Since the onset of the wars in Iraq and Afghanistan, the number of active duty servicemembers diagnosed with sleep disorders has increased dramatically.

The two most prevalent disorders include sleep apnea - interrupted breathing during sleep - and insomnia - trouble falling or staying asleep.

Recent data released by the Armed Forces Health Surveillance Center showed that in 2000 there were 3,563 active duty servicemembers diagnosed with sleep apnea and 1,013 servicemembers diagnosed with insomnia. In 2009, there were 20,435 diagnosed with sleep apnea and 19,631 diagnosed with insomnia.

"Since the onset of the wars, soldiers upon redeployment have more sleep problems," confirmed Lt. Col. Vincent Mysliwiec, the chief of Pulminary/ Critical Care/ Sleep Medicine at Madigan Army Medical Center. "The biggest increase in sleep disorders diagnosed is insomnia.  In 2003, insomnia accounted for about 10 to 20 percent of the patients we saw with sleep issues.  Now this number has increased to about 50 percent of our patients."

Although there is little evidence that directly ties the increase in sleep disorders to the ongoing wars, a study conducted by the University of Pittsburgh in collaboration with the National Institute of Health showed that soldiers who returned from the war in Iraq are highly prone to developing severe sleep disorders. This is due in part to the link between sleep conditions and traumatic brain injury and post-traumatic stress disorder.

Sleep disturbances including nightmares and insomnia are characteristics of PTSD.

More commonly, the flux is attributed to improved screening of soldiers upon redeployment for traumatic brain injury or PTSD - both of which are linked to sleep disorders.

"There is a greater awareness in the medical society that sleep apnea is there," Mysliwiec said. "Soldiers that present with a sleep disorder undergo a sleep study that helps to diagnose sleep apnea and other sleep disorders."

Risk factors of sleep apnea include: obesity, large tonsils or adenoids, shape of the head or neck, receding chin, enlarged tongue, being male, over the age of 40, and nasal congestion.

Insomnia is one of the most common reasons for referral to mental health services in active duty servicemembers, he said. Insomnia often develops into a chronic problem that is characterized by nighttime symptoms and daytime impairments, such as feeling drowsy, moodiness, lack of concentration, decreased energy, lack of motivation, and a decrease in work performance.

"Post-Deployment insomnia may reflect the persistence of heightened arousal during sleep, and irregular sleep-wake schedules acquired during the high-demand context of deployment and military operations," the University of Pittsburg study showed.

Similar to PTSD, servicemembers are being educated about sleep disorders.  Upon redeployment, servicemembers fill out health assessment forms that ask if they have issues with snoring, excessive sleepiness, morning headaches, decreased concentration, or choking or gasping while sleeping.

Then the servicemembers who meet the medical criteria undergo a sleep study called a polysomnography, a test that records the patient's brain waves, heartbeat, and breathing during an entire night.

"We all stop breathing during sleep," Mysliwiec said. "The only way to diagnose sleep apnea is a sleep study."

At MAMC the number of times this test is given also has increased in the past 10 years.

In 2003-2004, there were about 350 sleep studies performed on active duty servicemembers each year at MAMC.  In 2007-2008 there were 900 sleep studies performed, Mysliwiec said.

"We are nearing our capacity for the number of tests we can perform in a year," he said.

Once a diagnosis of sleep apnea is confirmed, there are three levels of the disorder characterized by the number of times the patient stops breathing during sleep.  Mild sleep apnea is a person who quits breathing 5 to 15 times per hour, moderate is 15 to 30 times per hour, and severe is a person who stops breathing more than 30 times an hour.

Depending on the severity of the disorder, there are several treatments available.  Mild sleep apnea can be treated with weight loss or changing sleep position.  Another type of treatment involves the use of a continuous positive airway pressure, or CPAP, device that generates air that inflates or keeps the airway open.

The most invasive treatment of apnea is bimaxillary advancement surgery, during which the surgeon makes incisions inside the mouth that separate the upper jaw from the skull, repositions the bones of the upper jaw, and cuts and repositions the lower jaw.

Madigan is one of the largest centers in the Department of Army that performs the surgery, he said.

"A lot of centers do not like to do the surgeries ... but it is a very good option," he said.

If left untreated, sleep apnea can lead to high blood pressure and other cardiovascular disease, memory problems, weight gain, headaches, and motor vehicle accidents.

"Sleep apnea mirrors the rise in obesity," he said. "If a person can lose ten pounds, it will improve their sleep apnea."