Tag Archives: sleep

Wellness assessment at USASMA reveals common problem: not enough sleep

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By CLIFFORD KYLE JONES
NCO Journal

When representatives from the Executive Wellness Center assessed Class 67 at the U.S. Army Sergeants Major Academy recently, they found themselves doling out the same advice to many of the sergeants-major-to-be: Get more sleep.

Lt. Col. Cyndi McLean was one of three medical professionals who reviewed students’ responses to a questionnaire about healthy habits related to the three elements of the Performance Triad — activity, nutrition and sleep.

McLean is a physical therapist and said one problem area came up over and over again.

“I would love to say that it was activity,” she said, but many of the students’ biggest shortcoming was sleep.

“A lot of them don’t realize what optimal sleep is,” she said. “They don’t realize healthy hygiene habits. It’s something that is very fixable. I think that we all sometimes jump to more of a clinical or medical diagnosis: ‘I have sleep apnea.’ Well, maybe there’s some room for improvement there and some things that we can do to help you in that category and not just give it a test, give it a label, give it a diagnosis. We really want to help you through that process to truly optimize your sleep.”

A student in the U.S. Army Sergeants Major Academy's Class 67 has his body fat composition checked. (Photo by Clifford Kyle Jones / NCO Journal)
A student in the U.S. Army Sergeants Major Academy’s Class 67 has his body fat composition checked. (Photo by Clifford Kyle Jones / NCO Journal)

At the beginning of their school year, the more than 600 students of Class 67 took part in the first assessments of the office’s new Executive Wellness Program. The program is intended to bring the Performance Triad and resilience training together to help the senior noncommissioned officers become better Soldiers and leaders.

McLean said that not getting enough sleep can be the root of many other performance problems. If Soldiers sleep better, she said, they start to see benefits in other areas, such as improved eating and activity levels and reduced anxiety.

Lt. Col. Devvon Bradley, a licensed clinical social worker who also took part in the assessments, agreed that sleep is the linchpin for performance.

“It’s interesting because, in here, every time I see a sleep problem up front, it leads to the nutrition issues and then the activity at the end,” he said. “There are pain issues and there are also dietary issues, almost like a direct correlate. If there are no sleep issues up front, it’s less likely that there are nutrition problems and less likely that there are physical problems — pain issues — at the end.

Lt. Col. Cyndi McLean, a physical therapist, speaks with a student in the U.S. Army Sergeants Major Academy's Class 67 during an assessment by the Executive Wellness Program. (Photo by Clifford Kyle Jones / NCO Journal)
Lt. Col. Cyndi McLean, a physical therapist, speaks with a student in the U.S. Army Sergeants Major Academy’s Class 67 during an assessment by the Executive Wellness Program. (Photo by Clifford Kyle Jones / NCO Journal)

“The connection between sleep, activity and nutrition? There’s no doubt in my mind about it,” he continued. “It’s a triad, and each one contributes to the other. If you can help one, you can help the others. It looks like sleep is in the lead, in terms of if you fix it first, you have a better chance of fixing the other stuff.”

McLean said that sleep issues not only lead to problems in other areas but also noted that not sleeping well can make it harder to resolve Soldiers’ other problems.

“If I see that you have a pain issue, but you’re not willing to address your sleep habits, I’m not going to be able to get you as good as I possibly could,” she said. “Your prognosis is going to be on the lesser side. Once those people open up (about sleep), it’s amazing how much of their chronic pain, their aches, their issues like that get better as well.”

As McLean, Bradley and registered dietitian Capt. Michelle Stone reviewed Class 67’s questionnaires, the future sergeants major were categorized as green, amber or red in each of the three Performance Triad areas.

“What I’m seeing on people’s faces is the lightbulb going on,” Bradley said.

