PHOTOS: SHUTTERSTOCK

Shortly after returning home from his first combat engineer deployment to Iraq in 2007, Ben Weakley woke up in the middle of the night. Before he was fully conscious, he realized he was throwing objects around his bedroom, hunting for a rifle.

That was followed by evenings when he would wake up with night terrors, soaked in sweat and “screaming so loud that I scared the children and drove my wife from our bed.”

In the military, 40-70% of service members have insomnia, and more than 70% say they get less than seven hours of sleep a night. And the problem often doesn’t go away after people retire from the armed forces.

The stress of serving in war zones obviously plays a part in those numbers. But Anne Germain, a world-renowned sleep expert who runs a new sleep health company in Pittsburgh called Noctem Health, says military sleep deficits go beyond that.

Germain says she thinks the military might actually have an unconscious bias toward recruiting and promoting people who can function with less sleep than normal.

Dr. Vincent Mysliwiec, a leading sleep researcher in San Antonio, Texas who retired as an Army colonel in 2019, says a 24/7 mindset also contributes.

“Most jobs are 8 or 10 or 12 hours, but military commanders typically have around-the-clock on-call jobs, overseeing from 40 to 300 service members until they give up those positions,” he says. On top of that, there is the “inherent stress of your position, because when you make a mistake when you’re serving in the military, it’s a little different than, ‘I mismanaged the accounting.’”

Germain says that stress doesn’t stop after retirement. “Being hypervigilant and not sleeping that much might be good for survival. But I’ve talked to hundreds of soldiers who say, ‘I’ve been back for years and I sleep at home the same way I slept in the field.’”

To help service members and others who experience insomnia and other sleep issues, Germain has developed a comprehensive digital platform that allows health care providers and their patients to get the latest evidence-based advice on solving sleep problems.

For the 15% of service members who suffer post-traumatic stress disorder or PTSD, sleep problems are even worse, as Weakley, who retired from the Army in 2019, and Jonathan Simmonds can attest.

Simmonds, of Pinehurst, North Carolina, retired from the Air Force Special Operations Command as a master sergeant in 2021. When he joined the Air Force in 2009, “I could hit the pillow and fall asleep immediately. Toward the end of my career I was so anxious that I would sleep only intermittently. I couldn’t fall asleep at night. I wouldn’t sleep for three or four days and then I would crash for a night.”

If I get three or four days of less than four hours of sleep a night, I’m in trouble. I will get paranoid …my ability to regulate my nervous system is shot.

—Ben Weakley

She Admired Their Courage

Germain first got involved in sleep analysis nearly 30 years ago, when she was an undergrad in Montreal, looking for research experience. The director of a dream research lab gave her a chance to work there, and “I totally fell in love with it,” she says. “We were studying dreams and working with people who suffered from nightmares related to traumatic experiences, and these people were so strong and resilient, despite all their difficulties.

“What they kept asking was, ‘If only I could have one good night of sleep,’ and I thought, I can do that. I can give people one good night of sleep.”

Eventually, she landed at the University of Pittsburgh, where she developed an international reputation, especially in working with military veterans and others suffering from PTSD. She took a leave from Pitt in 2019 to found Noctem Health.

Patients with Noctem’s COAST app — which stands for Clinician-Operated Assistive Sleep Technology — can track their sleep quality and quantity, keep a daily log and get personalized advice on making adjustments. The COAST algorithm offers possible solutions to individuals’ sleep problems, based on cognitive behavioral therapy principles and the patient’s individual experience, but leaves the final decision in the hands of the patients and their doctors.

Germain says one motivation for developing the app is that there is a shortage of sleep specialists around the nation, and COAST can help overcome that gap. Most people fail to stick with self-tracking sleep apps on their own, she says, so involving patients’ doctors in the COAST app is crucial.

“It’s the principle that you’re accountable to other human beings,” she says. To date, COAST is being used by more than 600 patients in 19 clinics and 12 military treatment facilities around the nation, and Noctem Health recently signed an agreement to expand into Canada.

The app is designed for anyone to use — studies show that about a third of the civilian population suffer from insomnia or insufficient sleep — but it still has a strong focus on the military, in part because the company has received $4.8 million in funding from the U.S. Department of Defense, its largest single source of financial support.

COAST Was a Lifeline

Simmonds, the former Air Force officer, worked for Noctem Health when he left the military last year, so he got to see it as a patient using the app and an employee helping to develop it for use by the Veterans Health Administration and other groups.

