The Wars Are Not Over

US veterans are in trouble.  Veterans returning to the work place are finding it difficult to find jobs with their unemployment rate north of 12%, versus the (falsely low) figure of 9% for the country.  One reason is many have come back ill.  What sort of ailments is the question.

We can get a small idea in indirect ways.

Recently the Army’s research unit at Walter Reed did follow-up studies on 300 veterans with Post Traumatic Stress Disorder, some with physical injuries – blast or traumatic brain injury – and some without.

Some figures were  predictable – 49% had insomnia.

Other figures were not.  Fully 56% of this group of young men had sleep apnea to a significant degree.  And 87% complained of daytime sleepiness.

Try getting a job when you’re sleepy all day.

And who had sleep apnea? For those with blast injuries, 26%.  If there was a history of blunt trauma, 54%.

But the group with the highest sleep apnea were those without traumatic brain injury – 78%.

It’s not easy to know what the completely comparable figures are for males in the non-veteran population.  Most researchers might argue it’s perhaps a few percent.

These veterans have a lot more sleep apnea than they should.

Sleep Apnea, a Systemic Disease

Much of the population thinks of sleep apnea as a disease of sleep alone.  People snore a lot, stop breathing, wake up their partners, and feel sleepy during the day.

If only it were that simple.

Sleep apnea causes systemic inflammation.  Blood pressure goes up.  There are higher rates of depression and anxiety disorders.  Particularly in younger populations, like veterans studied at Walter Reed, heart attacks and cardiovascular death rates increase.

Why Are Apnea Rates So High?

Original press reports wondered if unnoticed sleep apnea had itself been a risk factor for PTSD.

That may be putting the cart before the horse.

PTSD is difficult to treat; traumatic brain injury is very difficult to treat.  Many of the drugs used to treat either can cause weight gain – the largest factor increasing sleep apnea rates in young and middle aged adults. People with anxiety and depression also tend to eat more. If you have PTSD or traumatic brain injury you tend to be more sedentary, a result exacerbated by the physical debilities added by brain and body trauma.  The more sedentary you are, the highest the risk of cardiovascular death.

These are medical problems that make all the accompanying disorders worse.

The Military, Families and the Economy

The military is quite aware of what returning veterans are facing.  The VA knows it must  gear up to treat them, and will be treating them for decades.

Whether the money will be there is another story.  Federal budget cuts are mandated under the recently passed budget.  Military spending will be hit, and medical spending is an obvious target.

Which means a greater burden on families to care for their spouses, brothers, sisters, and children.  That’s difficult in a good economy, and potentially murderous in a bad one.

Public Health and the Wars

Most economic summaries of the cost of the  Iraq and Afghan wars look at numbers killed and numbers maimed, dollar costs of military deployment and direct costs paid to supported governments.

There are other costs which the American population will be paying for several decades.  They include the large number of veterans who have come back hurt, injured with medical disorders that last throughout life.  The rates of PTSD and TBI are high.  The associated medical problems are greater still.

The American public is proud of its volunteer army who bear the costs of war.  Now they have to become aware of the medical, health, social and psychological costs that do not go away.

Recognizing what people have gone through – and will go through – should make new public initiatives possible.  They will be necessary to more easily enable  veterans to find jobs, social support, and health care from communities across the country.

Some actions will be obvious – like giving veterans preference for public service jobs.  Others may not be, like setting up nutritional counseling for veterans, or special discounts at sports and gym facilities.

Getting a few pounds lighter can change someone with sleep apnea to someone without it.  Moving under your own strength can fight depression as well as weight gain.

The military and the VA can’t do it all.  We will need to create different public health approaches to what will be a long, growing public health problem.

Because we really are in this together.