Sleep Disturbances Linked to Chronic Pain in Military Personnel

Sleep disturbances and chronic pain are closely linked among military personnel, according to findings published in the Journal of Sleep Research.

Researchers conducted a scoping review of 16 observational and interventional studies that evaluated both sleep and pain outcomes in active military and veteran populations. Eligible studies, conducted through April 2024, assessed sleep impairment and chronic pain simultaneously, with several also examining psychiatric variables such as depression, anxiety, posttraumatic stress disorder (PTSD), and suicidal ideation. Studies focused on cancer-related pain, sleep apnea, or traumatic brain injury were excluded.

The final cohort included 15,060 participants, of which 12,360 were used for analysis. The majority of analyzed participants were veterans (97%) and men (53%), and the mean (SD) age was 42.03 (6.47) years. Of the 16 studies, 9 were observational and 7 were interventional, including 4 randomized controlled trials and 3 quasi-experimental designs.

Observational data suggested a bidirectional association, with poor sleep predicting worse pain outcomes over time, and chronic pain associated with the development or persistence of sleep disturbances. Depression, anxiety, and PTSD emerged as consistent covariates across studies.

Intervention trials assessed a range of nonpharmacologic treatments, including behavioral therapy for insomnia, resistance training, mindfulness, hypnosis, bright light therapy, and biofeedback. Several studies demonstrated that improvements in one domain, like sleep, were associated with secondary improvements in pain or mental health symptoms. Resistance exercise and mind–body programs were associated with improved sleep quality and reduced pain intensity.

However, findings across studies were heterogeneous. Tools used to assess pain and sleep varied, with the Brief Pain Inventory and Pittsburgh Sleep Quality Index being the most frequently used. Follow-up durations also ranged widely, from 13 days to 18 years. Only a few studies included objective measures such as actigraphy.

Study limitations include inconsistent diagnostic criteria, variable study quality, and a lack of standardized intervention protocols. The authors also noted that the causal direction between sleep and pain could not be definitively established.

“Our scoping review demonstrates clear connections between chronic pain, sleep quality and overall quality of life, underscoring the importance of assessing and monitoring the impact of pain in the military, regardless of age and gender,” the study authors concluded.