DR. JOSEPH MACFADDEN, Ph.D., M.S.
Research, Studies and Analysis
Directorate of Analysis and Prevention
U.S. Army Combat Readiness Center
Fort Rucker, Alabama
Obstructive sleep apnea (OSA) is a serious sleep disorder that affects a growing number of service members and veterans. It causes repeated interruptions in breathing during sleep, which prevents restful sleep and leads to chronic fatigue (Newson, R. & Singh, A, ). In a military setting, where focus, reaction time and decision-making are critical, this kind of fatigue can be dangerous. Alongside undiagnosed medical conditions like OSA, many service members also suffer from general sleep deprivation due to long hours, intense workloads or voluntary behaviors like excessive late-night gaming or internet use. Whether intentional or not, sleep loss is a widespread issue in today’s armed forces.
In fiscal year , the Department of Veterans Affairs (VA) reported that more than 571,000 veterans were diagnosed with service-connected sleep apnea, including obstructive, central and mixed forms. This made sleep apnea the most commonly compensated respiratory condition among veterans (U.S. Department of Veterans Affairs, 2023). Most of those diagnosed receive a 50 percent disability rating, largely due to the need for a CPAP machine to treat the condition (The Rep for Vets, 2023). However, changes to the VA rating schedule expected in 2025 may remove the automatic 50 percent rating and instead focus on how well the treatment improves daily functioning (VA Claims Insider, 2023).
Despite the large number of reported cases among veterans, OSA is likely underdiagnosed, especially among active-duty personnel. This is partly due to the high operational tempo of military life, which normalizes exhaustion. Soldiers often work long shifts, rotate between day and night operations, and sleep in challenging environments where quality sleep is sporadic. Fatigue is frequently accepted as part of the job, which means serious sleep issues may go unnoticed or unreported.
Many service members push through the symptoms out of concern for their careers or fear of being seen as weak or unfit for duty. In fact, according to the National Safety Council (), approximately 13 percent of workplace injuries can be attributed to sleep problems, which are closely linked to fatigue. However, these figures are likely conservative estimates, as fatigue-related incidents are often underreported due to various factors, including workplace cultures that discourage reporting and the subjective nature of fatigue symptoms.
In addition to medical sleep disorders, behavioral causes of fatigue are also a concern. Some service members knowingly cut back on sleep to stay up late gaming, watching shows or browsing the internet. While this may seem harmless, the lack of rest can impair performance, increase risk-taking behavior, and reduce physical and mental readiness. When combined with the stress of military duties, this kind of fatigue can contribute to dangerous outcomes.
Fatigue has also been linked to safety incidents. According to the Army Safety Management Information System (ASMIS) 2.0, there were 20 Class A on-duty ground mishaps and 11 Class A aviation mishaps in fiscal year , which resulted in 11 ground and 14 aviation fatalities. Of the 31 reported mishaps resulting in 25 fatalities, fatigue was identified in only four cases. Because fatigue is rarely tracked in detail in safety reports, the true impact may be significantly underestimated. This is indicated in other studies where personnel involved in mishaps later report that they were too tired, distracted or mentally foggy to safely perform their tasks (Ju, H., et al., ).
Fatigue can lead to unsafe practices, such as taking shortcuts or skipping steps in procedures, ignoring safety checks or making poor decisions in high-risk environments. When tired, even the most experienced personnel are more likely to cut corners. These shortcuts may save time in the moment, but they can increase the likelihood of injuries or deaths in training and operational missions.
To address these challenges, fatigue must be recognized by leaders not only as a personal health issue, but also as a critical factor impacting mission readiness. Programs and sources like Holistic Health and Fitness (H2F) and the Leader’s Guide to Soldier and Crew Endurance provide valuable tools, individualized assessments, and resources that promote overall wellness and emphasize the importance of quality sleep.
The H2F program helps service members combat sleep deprivation and daytime fatigue by promoting better sleep hygiene, physical readiness and mental resilience. Through integrated training and recovery strategies, H2F enhances alertness, reduces injury risk and improves overall performance.
The Leader’s Guide to Soldier and Crew Endurance (Alger, et al., ) is a practical resource for managing fatigue in military settings. The guide outlines clear fatigue indicators, offers countermeasures like adjusting schedules and promoting recovery, and emphasizes the benefits of strategic napping. It’s a valuable tool for leaders to improve Soldier readiness and maintain effectiveness during operations. Leaders play a key role in creating and maintaining a culture that prioritizes rest by normalizing conversations about sleep, reducing the stigma around fatigue and reporting fatigue or sleep issues, and making sure that screening and treatment for OSA and other sleep disorders are readily available. By taking a proactive and supportive approach, the military can enhance individual performance and reduce workplace injury because of fatigue.
Just as physical fitness and mental resilience are vital to the success of service members, so is quality sleep. If left untreated, OSA can lead to or worsen serious medical conditions, such as hypertension (high blood pressure), stroke and Type 2 diabetes, and impair cognitive function. Ensuring service members get the sleep they need can help prevent mishaps, protect lives and improve overall performance.
References
Alger, S., Boggs, J., Burke, T., Caldwell, J., Caldwell, J. L., Kelley, A., Mantua, J., Olins, E., & Riedy, S. (). Leader’s guide to Soldier and crew endurance. Retrieved from https://safety.army.mil/Portals/0/Documents/ON-DUTY/MILITARYOPERATIONSANDTRAINING/Standard/Leaders-Guide-for-Crew-Endurance.pdf.
Ju, H., Kim, H-C., Jang, S-W., Won, Y., Park, S-G, & Leem, J-H. (). Relationship between fatigue severity scale and occupational injury in Korean workers. Annual Occupation Environmental Medicine. Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC8203839/.
Holistic Health and Fitness (). What is holistic health and fitness? Retrieved from https://h2f.army.mil/Unit-resources/.
National Safety Council (). Fatigue in safety-critical industries: Impact, risks & recommendations. Retrieved from https://www.nsc.org/workplace/safety-topics/fatigue/fatigue-reports.
Newsom, R. & Singh, A. (). Obstructive sleep apnea: What it is, how to recognize it, why it matters, and how it can be treated. Sleep Foundation. Retrieved from https://www.sleepfoundation.org/sleep-apnea/obstructive-sleep-apnea.
U.S. Department of Veterans Affairs. (). Annual Benefits Report: FY 2023. Retrieved from https://www.benefits.va.gov/REPORTS/abr/docs/2023-compensation.pdf.
The Rep for Vets. (). VA Sleep Apnea Rating Changes. Retrieved from https://www.repforvets.com/sleep-apnea-va-rating-changes.
VA Claims Insider. (). VA Sleep Apnea Rating Changes Explained. Retrieved from https://vaclaimsinsider.com/va-sleep-apnea-rating-changes.