Lt. Col. Devvon Bradley, a licensed clinical social worker, left, speaks with a student in the U.S. Army Sergeants Major Academy's Class 67 during an assessment for the Executive Wellness Program. (Photo by Clifford Kyle Jones / NCO Journal)
Lt. Col. Devvon Bradley, a licensed clinical social worker, left, speaks with a student in the U.S. Army Sergeants Major Academy’s Class 67 during an assessment for the Executive Wellness Program. (Photo by Clifford Kyle Jones / NCO Journal)

Many of the NCOs didn’t realize they were red in the sleep category, he said, and now they not only know they have a problem but also know where to get help.

Sgt. 1st Class Darin E. Elkins, the NCO in charge of the Executive Wellness Center, coordinated and led the assessments, and he saw the same lightbulbs turn on.

“Once you identify an area where you’re not doing well, you think, ‘Oh, I didn’t realize that. Oh, I didn’t realize that taking in two or three cups of coffee or energy drinks at 6 p.m. is impacting my sleep, which is impacting my cognitive abilities, which is impacting my output,’ ” Elkins said. “Once we’ve identified it for them and say here’s a way to better optimize these things that they’re doing, then they can start making the changes. If you always do what you’ve always done, you get the same outcomes.”

The assessments were just the beginning of the program. Throughout the school year, the students of Class 67 will be given more training on the Performance Triad and resilience, and Bradley expects their personal realizations and training will pay dividends well beyond these particular NCOs.

“They’re leaders in the Army,” Bradley said, “so when they go back out to their units, they will push the same message of science and wellness.”

Commentary: The Army has a sleep problem. Here’s how to fix it

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NCO Journal staff report

Army Maj. Jeff Jager and Former Marine Corps Sgt. Aaron Kennedy say the Army has a sleep deprivation problem in a commentary published in the Army Times.

“Studies show sleep deprivation offers effects equal to drinking alcohol, and continued lack of sleep has the potential of being even more deadly,” Jager and Kennedy write. “We would never allow a drunken Soldier to lead an ambush, so why do we consider it acceptable or even admirable to send one with lack of sleep into life-threatening situations?

“The Army’s culture of sleep deprivation begins during basic training, although the Center for Initial Military Training has taken steps recently to incorporate additional sleep into the platform,” the continued. “It continues through the first unit of assignment, where we interrupt sleep with training and other duties until going without rest becomes ingrained in our Soldiers.”

Jager and Kennedy note that the Army is attempting to address sleep problems with its Performance Triad, but a survey they conducted of active-duty and reserve-component Soldiers found that nearly 42 percent had never heard of the triad and that 18 percent didn’t agree with it. They offer some suggestions for fixing the military’s sleep deprivation problems, including raising awareness and enforcing sleep standards.

Read the article.

Lack of sleep leads to lack of readiness, experts say

By DAVID VERGUN
Army News Service

Looking back on the long duty hours required of him as a drill sergeant, sometimes 26 in a stretch, Staff Sgt. Jacob Miller said he realized he has put himself and others in danger more than once.

Miller, who was named the 2015 Drill Sergeant of the Year, spoke at the Army Office of the Surgeon General-sponsored Performance Triad Sleep Summit on Dec. 9.

Staff Sgt. Jacob Miller, the 2015 Drill Sergeant of the Year, discusses how lack of sleep degrades performance. He spoke during the Army Office of the Surgeon General-sponsored Performance Triad Sleep Summit, Dec. 9, 2015. (Photo by David Vergun / Army News Service)
Staff Sgt. Jacob Miller, the 2015 Drill Sergeant of the Year, discusses how lack of sleep degrades performance. He spoke during the Army Office of the Surgeon General-sponsored Performance Triad Sleep Summit, Dec. 9, 2015. (Photo by David Vergun / Army News Service)

Since those long days “on the trail,” Miller said Army guidance has directed more time for sleep for drill sergeants, but enforcement of that is still needed. He added that a shift in culture and leader engagement are also necessary to change old thinking that going without sleep is the mark of a dedicated worker.

Col. Ramona Fiorey, acting director of Quality and Safety, U.S. Army Medical Command at the Pentagon, said senior Army leaders are taking sleep, along with activity and nutrition, seriously now. Those three things are termed the Performance Triad and are considered key factors to increasing performance and resilience and reducing injuries and accidents.

