Perceptions of purpose, cohesion, and military leadership: A path analysis of potential primary prevention targets to mitigate suicidal ideation.

Rates of suicide in the US Army continue to rise, and by some accounts exceed the general population. This increase has renewed efforts to identify protective factors that may inform novel suicide prevention strategies. Previous research has demonstrated that a sense of purpose in life and perceived cohesion with military peers are related to a reduction in the severity of suicidal ideation (SI). Additionally, research in military samples supports decreased SI in Soldiers who endorse that their leaders convey a sense of purpose and meaning in their shared mission. However, no work has investigated whether these leadership styles relate to a sense of felt purpose and perceived cohesion in Soldiers and thus the indirect effect of these leadership styles on SI. Active duty Army Soldiers (n = 1,160) completed self-report measures of purpose in life (PiL), perceived cohesion, ethical leadership, loneliness, and SI. Indirect effect analyses were conducted to determine how leadership behaviors indirectly relate to SI through PiL and perceived cohesion. Indirect effect analyses revealed that ethical leadership had an indirect effect on reduced SI through increased PiL. In the same parallel indirect effect analysis, ethical leadership was related to less SI through increased perceived cohesion and decreased loneliness sequentially. Enhanced leadership training that effectively increases Soldier purpose may be an important primary prevention tool to mitigate the effect of suicide risk factors. This primary prevention strategy may help augment existing suicide surveillance and clinical prevention efforts to reduce Soldier risk for suicide.

Distinguishing the Effects of Life Threat, Killing Enemy Combatants, and Unjust War Events in U.S. Service Members.

Although previous studies have identified behavioral health risks associated with combat exposure, it is unclear which types of combat events are associated with these risks, particularly regarding contrasts among the risks associated with life-threatening experiences, killing combatants, and exposure to unjust war events, such as killing a noncombatant or being unable to help civilian women and children. In the present study, we examined surveys from 402 soldiers following deployment (i.e., baseline) and again 13 months later (i.e., Year 1). Regression analyses were conducted across a range of behavioral health (e.g., posttraumatic stress disorder, depression, suicide ideation, anxiety, somatic, insomnia, aggression) and benefit-finding measures, each controlling for two combat event categories while assessing the predictive utility of a third. The results suggested that life-threatening events were associated with poor behavioral health at baseline, relative risk (RR) = 10.00, but not at Year 1, RR = 2.67. At both baseline and Year 1, killing enemy combatants was not associated with behavioral health, RRs = 1.67-3.33, but was positively associated with benefit-finding, RRs = 26.67-40.00. Exposure to unjust war events was associated with a transdiagnostic pattern of behavioral health symptoms at baseline, RR = 40.00, and Year 1, RR = 23.33. Overall, the results suggest unjust war event exposure is particularly injurious, above and beyond exposure to other combat-related events. Future research can build on these findings to develop clearer descriptions of the combat events that might place service members at risk for moral injury and inform the development of assessment and treatment options.

Amplified PTSD Symptoms From Self-Attributed Moral Transgressions are Linked to Internalized Moral Identity During Military Deployment.

INTRODUCTION: Military personnel frequently experience stressful, morally challenging situations that can lead to posttraumatic stress disorder (PTSD). The relationships between moral identity, transgressive acts, and symptoms related to posttraumatic stress disorder (i.e., posttraumatic stress symptoms; PTSS) among U.S. Army Soldiers were assessed. MATERIALS AND METHODS: A convenience cohort of 1,547 soldiers completed a survey assessing moral identity and PTSS before deployment. A subset of 505 soldiers completed another survey assessing transgressive acts and PTSS during deployment. Exploratory and confirmatory factor analyses were conducted to determine the underlying factor structure of the measures of moral identity and transgressive acts. Generalized linear modeling, robustness checks, and sensitivity analysis were used to evaluate the predictive relationships. RESULTS: Moral identity did not directly predict PTSS during deployment. However, self-attributed and betrayal-based transgressive acts were significant predictors. Specifically, self-attributed transgressive acts and PTSS were moderated by internalized moral identity; individuals with a higher internalized moral identity experienced more severe PTSS following self-attributed transgressive acts. These findings were consistent across various model checks, including covariate adjustments, data imputation, and the application of a data quality filter. CONCLUSIONS: The study highlights the significant role of self-attributed moral transgressions during deployment in the development of PTSS among military service members-especially in those with a strong internalized moral identity. This finding suggests a "target of opportunity" for the development of intervention strategies that mitigate PTSS by addressing the moral dimensions of military service.

