Sleeping Challenges and Solutions


Sleeping BabyThis post is based on the article written by Anthony Panettiere, a Neurologist and Sleep Medicine Specialist at the National Intrepid Center of Excellence. The article was written for the military community, but the wisdom of Panettiere’s article pertains to all people, whether or not they are recovering from a major adversity. Text under the heading “Article” is from Panettiere’s article but, questions under the same heading are from the DoDLive summary of Panettiere’s article.

The appearance of external hyperlinks does not constitute endorsement by the United States Department of Defense, the United States Department of the Navy, or the Walter Reed National Military Medical Center (WRNMMC) of the linked web sites, or the information, products or services contained therein. For other than authorized activities such as military exchanges and Morale, Welfare and Recreation (MWR) sites, the United States Department of Defense, the Department of the Navy and Walter Reed National Military Medical Center (WRNMMC) do not exercise any editorial control over the information you may find at these locations.


Advances in protective equipment have helped minimize injuries to the head, chest and abdomen, resulting in lower death rates. What would have been a lethal injury to the head in the past, now results in traumatic brain injury (TBI) instead.

In patients with TBI and PTSD [Post Traumatic Stress Disorder], sleep is almost universally affected. The most common symptom is insomnia (difficulty falling asleep, staying asleep, or waking up too early). The cause is often complex and not usually resolved by simply using sleep medications. Often there is a interplay between the insomnia and additional symptoms such as headaches and chronic pain, mood disturbance, nightmares and hyperarousal. Treating any one of these symptoms, while possibly helpful, is usually not sufficient for fully relieving the insomnia.

A study of more than 700 patients at the National Intrepid Center for Excellence found sleep-disordered breathing  occurs at a surprisingly high rate in TBI and PTSD patients. With this condition, a patient will either stop breathing or breathe shallowly throughout the night, causing arousals and sleep disturbance. Like insomnia, sleep-disordered breathing is complex and often involves multiple factors. As is often the case in TBI, other injuries of the musculoskeletal system can occur that may limit the ability to exercise, resulting in potential weight gain. Increasing body fat has clearly been associated with an increased risk for sleep-disordered breathing, according to the medical journal SLEEP. Chronic pain conditions may also prompt the need for certain medications, many of which can promote sluggishness and weight gain.

Treatment options for sleep-disordered breathing include diet and exercise to reduce body fat, nasal continuous positive airway pressure therapy, an oral appliance and surgery. The nasal therapy is regarded as the gold standard. Ambient air is drawn into a small motorized device, pressurized and delivered to the patient via a hose and mask. The air column keeps the airway open, preventing pauses in breathing. Surgery is the last option since, like any surgery, it comes with some risks.  

The average wakefulness for a person is 16 hours, meaning that if you awoke at 6 a.m., you would tend to get sleepy around 9:30-10 p.m. Exercise promotes your ability to fall asleep in the evening and stay asleep throughout the night. Patients can work up to doing 45 minutes a day of moderate exercise including both cardio and muscle-toning exercises. Check with your doctor before embarking on an exercise regimen.

What can you do if you are having difficulty sleeping or feeling well rested while you are recovering from TBI, PTSD, or both? In its summary of Panettiere’s article, the DoDLive suggests the following activities:

  • Talk to your doctor. An underlying issue may be contributing to your sleep problem. Make sure you keep an open dialogue with your healthcare provider to ensure all symptoms and concerns are addressed.
  • Eat healthy and engage in doctor-approved moderate exercise. Poor diet and excess body fat can contribute to sleep-disordered breathing and wakefulness. Staying in shape and eating right will help keep your body on track. Panettiere recommends “45 minutes a day of moderate exercise, including both cardio and muscle-toning exercises.” His advice comes with a strong warning: check with your doctor before starting an exercise regimen.
  • Stick to a schedule. Consider waking about the same time every day during the week and no more than one hour later on weekends. Also, beds should be used for sleep only; no books, TVs, electronic devices, homework or talking on the phone allowed. Make sure while you’re there that you’re logging seven and a half to eight hours of sleep each night.
  • Help yourself unwind. Panettiere tells his patients ‘you really only control waking up, not falling asleep.’ Try to avoid naps during the day and turn your mind towards low-key, comforting thoughts and activities about an hour before bedtime to help your body transition.

Call to Action

Please use the text box below this post to share the solutions that enable you to sleep soundly and wake up feeling well rested.


Click here to read another post about sleep.

If you want to read Panettiere’s full article, click here.

Thanks to Google for helping me find both articles I used in this post; Bing for helping me find the picture I used in this post; Anthony Panettiere for writing the original story; National Intrepid Center of Excellence for committing its resources to the original article; DoDLive for summarizing the article; and all the other people who, directly or indirectly, made it possible for me to include the picture and text I used in this post.


2014-0429 Dr PanettiereDr. Panettiere is neurologist and sleep medicine physician at the National Intrepid Center of Excellence (NICoE) at the Walter Reed National Military Medical Center in Bethesda, Maryland. He is a retired Navy Captain who served 25 years on active duty, including a tour as the Navy Surgeon General’s Specialty Leader for Neurology, and was involved in the establishment of the sleep laboratory at Naval Medical Center Portsmouth.

Dr. Panettiere earned a Bachelor of Science Degree from Shippensburg University in 1982, and then attended medical school at the Uniformed Services University of Health Sciences (USUHS), earning his Doctor of Medicine degree in 1986. After completing his internship in Family Practice at Jacksonville Naval Hospital, he then received Flight Surgery Certification in Pensacola Florida, serving as a Flight Surgeon at Naval Test Center Patuxent River MD. After serving with U.S. Marine combat forces in Operation Desert Shield and Storm, he then completed Neurology Residency at the National Naval Medical Center in Bethesda. He later completed a Sleep Medicine and Epilepsy fellowship at Duke University Medical Center.

Dr. Panettiere is Board Certified in both Neurology and Sleep Medicine, and is a member of the American Academy of Neurology (AAN), the American Association of Sleep Medicine (AASM) and the American Medical Association (AMA). In addition to his clinical work, he has co-authored several posters on Sleep and TBI/PTSD. He also has given numerous lectures on the topics of Sleep Disturbances in TBI and PTSD, Headache Assessment in TBI and PTSD, and “How to Make your Medical Presentation Memorable.”


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