Some US war veterans long for sleep - bingeing on alcohol for sedation - others fear it, writes Jia-Rui Chong
BY THE time the sun begins to rise over his Mira Mesa neighbourhood, Mitch Hood has been up for about 18 hours.
He washes a caffeine tablet down with two cans of Red Bull, and finishes it off with a gulp of Pepsi. He figures this will keep him awake for four more hours. Then, he jumps back into his video game.
Hood, 25, spent two tours with the marines in Iraq. Now, like many other veterans and millions of civilians, he faces a new enemy: sleep.
"I'm afraid I'm going to have nightmares and I'm going to get stuck there," he says. "I try with all my strength not to sleep."
When he eventually crashes and sleep overtakes him, Hood relives combat, or sometimes his mind creates new horror-filled scenarios. Once, he punched his fiancée, Natalya Gibson, while having a nightmare.
Sleep and wakefulness issues were the most common health problems described by recently returned soldiers, researchers at Walter Reed Army Medical Center found in a study published last year.
About 36 per cent of army troops who have been back from Iraq for a year said they struggled nearly every day with feeling tired.
About 34 per cent said they had difficulty falling asleep, staying asleep or sleeping too much, nearly every day.
About one-third of the total US adult population reports sleep problems, but studies have shown that such problems are much more common in combat veterans than in other young adults, says Steve Woodward, a sleep expert at the Department of Veterans Affairs centre on post-traumatic stress disorder (PTSD). About 70 per cent of veterans being treated for the disorder have sleep problems, he says.
Sleep is a vulnerable state, Woodward says. "When animals are exposed to a severe threat . . . the basic adaptation is to wake up more frequently," he says.
Bill Rider, a 63-year-old Vietnam veteran, knows the signs. He has seen Hood and others like him in group meetings which he helps organise in Oceanside for combat veterans of different generations.
Some veterans have told him of how they long for sleep, bingeing on alcohol for sedation. Others, like Hood, fear it. Rider has seen veterans stay up for 72 hours and work themselves into a delirious, manic state.
Thinking about Hood, he says: "That was me 30 years ago." During his tours in Iraq in 2003 and 2004, Hood dug trenches and hauled 100-pound cables as a field wireman in marine wing communications squadron 38 out of marine corps air station Miramar.
The pressure was always on during those assignments, he says, because the communication lines were essential for air strikes and medical evacuations.
There were days when "I'd be lucky to get four hours of sleep", says Hood. "It got to the point where we had to choose between bathing ourselves and sleep, between sleeping or eating."
In 2004, Hood returned to San Diego from Iraq and left the marines two years later with an honourable discharge. He is now an online student, studying computer science. A few months ago, he found out that he had a herniated spinal disc and sciatica, forcing him to use a cane. Hood thinks the pain probably makes his sleep less restful, but the main problems are the terrifying dreams that begin almost immediately after he closes his eyes.
A doctor has prescribed a low-dose antidepressant called trazodone, which has a sedative effect. "I use it here and there," Hood says. But "it basically sticks me in an eight-hour nightmare fest, so that's not a solution for me".
Doctors know it can also be risky to prescribe sleeping pills to veterans with PTSD, because up to 60 per cent of them struggle with substance abuse, says Dr Tasha Souter, medical director of the trauma recovery program at the VA Palo Alto Health Care System. Some doctors have had some good results prescribing Ambien, which is less addictive, and the hypertension drug prazosin, which can reduce nightmares.
But there is no panacea. "Sleep problems are one of the most difficult symptoms of PTSD to treat," Souter says. "It's not uncommon for veteran patients to have 20, 30 years of difficulty sleeping."
In time, Hood tries to avoid sleep. A recent period of wakefulness began when he rose at noon one Thursday after about three hours of bad sleep. He dreamed he was in the middle of a chemical attack, and awoke wondering why he wasn't wearing his chemical suit.
The dream was veined with the fear he felt during one incident in Iraq. Sirens went off indicating a possible chemical attack. Hood couldn't make it back to the bunker, so he was lying face-down in a gutter. He couldn't get his gas mask to seal. Twenty minutes later, the all-clear siren finally sounded.
He was trying to banish the chemical attack nightmare from his thoughts when he shows up at the weekly meeting of the American Combat Veterans of War in Oceanside.
As group members went around the conference table describing work and medical issues, Rider, the Vietnam veteran, looked over at Hood. "You look great, by the way," Rider says. "Do you feel better?"
Hood wonders whether it was his new haircut. "No," he tells Rider. "No, not really."
Ray Metcalf, a 74-year-old Korean War veteran approaches Hood and another young Iraq veteran during a smoke break and asks: "Do you have bad dreams?"
As the young men nod, Metcalf recounts a nightmare he had a few weeks previously about getting shot down in a helicopter in Korea. Metcalf says that he read in a booklet on PTSD that it's best to get out of bed if you can't sleep. He recommends going into the living room to watch a movie.
Hood listens intently.
Later, as he stands outside smoking, he starts to think about one of the most horrifying incidents of his second tour.
He closes his eyes as he talks about the time he was on a convoy and a roadside bomb blew up a Humvee in front of him. His buddy, a turret gunner, died in the blast. The convoy stopped, but another improvised explosive device was found behind them. A civilian bus drove over the bomb before it could be disposed of.
In one recurring dream, he says: "I'm up there with my buddy. I pull him out of the Humvee. The medevac helicopter is on top of a hill. I'm carrying him. He keeps getting heavier and heavier and sinking into the ground and I drag him. Gravity is increasing. I can't get him to the chopper."
He pauses, lost in thought. The rumble of morning traffic hangs in the air.
Hood says talking to the other soldiers about sleep problems has "really taken a load off my shoulders to know I'm not the only one".
But he isn't sure how to apply their advice. He has been thinking about getting a dog, which he says would help him feel someone else was on watch.
"I'll try anything," Hood says. "I'm almost at the point where I'd be willing to give a body part for one good night's sleep, no nightmares, the type of sleep where you wake up feeling renewed."
In the meantime, 19 hours has passed since his nap and Hood is waiting for the caffeine to kick in. He is waiting for his second wind.
- (LA Times/Washington Post)