In November 2022, he made the decision to stay at home to take care of his daughters, a 7-year-old and a 9-month-old who gurgled happily on his lap during a recent Zoom interview. Simmonds tried several treatments for his sleep problems before his medical retirement, but the COAST app was the first technique that gave him any lasting relief.

At first, though, it actually made his sleep worse, a not uncommon experience when doctors are trying to get people on a regular sleep schedule.

“When I had insomnia,” he says, “I actually had more flexibility on when I could go to sleep,” but Germain, who served as his sleep doctor, wanted him to stick to a regular time for going to bed and rising. In fact, she and other experts say that one of the most important practices for someone with insomnia is getting up at the same time each day, regardless of how poor their sleep was the night before.

Eventually, “I actually started to normalize my sleep, and it was nice to be able to talk with Anne when I needed to. It wasn’t just a standard [therapy] process, because it was tailored to my needs.”

His combat experience gave him a lot to overcome. Many people don’t realize that the Air Force has special operations officers who work with Green Berets, SEALS and other special units to call in air support. When he wasn’t communicating with air traffic controllers, Simmonds functioned like any other soldier. He frequently hoisted a shoulder-mounted recoilless rifle whose noise and vibrations gave him small traumatic brain injuries. “There were many times I fired that shoulder-mounted weapon more than the recommended number of times a day and by the end of the day I was nauseated and throwing up, which are the typical signs of having a TBI.”

Simmonds, who deployed to Africa, Yemen, Iraq and Afghanistan, also was nearby when several improvised explosive devices, or IEDs, and door breaching explosions went off, which also sent shock waves through his brain.

After 13 years, “I started thinking, why is my cognition so much worse than it used to be? Why can’t I remember where I put my keys?” While he still receives treatment for his PTSD, Simmonds holds no bitterness over his military service. “I absolutely loved my job and loved serving. It was unfortunate I had to stop, honestly speaking.”

Weakley, the Army veteran who lives in Kingsport, Tennessee, knows full well how the sleep patterns of the war zone follow you home.

“When you’re in an environment where you’re sleep-deprived and going to sleep at the wrong time can be life threatening,” he says, “sometimes going to sleep at home began to feel kind of dangerous. My body would shut down but I’d jerk myself awake. My wife would talk about my whole body shuddering.”

While he hasn’t received any specific treatment for his sleep difficulties, Weakley says he knows how important good sleep is in mitigating his PTSD. “My lived experience is that when my sleep gets worse — if I get three or four days of less than four hours of sleep a night, I’m in trouble. I will get paranoid. I get very, very anxious, the hypervigilance goes through the roof, and my ability to regulate my nervous system is shot.”

Weakley is director of development at Community Building Art Works in Bethesda, Maryland, which builds bridges between veterans and civilian life through writing and art. He has published one book of poetry, “HEAT + PRESSURE,” and is working on a memoir about his military service. He says writing has been a major form of therapy and self-discovery for him.

To find out more about Noctem Health, go to noctemhealth.com/about

Overcoming Nightmares

One major issue Weakley and many other veterans have faced is bad dreams.

Matthew Walker, a well-known sleep specialist at the University of California at Berkeley, says we all experience such dreams, but normally, our brain lets us process these experiences without the surge of fight-or-flight hormones that would be present if we were awake.

When our dream state functions normally, he says, it allows us to deal with what bothers or frightens us so that we don’t experience the same rush of emotions the next time we encounter those situations.

People with PTSD often can’t handle dreams normally, though. In extreme cases, they will act out their negative dreams. More often, they will awaken violently, drenched in the emotions they originally experienced.

Germain agrees with Walker’s hypothesis and says there is an effective way to deal with this problem, a technique called image rehearsal therapy. With the help of doctors, patients can learn to rehearse their bad dreams and change the endings — and there is solid evidence that it actually works.

The image rehearsal therapy information is included in the COAST app, she says.

In her constant effort to find ways to make sleep healthier and more satisfying for veterans, there has been one major helpful development.

“The attitude in the military used to be, ‘You’ll sleep when you die.’ But now the belief is that sleep is key to maintaining the ability of warfighters. Monitoring and managing sleep as a means to optimize soldiers’ readiness has taken on a lot of weight.”

Mark Roth is a freelance writer and the former science editor of the Pittsburgh Post-Gazette.