Effects on Performance

Dr. Thomas J. Balkin, a scientist at Walter Reed Army Institute of Research in Silver Spring, Maryland, described findings from his research on sleep deprivation.

Participants were divided into groups, with some getting nine hours of sleep, others seven, five and three over a seven-day period. Participants were then given psychomotor vigilance tests each day to determine their reaction time to visual stimulus, he said.

The results showed marked declines for the five- and three-hour groups each day. After the seven-day trial period, the participants in all groups were allowed eight hours of sleep and tested again each day. Performance for all groups shot back up very quickly, especially on the first day. However, performance didn’t recover to pre-trial levels, except for those who “banked” sleep, or had nine hours of sleep the week before the deprivation.

Balkin noted that other studies from Department of Defense research laboratories have “demonstrated the significant effects of sleep deprivation and fatigue on cognition, attention, reaction time and moral reasoning, all of which are critically important for operational effectiveness.”

Research also suggests, he said, that “more is better” when it comes to sleep and that getting more than eight hours of sleep a night establishes a sleep reserve in case sleep is lost one or more nights in the future.

Sleep Disorders

One in 20 active-duty Soldiers are on sleep medications, according to the Army Office of the Surgeon General, or OTSG, “Health of the Force” report released in December.

Lt. Col. Jacob Collen, a sleep-medicine physician who also specializes in pulmonary issues on Joint Base San Antonio, Texas, told the summit that physicians usually prescribe Ambien, or zolpidem, to Soldiers suffering from insomnia. While it does work in getting Soldiers to fall asleep, zolpidem is a sedative, and it’s also known as a hypnotic.

Collen said that since there are only 24 sleep specialists in the Army, serving more than 1 million troops, an attending physician may not realize that there are non-prescriptive treatments that are effective for sleep issues.

Currently, the most effective treatment is cognitive behavioral therapy for insomnia, or CBTi, he said.

Lt. Col. Ingrid Lim, sleep lead for Performance Triad, OTSG also described BBTi, or brief behavioral therapy for insomnia. BBTi is not only effective in treating sleep problems, but can also be used with patients who have medical and psychiatric conditions, and it can be delivered in a primary care setting.

CBTi treatments last several weeks and BBTi less, she said. Both involve encouraging change to thought patterns and behaviors that are the underlying causes contributing to poor sleep.

While CBTi and BBTi are evidence-based and clinically proven to be effective, there are, unfortunately, “watered-down versions” of those therapies that are out there, Collen said. These pseudo-versions cherry-pick from the manual rather than using the full approach.

“We want Soldiers to get the rigorous, evidence-based version,” he said. “It would be better to have no treatment at all than to get the wrong one.”

The solution, Collen said, is to provide more physicians — not just the 24 sleep specialists — training in CBTi and BBTi. Mobile training teams could be used to educate health care providers, including integrated behavioral health consultants.

Lim said that another common sleep disorder Soldiers suffer from is obstructive sleep apnea, which occurs when breathing stops and then starts in cycles. She said the treatment for that is a Continuous Positive Airway Pressure, or CPAP device, which pumps oxygen into the nasal passage to restore normal breathing.

Inadequate Sleep

Lim said inadequate sleep, meaning less than seven or eight hours, is a huge concern.

The Health of the Force report notes that one-third of Soldiers get five hours or less of sleep per night, and 62 percent of Soldiers get less than seven. The report lists possible effects of inadequate sleep:

– Increased musculoskeletal injuries

– Risk of behavioral health disorders

– Greater susceptibility to illnesses

– Likelihood of developing symptoms of anxiety, depression and post-traumatic stress

And finally, the report notes that “individuals who routinely get five to six hours of sleep perform much like a person with a blood alcohol content of 0.08.”

Lim said there are many steps Soldiers can take themselves to get better rest. The three prongs of the Performance Triad – sleep, activity and nutrition – interact with each other. Limiting junk food and not drinking caffeinated beverages before going to sleep are two examples of how to positively impact sleep, she said.