Measurement validity of the six-factor model of psychological well-being in a military sample: Implications for measuring well-being in service members.

Subjective well-being is a positive psychological construct that has important implications for the U.S. Military's goal to develop service members' strengths and support their overall thriving and downstream resilience. Despite this, the concept of well-being has not been well studied in military populations who have unique work demands, stressors, and autonomy/agency in daily life compared to civilians. To address this shortcoming in the literature, the present study assessed Ryff's measures of psychological well-being (PWB) in 1,333 U.S. service members prior to the deployments in the Middle East. Various methods attempting to validate the theoretical model purported by Ryff were unsuccessful, and exploratory factor analyses did not result in a novel model for this population. Future research should continue to evaluate proposed models of soldier well-being and propose novel theories, as well as measures, to assess this important construct. Implications are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Distanced self-talk increases rational self-interest.

Does stepping back to evaluate a situation from a distanced perspective lead us to be selfish or fair? This question has been of philosophical interest for centuries, and, more recently, the focus of extensive empirical inquiry. Yet, extant research reveals a puzzle: some studies suggest that adopting a distanced perspective will produce more rationally self-interested behavior, whereas others suggest that it will produce more impartial behavior. Here we adjudicate between these perspectives by testing the effects of adopting a third-person perspective on decision making in a task that pits rational self-interest against impartiality: the dictator game. Aggregating across three experiments (N = 774), participants who used third-person (i.e., distanced) vs. first-person (i.e., immersed) self-talk during the dictator game kept more money for themselves. We discuss these results in light of prior research showing that psychological distance can promote cooperation and fairmindedness and how the effect of psychological distance on moral decision-making may be sensitive to social context.

Behavioral Health Screening in Military Cystic Fibrosis Centers: A Survey.

INTRODUCTION: Cystic fibrosis (CF) is the most common life-threatening genetic illness in the United States. People with CF as well as their caregivers are up to three times more likely to report experiencing symptoms of depression and anxiety than those without CF. In 2016, the Cystic Fibrosis Foundation and the European Cystic Fibrosis Society came together to form the International Committee on Mental Health in CF and released guidelines outlining behavioral health (BH) screening recommendations for patients with CF and at least one primary caregiver. This study sought to characterize the role of BH care in routine CF treatment within the DoD health care system and identify potential opportunities for improvement. The resultant brief report is intended to elucidate and present identified areas of improvement as well as to inform further research projects in this field. MATERIALS AND METHODS: A representative sample of program leaders (8 of 12; five program directors and three nurse coordinators) from all six affiliate CF centers in the DoD completed a 23-item web-based survey. This study sought to identify the following: (1) What tools are DoD affiliate CF centers using to screen patients with CF and their caregiver(s) for psychological distress and how often does screening take place? (2) What is the composition of the DoD's CF BH teams by specialty and to what degree are BH personnel available to support the needs of CF patients? (3) How comfortable are program directors and nurse coordinators in screening patients with CF and their caregiver(s) for indicators of psychological distress? (4) How familiar are CF BH teams with the use of the U.S. Military's Behavioral Health Data Portal (BHDP)? This descriptive study was approved by the Human Use Committee at the Tripler Army Medical Center. RESULTS: The results of this study indicated that 80% of the DoD affiliate CF centers are screening patients with CF who are 12 years and older and at least one caregiver at least annually for depression and anxiety with the Patient Health Questionnaire depression module and generalized anxiety disorder screening tool, respectively. Reported screening tools for suicidality were not standardized across centers. All respondents indicated that there is a designated social worker in their CF clinic team. Three-quarters of respondents reported that their social worker is physically present in CF clinics 75%-100% of the time. Other types of BH team members varied by clinic. Program directors and nurse coordinators on average indicated feeling "somewhat comfortable" in screening patients with CF for depression, anxiety, and suicidality. Eighty percent of program directors reported being "not so comfortable" in screening caregivers for depression, anxiety, and suicidality, with nurse coordinators on average reporting feeling "somewhat comfortable." Eighty percent of affiliate CF centers indicated that they are unaware of, are not utilizing, or do not have access to the BHDP to screen and record BH data for patients with CF or their caregiver(s). CONCLUSIONS: This study characterized routine CF BH care at DoD affiliate CF centers. Areas for improvement include the standardized use of screening tools for suicidality, increased provider comfort with screening, and streamlined recording and tracking of this data using the BHDP. Limitations of this study include inherent self-report bias, specifically social desirability bias. Steps toward suggested improvements and further utilization of the BHDP may improve BH care for patients with CF and their caregiver(s) in addition to facilitating future research.

