, gasp or stop breathing at night.
- Cut caffeine after midday and alcohol within 6 hours of bed for one week.
- Download Insomnia Coach or ask your GP about CBT for insomnia.
Questions people ask
Why can't veterans sleep after leaving the military?
What is the best treatment for insomnia in veterans?
Is sleep apnoea common in veterans?
How many hours of sleep do adults need?
- American Academy of Sleep Medicine, summary of Mysliwiec et al., Sleep (January 2013). https://aasm.org/active-duty-military-personnel-prone-to-sleep-disorders-and-short-sleep-duration/
- Colvonen, Almklov, Tripp et al., "Prevalence rates and correlates of insomnia disorder in post-9/11 veterans enrolling in VA healthcare", Sleep (2020). https://escholarship.org/uc/item/5bf3t5x3
- Military.com, "Veterans Have Higher Rates of Insomnia Than Non-Veterans" (October 2020). https://www.military.com/benefits/veterans-health-care/2020/10/29/veterans-have-higher-rates-of-insomnia-non-veterans.html
- RAND Corporation, "Improving Sleep Health for U.S. Servicemembers", Research Brief RB-9824 (2015). https://www.rand.org/pubs/research_briefs/RB9824.html
- U.S. Department of Veterans Affairs, "Sleep Problems and PTSD". https://www.ptsd.va.gov/understand/related/sleep_problems.asp
- NHS, "Insomnia". https://www.nhs.uk/conditions/insomnia/
- NHS, "Obstructive sleep apnoea". https://www.nhs.uk/conditions/obstructive-sleep-apnoea/
- Centers for Disease Control and Prevention, "About Sleep". https://www.cdc.gov/sleep/about/index.html
- The Pharmaceutical Journal, "NICE recommends prescribing mobile app over sleeping pills for treatment of insomnia" (May 2022). https://pharmaceutical-journal.com/article/news/nice-recommends-prescribing-mobile-app-over-sleeping-pills-for-treatment-of-insomnia
- U.S. Department of Veterans Affairs, "Insomnia Coach" app. https://mobile.va.gov/app/insomnia-coach
Total Veteran helps people leaving the forces make the crossing into civilian life with a plan, a coach, a peer and an app, built on doctoral research. We work with UK and US veterans and ex-forces, their families and the organisations that support them. Our Journal is free, independent of government and sourced throughout.
Make the crossing with a plan, a coach and a peer.
Total Veteran cohorts bring small groups of UK and US veterans together for one-to-one coaching, a peer Bravo and a written Personal Mission Architecture. Places are limited. Register interest and we will contact you before the first cohort opens. No commitment.
Thanks, you are on the list.
We will contact you before the first cohort opens. Keep reading the Journal in the meantime.