If Soldiers are not eating right or exercising, sleep quality suffers, so they might want to change what they’re doing, she said.

“Sleep needs to be a Soldier’s resource like ammo,” Lim said. “Are you going to go across the line without adequate fuel for your vehicle, ammo and food? Why are we going to cross the [line of departure] without sleep?”

Army seeks feedback on new Performance Triad app

By DAVID VERGUN
Army News Service

Important information and helpful links on sleep, activity and nutrition — the three components of Performance Triad — are now available as an app that can be downloaded to any smartphone.

While version 1.0 of the app is useful in its current form, future versions will contain interactive features, said Lt. Col. Myong S. Woo, health informatics officer and technical lead for Performance Triad. The Army Office of the Surgeon General would like to receive feedback from Soldiers, Army civilians and family members about exactly what they would like the app to feature, she said, as app developers are meeting next month to discuss future versions.

Important information and helpful links on sleep, activity and nutrition -- the three components of Performance Triad -- are now available as an app that can be downloaded to any smartphone. (Photo by David Vergun)
Important information and helpful links on sleep, activity and nutrition — the three components of Performance Triad — are now available as an app that can be downloaded to any smartphone. (Photo by David Vergun)

Commanders have already expressed interest in an interactive dashboard feature that would allow them to provide guidance to their troops or answer any questions or concerns they might have, she said, adding that Soldiers would have complete control of their confidentiality.

Perhaps Soldiers would like a daily inspirational message or tips on managing work, while getting the proper amount of sleep, or a nutritional tip of the day. Other possibilities, she said, include entering steps taken per day and hours of sleep or food eaten to track sleep wellness or calories.

Feedback like this will help guide future app development, Woo said, noting that “it’s now very much a work in progress.”

Users can visit their app store for this free app for iPhone, Android or Windows. Search for “Performance Triad” and download the app to the smartphone.

Once the app is downloaded, avatars of a Soldier, Army civilian, family member and retiree will be displayed. Users should click on their avatar, which will open up content most applicable to them, she said.

Content in the app is organized by the three sleep, activity and nutrition categories. Within each category are such things as frequently asked questions and links to helpful sites like Army wellness centers, the Human Performance Resource Center and Operation Supplement Safety.

After reviewing the content, users should click on “review” to provide feedback, she said, adding that she hopes squad leaders and other leaders can promote the app to their Soldiers and their own family members.

The app supports the Army’s Ready and Resilient Campaign by giving Soldiers and family members the tools they need to maintain peak performance, Woo said, adding that August is Performance Triad month, and it’s also the one-year anniversary when the first Performance Triad pilot course started.

The Army Public Health Command, U.S. Army Training and Doctrine Command, U.S. Army Combined Arms Support Command and U.S. Army Sustainment Center of Excellence also participated in the apps development and will participate in future revisions, Woo said.

Performance Triad fosters professional Soldier athletes

By MARTHA C. KOESTER
NCO Journal

Army officials are looking to usher in a new era of the professional Soldier-athlete, led by graduates of the Performance Triad course, which was piloted at three Army installations this year. The course focuses on three tenets ─ nutrition, sleep and activity ─ as the keys to optimizing Soldiers’ performance. After the data and feedback collected is reviewed, which is expected to be complete in the spring, the Army will determine if the Performance Triad concept will be rolled out to the rest of the force.

“This is the stuff that [Soldiers] already do,” said Sgt. 1st Class Darin E. Elkins, who works in the rehabilitation and reintegration division of the Office of the Surgeon General of the Army in Falls Church, Va. “They already eat, they already sleep, they are already active. We are giving them a guide on how to use those tenets better.”

Don’t call it a ‘program’

Not to be dismissed as just the latest Army program, Elkins said, the Performance Triad offers an opportunity for real change.

“We see it over and over again,” he said, “that Soldiers come into this thinking it is just another Army program, another rock in their rucksack, and they are only there because they have to be. But within an hour of understanding what it actually is, the light goes on, and their attitude changes.”