Hitting the mark: The influence of emotional culture on resilient performance.

Previous research has established the role of positive emotional cultures such as companionate love and joy in predicting team performance. Building on this work, the present study analyzes the role of positive emotional culture variables as predictors of resilient performance by examining patterns of objective team performance in U.S. Army tank crews over time. We also broaden the emotional culture domain by investigating an action-oriented positive emotional culture of optimism and a negative emotional culture of anger. During a high-stakes international military training exercise, 55 U.S. Army tank crews (N = 175) completed a pre-qualification performance event, a final qualification performance event, and surveys at baseline and after both events. The positive emotional culture of optimism predicted a pattern of resilient performance defined as a rebound from poor pre-qualification performance. Emotional cultures of joy and optimism also directly predicted final performance, but neither the emotional culture of companionate love, nor the emotional culture of anger was a significant predictor. Results demonstrate the distinct nature of each of these emotional culture variables, and show that these variables differ from group trait affectivity and cohesion. Teams with a strong emotional culture of optimism were better positioned to rebound in the face of poor performance, suggesting that organizations that promote an optimistic culture develop more resilient teams. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Transitioning from daytime to nighttime operations in military training has a temporary negative impact on dynamic balance and jump performance in U.S. Army Rangers.

OBJECTIVES: Explore the impact transitioning from daytime to nighttime operations has on performance in U.S. Army Rangers. METHODS: Fifty-four male Rangers (age 26.1±4.0 years) completed the Y-Balance Test (YBT), a vertical jump assessment, and a grip strength test at three time points. Baseline testing occurred while the Rangers were on daytime operations; post-test occurred after the first night into the nighttime operation training (after full night of sleep loss), and follow-up testing occurred six days later (end of nighttime training). RESULTS: On the YBT, performance was significantly worse at post-test compared to baseline during right posteromedial reach (104.1±7.2cm vs 106.5±6.7cm, p=.014), left posteromedial reach (105.4±7.5cm vs 108.5±6.6cm, p=.003), right composite score (274.8±19.3cm vs 279.7±18.1cm, p=.043), left composite score (277.9±18.1cm vs 283.3±16.7cm, p=.016), and leg asymmetry was significantly worse in the posterolateral direction (4.8±4.0cm vs 3.7±3.1cm, p=.030) and the anterior direction (5.0±4.0cm vs 3.6±2.6cm, p=.040). The average vertical jump height was significantly lower at post-test compared to baseline (20.6±3.4 in vs 21.8±3.0 in, p=.004). Baseline performance on YBT and vertical jump did not differ from follow-up. CONCLUSIONS: Army Rangers experienced an immediate, but temporary, drop in dynamic balance and vertical jump performance when transitioning from daytime to nighttime operations. When feasible, Rangers should consider adjusting their sleep cycles prior to anticipating nighttime operations in order to maintain their performance levels. Investigating strategies that may limit impairments during this transition is warranted.

Association Between Self-Reported Sleep Quality and Musculoskeletal Injury in Male Army Rangers.

