Literature Review: Sleep Disturbance and Alcohol Use in Veterans

This literature review investigates the complex relationship between sleep disturbance and alcohol use disorder (AUD) in veterans. The review synthesizes several studies that explore the prevalence of sleep disorders, such as insomnia and sleep apnea, among veterans, linking them to factors like combat exposure, PTSD, and aggression. Several articles highlight the high incidence of sleep problems, often exacerbated by alcohol consumption as a coping mechanism. The review examines the tools used to assess sleep quality and mental health, such as the PSQI and SSI, and discusses the impact of alcohol on sleep patterns. Studies included in this review show that alcohol misuse is associated with more severe sleep disorders. The review concludes by emphasizing the challenges veterans face, including combat-related trauma and the subsequent reliance on alcohol, underscoring the need for interventions that address both sleep disorders and AUD to improve the mental and physical health of veterans.

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1LITERATURE REVIEW
Introduction
In the following article, we will be conducting a literature review regarding the sleep
disturbance and coping affecting alcohol use disorder among veterans.
Literature review
In a paper, it has been stated that a sleep disorder can give rise to several types of health
problems. It has been observed that substance use disorders (SUDs) such as drugs and alcohol
has been higher in individuals along with posttraumatic stress disorder (PTSD). Disordered sleep
can cause insomnia, sleeping during the daytime and many more. The paper suggests that
consistent substance use can cause more severe sleep disorders as a result of the progress of sleep
forbearance and abandonment (Vandrey, Babson, Herrmann & Bonn-Miller, 2014).
In the article of Plumb, Peachey and Zelman (2014), the researchers tried to identify the
causes of sleep impairment by conducting a comprehensive survey. They selected 375 people
who were still serving and some veterans who belonged to operations enduring freedom and
Iraqi freedom and tried to assess the relation among population, military history, experience of
the combat and mental disorders. To evaluate the sleep deficiency the researchers used tools such
as Pittsburgh Sleep Quality Index (PSQI), PTSD Checklist–Military, the Patient Health
Questionnaire-9 and the Generalized Anxiety Disorder-7. The scores of the global PSQI showed
that 89% veterans had sleep problems and causes were experience to combat, and severe
depression, anxiousness, and PTSD symptoms.
In a paper it has been identified that aggression is of a great concern among the combat
veterans. It is highly related to symptoms of posttraumatic stress disorder (PTSD). The paper

2LITERATURE REVIEW
also suggested that veterans who have significant aggression and symptoms of PTSD are likely
to get involved with alcohol misuse which might significantly worsen the condition of both
aggression and PTSD (Stappenbeck, Hellmuth, Simpson & Jakupcak, 2014).
In another article by Perney, Rigole, Mason, Dematteis and Lehert (2015), the researchers
tried to assess the psychometric aspects of the Short Sleep Index (SSI) comparative to the longer
Pittsburgh Sleep Quality Index (PSQI), which is extensively used for gauging night disturbance
of alcohol abuse patients during and after the withdrawal of the alcohol. The researchers
conducted a cross-sectional survey and for that 257 alcoholic patients (88 females and 169 men)
were recruited from academic hospitals and community treatment center. The commonness of
sleep disturbance and related sleep disorders were measured through the PSQI and the SSI and it
resulted 73.5 per cent and 74.3 per cent, correspondingly.
In the article of Pan, Wang and Wang (2014), the researchers tried to assess the
frequency of sleep apnea (SA) and study its relation with potential aspects involving uptake of
alcohol, breathing issues, high glucose level, and high blood pressure. The researchers conducted
a cross-sectional study by selecting a total of 823 people suffering from SA and 38,638 controls
from the 2011 National Survey on Drug Use and Health Data. The study found that the SA was
higher in males compared to that of females, and it increased with the increase in age. It was also
proved that alcohol consumption, asthma, diabetes, age and high blood pressure was highly
related to sleep apnea.
Conclusion
Thus, it can be concluded that veterans do have to face several challenges which normal
people do not face, like combat exposure, aggression, depression due to loss of colleagues and

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many more which hamper their sleep cycle. Thus, in order to cope up with that, veterans rely on
alcohol consumption. Though what the effect of alcohol consumption will be on the veterans
depends on the rate of consumption; it can be beneficial also, and can have a serious health issue
(Fernandez-Sola, 2015).

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References
Fernandez-Sola, J. (2015). Cardiovascular risks and benefits of moderate and heavy alcohol
consumption. Nature Reviews Cardiology, 12(10), 576.
Pan, Y., Wang, W., & Wang, K. S. (2014). Associations of alcohol consumption and chronic
diseases with sleep apnea among US adults. International journal of high risk behaviors
& addiction, 3(2).
Perney, P., Rigole, H., Mason, B., Dematteis, M., & Lehert, P. (2015). Measuring sleep
disturbances in patients with alcohol use disorders: a short questionnaire suitable for
routine practice. Journal of addiction medicine, 9(1), 25-30.
Plumb, T. R., Peachey, J. T., & Zelman, D. C. (2014). Sleep disturbance is common among
servicemembers and veterans of Operations Enduring Freedom and Iraqi
Freedom. Psychological services, 11(2), 209.
Stappenbeck, C. A., Hellmuth, J. C., Simpson, T., & Jakupcak, M. (2014). The effects of alcohol
problems, PTSD, and combat exposure on nonphysical and physical aggression among
Iraq and Afghanistan war veterans. Psychological Trauma: Theory, Research, Practice,
and Policy, 6(1), 65.
Vandrey, R., Babson, K. A., Herrmann, E. S., & Bonn-Miller, M. O. (2014). Interactions
between disordered sleep, post-traumatic stress disorder, and substance use
disorders. International review of psychiatry, 26(2), 237-247.