Recently, we have observed an apparent increased incidence of alpha wave intrusion into N2 and N3 sleep in military and ex-military personnel. Conversations with military physicians in Honolulu, San Antonio, and the sleep center at Walter Reed also suggested that they are seeing an increased number of active duty personnel with this phenomenon.
The significance of this finding is not clear and has not been systematically studied. From a 30,000 foot perspective, the US has never before done sleep medicine evaluations on returning active duty personnel and veterans recently discharged from the military. One reason is the compensation which the service member or veteran receives if a diagnosis of sleep apnea is made. None the less, many of the OIF/OEF veterans have sleep problems including complaints of non-restorative sleep along with the other sleep problems including difficulty of initiating and maintaining sleep (DIMS) as well as disorders of excessive somnolence (DOES). These complaints engender sleep medicine consultations many with attended polysomnograms. This apparent increased frequency in returning soldiers and veterans has not been previously reported.
Alpha delta sleep was first reported by Hauri et al. in 1973.1 It is most often reported in chronic pain situations. Treatment usually involves treatment of the underlying condition. Patients with fibromyalgia have shown an increased incidence of alpha intrusion.4 A recent report of patients with depression who had PSGs showed a two-fold increase in alpha intrusion.2 A Medline search with keywords of alpha delta sleep in veterans and active duty military returned no articles. However, we have reported one case which has been fairly characteristic.3
The patients seem to have in common current or prior military service, usually with one or more deployments to war zones. Many have a sleep disordered breathing diagnosis, especially in veterans (weight gain). Treatment of the OSA with CPAP generally does not reduce the observed alpha intrusion.
Several questions are raised by this finding:
What is the reason for this increased finding compared to a civilian population group where it is seen very infrequently?
Why is it seen in current returned veterans but not apparently in the older Vietnam era veterans?
Is there a clinical significance (non-restorative sleep) of sleep deprivation which is associated with depression, self-harm, etc.?
Are there medications which could improve the nonrestorative sleep symptoms?
What is the natural history of the alpha intrusion—does it spontaneously remit with time and/ or treatment of underlying disorders (depression)?
Is this observation merely an epiphenomenon, or is it like hypertension which took many years to elucidate the medical consequences of uncontrolled elevated blood pressure? Is it like OSA, where it was thought to represent a noisy inconvenience, but with study has been shown to be associated with many medical complications?
Many of the wounds suffered by our service personnel are not visible, and one wonders if this observation is an EEG manifestation of non-visible wounds. A systematic long term study of those patients with this phenomenon could be helpful in further defining care needed by those patients.
Clearly a multicenter registry with a structured long-term follow-up would be needed to begin to answer these questions.
DISCLOSURE STATEMENT
The author has indicated no financial conflicts of interest.
CITATION
Roehrs JD. Alpha Delta Sleep in Younger Veterans and Active Duty Military Personnel: An Unrecognized Epidemic? J Clin Sleep Med 2015;11(3):277.
REFERENCES
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