INTRODUCTION: Musculoskeletal injuries and insufficient sleep are common among U.S. Army Rangers. There has been limited research into whether indices of sleep differ between injured and uninjured Rangers. The purpose of this study was to investigate the association between self-reported sleep and musculoskeletal injury in Rangers. MATERIALS AND METHODS: A total of 82 Army Rangers (male, 25.4 ± 4.0 years) were asked if they currently have any musculoskeletal injuries; completed the Pittsburgh Sleep Quality Index (PSQI), the Insomnia Severity Index (ISI), and the Stanford Sleepiness Scale; and were asked about their average sleep quality/sleep duration over the preceding week. Rangers were then dichotomized into groups, one that reported a current musculoskeletal injury and another that did not. RESULTS: The reported musculoskeletal injury prevalence was 15.9% (n = 13). The Rangers that reported an injury, compared to those that did not, had a significantly higher Global PSQI score (6.7 ± 3.7 versus 4.5 ± 2.7, P = .012) and ISI score (10.9 ± 3.7 versus 7.2 ± 4.1, P = .003), both indicative of poorer sleep. The group reporting an injury rated their average sleep quality over the preceding week significantly lower compared to those that did not report an injury (50.8 ± 17.5 versus 68.9 ± 18.3, P = .001). There was no significant group difference in the average nightly sleep duration (6.1 ± 1.0 hours versus 6.5 ± 0.9 hours, P = .099). CONCLUSION: In this cohort of male Army Rangers, In this cohort of male Army Rangers, those with a musculoskeletal injury reported poorer sleep quality than uninjured Rangers. Sleep duration was not associated with reported injuries; however, both the injured group and uninjured group averaged less than the recommended amounts of sleep. Further investigation into the relationship between musculoskeletal injury and sleep in military personnel is warranted.

Sleep and occupational well-being in active duty special operations soldiers: A replication and expansion.

OBJECTIVE: To assess the relationship between sleep quality and occupational well-being in active duty military Service Members. DESIGN: Longitudinal prospective analysis. SETTING: An annual military training event. PARTICIPANTS: US Army special operations Soldiers (n = 60; 100% male; age 25.41 ± 3.74). INTERVENTION: None. MEASUREMENTS: The Pittsburgh Sleep Quality Index (PSQI) was administered prior to the training event, and the Emotional Exhaustion Scale, the Role Overload Scale, the Walter Reed Army Institute of Research Soldier-Specific Functional Impairment Scale, and the Perceived Stress Scale were administered after the event. Linear regression models were used to assess the relationship between sleep and occupational wellness measures, and the outcome measures of "good" and "poor" sleepers (per the PSQI scoring criteria) were compared with Student's t tests. RESULTS: Higher (poorer) PSQI Global Scores predicted poorer occupational wellness of all measures (emotional exhaustion: B = 1.60, P < .001, R2 = 0.25; functional impairment: B = 0.29, P = .03, R2 = 0.14; role overload: B = 0.28, P = .008, R2 = 0.12; and perceived stress: B = 0.34, P = .004, R2 = 0.20). There were additional relationships between specific PSQI component scores and occupational wellness measures, which is a replication of This team's previous work. Furthermore, emotional exhaustion (t(58) = -4.18, P < .001), functional impairment (t(59)= -3.68, P = .001), role overload (t(58) = -3.20, P = .002), and perceived stress (t(58) = -2.43, P = .02) were all higher in poor sleepers. CONCLUSIONS: The findings of this study suggest that US Army special operations Soldiers who have poorer sleep quality may be at increased risk for having poorer occupational well-being.

Sleep and high-risk behavior in military service members: a mega-analysis of four diverse U.S. Army units.

Experimental sleep restriction and deprivation lead to risky decision-making. Further, in naturalistic settings, short sleep duration and poor sleep quality have been linked to real-world high-risk behaviors (HRB), such as reckless driving or substance use. Military populations, in general, tend to sleep less and have poorer sleep quality than nonmilitary populations due to a number of occupational, cultural, and psychosocial factors (e.g. continuous operations, stress, and trauma). Consequently, it is possible that insufficient sleep in this population is linked to HRB. To investigate this question, we combined data from four diverse United States Army samples and conducted a mega-analysis by aggregating raw, individual-level data (n = 2,296, age 24.7 ± 5.3). A negative binomial regression and a logistic regression were used to determine whether subjective sleep quality (Pittsburgh Sleep Quality Index [PSQI], Insomnia Severity Index [ISI], and duration [h]) predicted instances of military-specific HRB and the commission of any HRB (yes/no), respectively. Poor sleep quality slightly elevated the risk for committing HRBs (PSQI Exp(B): 1.12 and ISI Exp(B): 1.07), and longer duration reduced the risk for HRBs to a greater extent (Exp(B): 0.78), even when controlling for a number of relevant demographic factors. Longer sleep duration also predicted a decreased risk for commission of any HRB behaviors (Exp(B): 0.71). These findings demonstrate that sleep quality and duration (the latter factor, in particular) could be targets for reducing excessive HRB in military populations. These findings could therefore lead to unit-wide or military-wide policy changes regarding sleep and HRB.