Soldiers are supplied with a guidebook and a Fitbit Flex wireless wristband, which helps track their nutrition, sleep and activity levels. A host of apps for mobile devices, including ArmyFit, MyFitnessPal and Fitbit Dashboard, are also recommended for Soldiers to further record their progress.

“We want to build a more resilient, more ready Soldier,” Elkins said. “A stronger Soldier that we can develop into a Soldier-athlete ─ that’s the mission.”

Prevention counts

"Some of the guys come in here drinking three Monsters a day," said Sgt. First Class Darin Elkins, senior enlisted advisor for the Rehabilitation and Reintegration Division and Performance Triad instructor. "There is an app called Fooducate, and we show them that this is a D- quality food, and these are all of the products that are in it. They are always shocked and say 'I don't want to drink that!' The Performance Triad shows them that there are better options for performance and how it affects their day to day life - in the Army and then beyond." (Photo by Meghan Portillo)
“Some of the guys come in here drinking three Monsters a day,” said Sgt. First Class Darin Elkins, senior enlisted advisor for the Rehabilitation and Reintegration Division and Performance Triad instructor. “There is an app called Fooducate, and we show them that this is a D- quality food, and these are all of the products that are in it. They are always shocked and say ‘I don’t want to drink that!’ The Performance Triad shows them that there are better options for performance and how it affects their day to day life – in the Army and then beyond.” (Photo by Meghan Portillo)

As health insurance costs continue to rise, the Army believes preventive care is crucial in its quest for healthier Soldiers. Long-term health benefits, reducing the risk of diseases and reducing the risk of health-care costs are behind the Army’s commitment to the Performance Triad.

“It’s very expensive to bring a new Soldier in, train him, feed him, clothe him. And then, if they’re broken, they’re of little or no use,” Elkins said. “The Soldier’s Creed says, ‘I will maintain my arms. I will maintain my equipment. I will maintain myself.’ But how do you maintain yourself? This is a guide to show how you do it.”

“As a medic, I think the Performance Triad is really good for overall wellness ─ that the body being healthy can overcome illnesses on its own,” said Sgt. Aaron Ormerod of Joint Base Lewis-McChord, Wash., the site of one of the pilot courses. “It’s a great idea for helping people to help themselves, rather than relying on the Army always handing out antibiotics for every little thing.”

During the 26-week course, which was also piloted at Fort Bliss, Texas, and Fort Bragg, N.C., squad leaders educated Soldiers on the importance of nutrition, sleep and activity, using an informal type of setting. Leaders were encouraged to use personal experiences to connect with their Soldiers during discussions.

“Whatever your approach is, we want you to look at your approach, whatever you do to motivate your Soldier,” Elkins said during a leaders’ course at Fort Bliss. “Again, it’s not a program. It’s a change in the DNA of the Army, so we change the DNA of society.”

“If you are a good squad leader, you are the center of your Soldier’s Army universe,” said Sgt. Maj. Michel Pigford, a Performance Triad instructor from the Office of the Surgeon General of the Army. “The knowledge you get from your sergeant is like no other.”

The 3rd Squadron, 38th Cavalry Regiment, 7th Infantry Division at JBLM; the 4th Battalion, 6th Infantry Regiment, 4th Brigade Combat Team, 1st Armored Division at Fort Bliss, and the 189th Combat Sustainment Support Battalion, 82nd Sustainment Brigade, 82nd Airborne Division at Fort Bragg took part in the pilot course.

“[The Performance Triad] is a tool just like anything else,” said Sgt. Brendon Wellendorf of JBLM. “As an NCO, my job is to ensure that my Soldiers are ready for their mission at hand. If they aren’t healthy, or they’re not physically fit enough to complete the mission, then I failed my job. So this is just another excellent tool to put in the toolbox.”

“I want to use this class to learn about the tools … and how to better talk to my Soldier,” said Staff Sgt. Christopher Stambaugh of Fort Bliss. “I know he eats some fruits and vegetables, and he doesn’t eat fast food too often, so that’s good. But I know he could use more exercise.”