Poor Subjective Sleep Quality Is Associated with Poor Occupational Outcomes in Elite Soldiers.

We aimed to assess the relationship between subjective sleep quality and occupationally-relevant outcomes in military personnel. Participants were from an elite unit of US Army soldiers who worked extended (~30 h) shifts (with minimal recovery time between shifts) during 3-week work sessions. Questionnaires assessing subjective sleep quality during the month prior (Pittsburgh Sleep Quality Index [PSQI]) were administered at the beginning of the session. Occupational outcomes (emotional exhaustion, functional impairment, role overload, daytime sleepiness) were assessed on the final day of the session. Regression analyses were conducted to link sleep quality and occupational outcomes. The study sample participants had relatively poor sleep prior to the exercise (PSQI Global score average = 6.3 ± 3.1). Higher PSQI Global Scores prior to the work session longitudinally predicted daytime sleepiness (f2: 0.56) after the work session. PSQI component 7, which queries daytime dysfunction attributed to poor sleep quality, longitudinally predicted emotional exhaustion, functional impairment, and role overload (f2 range: 0.19-0.70). In conclusion, poor sleep quality-in aggregation with occupationally-mandated sleep loss-is predictive of poorer subsequent occupational outcomes. Future work should aim to increase sleep opportunities prior to occupationally-mandated sleep loss in order to build resilience when sleep loss is unavoidable.

Punish or Protect? How Close Relationships Shape Responses to Moral Violations.

People have fundamental tendencies to punish immoral actors and treat close others altruistically. What happens when these tendencies collide-do people punish or protect close others who behave immorally? Across 10 studies (N = 2,847), we show that people consistently anticipate protecting close others who commit moral infractions, particularly highly severe acts of theft and sexual harassment. This tendency emerged regardless of gender, political orientation, moral foundations, and disgust sensitivity and was driven by concerns about self-interest, loyalty, and harm. We further find that people justify this tendency by planning to discipline close others on their own. We also identify a psychological mechanism that mitigates the tendency to protect close others who have committed severe (but not mild) moral infractions: self-distancing. These findings highlight the role that relational closeness plays in shaping people's responses to moral violations, underscoring the need to consider relational closeness in future moral psychology work.

Practice parameters for the use of actigraphy in the military operational context: the Walter Reed Army Institute of Research Operational Research Kit-Actigraphy (WORK-A).

BACKGROUND: The Walter Reed Army Institute of Research (WRAIR) Operational Research Kit-Actigraphy (WORK-A) is a set of unique practice parameters and actigraphy-derived measures for the analysis of operational military sleep patterns. The WORK-A draws on best practices from the literature and comprises 15 additional descriptive variables. Here, we demonstrate the WORK-A with a sample of United States Army Reserve Officers' Training Corps (ROTC) cadets (n = 286) during a month-long capstone pre-commissioning training exercise. METHODS: The sleep of ROTC cadets (n = 286) was measured by Philips Actiwatch devices during the 31-day training exercise. The preliminary effectiveness of the WORK-A was tested by comparing differences in sleep measures collected by Actiwatches as calculated by Philips Actiware software against WORK-A-determined sleep measures and self-report sleep collected from a subset of ROTC cadets (n = 140). RESULTS: Actiware sleep summary statistics were significantly different from WORK-A measures and self-report sleep (all P ≤ 0.001). Bedtimes and waketimes as determined by WORK-A major sleep intervals showed the best agreement with self-report bedtime (22:21 ± 1:30 vs. 22:13 ± 0:40, P = 0.21) and waketime (04:30 ± 2:17 vs. 04:31 ± 0:47, P = 0.68). Though still significantly different, the discrepancy was smaller between the WORK-A measure of time in bed (TIB) for major sleep intervals (352 ± 29 min) and self-report nightly sleep duration (337 ± 57 min, P = 0.006) than that between the WORK-A major TIB and Actiware TIB (177 ± 42, P ≤ 0.001). CONCLUSIONS: Default actigraphy methods are not the most accurate methods for characterizing soldier sleep, but reliable methods for characterizing operational sleep patterns is a necessary first step in developing strategies to improve soldier readiness. The WORK-A addresses this knowledge gap by providing practice parameters and a robust variety of measures with which to profile sleep behavior in service members.

Sleep loss is related to unstable stationary balance in U.S. Army soldiers in an operationally-relevant context.

BACKGROUND: Sleep loss negatively impacts stationary balance in a laboratory setting, but few studies have examined this link in a naturalistic environment. We tested this relationship in U.S. Army soldiers that often undergo mission-driven sleep loss and who conduct high-risk operations on precarious terrain. METHODS: Stationary balance was tested before and after a mission night. RESULTS: After mission-driven sleep loss, in more difficult conditions (but not easy conditions) balance was more unstable and more variable than a rested baseline condition. Furthermore, habitual sleep quality prior to sleep loss predicted the balance decrement after sleep loss. CONCLUSIONS: Therefore, mission-driven sleep loss may negatively impact soldier balance, but better sleep prior to the mission may mitigate these negative effects.

Crowdsourcing hypothesis tests: Making transparent how design choices shape research results.

To what extent are research results influenced by subjective decisions that scientists make as they design studies? Fifteen research teams independently designed studies to answer five original research questions related to moral judgments, negotiations, and implicit cognition. Participants from 2 separate large samples (total N > 15,000) were then randomly assigned to complete 1 version of each study. Effect sizes varied dramatically across different sets of materials designed to test the same hypothesis: Materials from different teams rendered statistically significant effects in opposite directions for 4 of 5 hypotheses, with the narrowest range in estimates being d = -0.37 to + 0.26. Meta-analysis and a Bayesian perspective on the results revealed overall support for 2 hypotheses and a lack of support for 3 hypotheses. Overall, practically none of the variability in effect sizes was attributable to the skill of the research team in designing materials, whereas considerable variability was attributable to the hypothesis being tested. In a forecasting survey, predictions of other scientists were significantly correlated with study results, both across and within hypotheses. Crowdsourced testing of research hypotheses helps reveal the true consistency of empirical support for a scientific claim. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

A Review of Environmental Barriers to Obtaining Adequate Sleep in the Military Operational Context.

INTRODUCTION: Sleep loss is ubiquitous in military settings, and it can be deleterious to cognitive, physiological, and operational functioning. This is especially true in the military operational context (e.g., training, garrison, combat) where continuous operations prevent adequate time for rest and recuperation. Furthermore, even when servicemembers do have opportunities for sleep, environmental disruptors in the military operational context make it difficult to obtain restorative sleep. Such environmental disruptors are potentially preventable or reversible, yet there is little public awareness of how to minimize or eliminate these sleep disruptors. Therefore, the goal of this review was to outline prominent environmental sleep disruptors, describe how they occur in the military operational context, and also discuss feasible strategies to mitigate these disruptors. MATERIALS AND METHODS: We discuss four factors - light, noise, temperature, and air pollution - that have previously been identified as prominent sleep disruptors in non-military settings. Additionally, we extracted publicly-available yearly temperature and pollution data, from the National Oceanic and Atmospheric Association and the Environmental Protection Agency, respectively, for major prominent military installations in the continental US in order to identify the sites at which servicemembers are at the greatest risk for environmental sleep disruptions. RESULTS: Based on previous literature, we concluded light and noise are the most easily mitigatable sleep-disrupting environmental factors. Air pollution and temperature, on the other hand, are more difficult to mitigate. We also propose that harsh/uncomfortable sleeping surface is a fifth critical, previously unexplored sleep disruptor in the military operational context. Furthermore, we identified several problematic military sites for air pollution for temperature. Specifically, each branch has major installations located in regions with extreme heat (especially the Army), and each branch has at least one major installation in a high air pollution region. These findings show that even when in training or garrison in the US, military servicemembers are at risk for having sleep disruption due to environmental factors. CONCLUSIONS: Environmental disruptors, such as light, noise, temperature, and air pollution, can negatively impact sleep in the military operational context. Simple, feasible steps can be taken to reduce sleep disruptions that are caused by light and noise. Yet there is a need for research and development on tools to mitigate air pollution, extreme temperatures, and inhospitable sleeping surfaces. Leadership at the discussed military bases and training facilities should focus on improving the sleep environment for individuals under their command. Such interventions could ultimately improve warfighter health, wellness, and operational performance, leading to greater warfighter readiness and lethality.