Recipe for success

The Performance Triad formula is simple for building healthier Soldiers. It calls for at least 150 minutes of activity per week, eating eight servings of fruits and vegetables daily, and getting seven to eight hours of sleep a day. It also means cutting out popular energy drinks such as Monster and Red Bull, and cutting back on cheeseburgers.

Sgt. Maj. Michel Pigford; Performance Triad senior enlisted advisor; speaks to a classroom of NCOs during Performance Triad training Oct. 3 at Fort Bliss; Texas. (Photo by Meghan Portillo)
Sgt. Maj. Michel Pigford; Performance Triad senior enlisted advisor; speaks to a classroom of NCOs during Performance Triad training Oct. 3 at Fort Bliss; Texas. (Photo by Meghan Portillo)

“I am amazed at how just wearing the FitBit Flex on your wrist makes Soldiers constantly think about that stuff,” said Staff Sgt. Adam Wolf of JBLM. “I had a couple of guys who decided not to go eat at Burger King because they didn’t want the additional calories on their nutritional sheet. So it’s a constant reminder throughout the day that they need to be trying to do things that optimize their performance.”

“We’re going to give you information on those Monsters [drinks] you love so much,” said Pigford during a squad leaders’ course at Fort Bliss. “There was a Soldier yesterday who found out that [the drinks] had the same properties as the carpet you walk on. He decided he wasn’t going to drink that anymore. But we’re not asking Soldiers to cut out everything they do.”

Physical activity is another important component of the Performance Triad concept.

“With the Fitbit Flex, we have had an increase in what Soldiers are actually doing,” Wolf said. “Now, I have Soldiers who no longer drive to work from the barracks or drive to the motor pool. They actually walk, because we have a competition to see who can get the most steps in a week. We’re seeing Soldiers become more active in their everyday activities versus just doing physical training at one period of time.”

When it comes to sleep, the Fitbit can help track the number of hours each Soldier gets, as well as offer insight into patterns and whether a deep sleep was achieved.

“If [a Soldier is] out eating junk food every night and only getting four hours of sleep because they’re out playing video games as soon as they get off work, you’re not going to have a very effective Soldier the next morning,” Wellendorf said. “[The Fitbit] is something that allows you to see exactly what [the Soldier’s] performance is when you’re not monitoring.”

Pigford and Elkins offered a list of information on sleep to a class of squad leaders at Fort Bliss.

“You have lost 20 percent of your cognitive ability just by not getting 6 to 8 hours of sleep,” Pigford said. “You wake up 20 percent dumber.”

“That means you pull your trigger slower,” Elkins added. “That means you drive your vehicle slower. That means you can’t process questions as fast. You’re not able to respond as fast.”

Change afoot

NCOs are the focus of the Performance Triad pilot course because Soldiers and squad leaders are the ones who make things happen, Elkins said.

“If you look at Army programs across the board ─ Sexual Harassment Assault Response and Prevention, Operations Security ─ it’s from the leadership down,” he said. “This, on the other hand, is from the Soldier up, how it impacts the unit and on up.

“That’s why we’re doing this ─ for you,” Elkins told Soldiers in one of the pilot courses at Fort Bliss. “This is not a program, this is a lifestyle. If you want to invoke change, you have to take part. Be part of the change.”

Ultimately, the goal of the Performance Triad plan is not to change people’s minds, Elkins said, but to show that there are better options to attain an optimal performance.

“I found that Soldiers became significantly more involved, that everyday they were saying things like, ‘Hey, man. It’s 9 o’clock, and I met my goal: 10,000 steps. I think I’m going to up my goal for the next week and see if I can do that,’” Wolf said. “Guys are actually bragging about it. It creates a healthy competition, I think.”

NCO Journal Writer Meghan Portillo contributed to this story.

For more information

Learn more about the Performance Triad and find some helpful tools at http://armymedicine.mil/Pages/performance-triad.aspx