National Defence Committee on Nov. 26th, 2013

[Dr. Anne Germain]

They are different things. One is the likelihood of having difficulty with sleep during the deployment; the other one is a survey of how many hours of sleep you get even when you're not deployed.

In this case, it was 72% of people who said they slept on a regular basis six hours or less. I know we would all like to sleep much less than we do so we'd have more time to do what we need to do, but six hours of sleep is cutting it short. It does have serious impacts on our functioning. Imagine how that is for service members who are exposed to different kinds of challenges.

[Mike Allen, Conservative, Tobique—Mactaquac, NB]

Okay, good.

Thank you.

Ms. Zipes, I want to ask you about the evolution of the technology you're using today. One of the comments you made was that before it was six months on even ground just to get an assessment on this, but you're moving much quicker and you're able to assess.

Can you comment a little about the evolution of the technology to get to where you are today, and how you see that going? What types of investment is it going to take to continue the progress on those types of tools?

[Helen Zipes]

Well, we're certainly learning as we're using it. We like to listen to the patients on what their needs are. They help us to determine what programs we have to develop. It's based on the feedback we get from them.

Certainly if you have a Wii machine, it's the same idea. You're interacting with a screen. Then the next generation had an avatar of yourself in the screen. Here there are some programs where you're actually in the screen because we can put the markers on.

I took a group to Israel to see how they used theirs, and theirs were much more primitive than this. We have two treadmills. Our platform moves in many more directions. Certainly as we're using it, we're finding things, and we're giving feedback to the company as well.

I don't remember whether we have a pneumatic system. It originally came with one system underneath it to move the actuators. It didn't work and it had to be changed, and the company changed it for us.

[Sean Gehring]

We used to have hydraulic actuators and now we have electrical ones.

As Helen was alluding to, one of the main things would be the ability to have that development time. The machine, as it sits presently, and the technology, are quite advanced.

One of the questions before was whether this is used with occupational therapy. Normally the way it works is that the technology and the treatment plans are taught to the students coming through, and they bring in new ideas. We're actually ahead of the schools now. When the graduates are coming out, we're educating them. We're actually having to say, “This is the new technology that's out there. How can you use this in your treatment plans?”

It's definitely the development and having time for the operator to say okay, and sitting down with the clinicians to ask what they need to better treat their patients.

[The Chair, Conservative, Peter Kent]

Thank you very much, Mr. Allen.

Mr. Larose.

[Jean-François Larose, NDP, Repentigny, QC]

Thank you, Mr. Chair.

My first question is for Dr. Germain. I would like to thank you for being here and for your presentation.

You mentioned that you worked with the American armed forces. You were in contact with senior officers. I was trained in the Canadian armed forces reserve. I remember the lack of sleep. It was basic training, in part because you have to experience major crisis situations.

I wondered if the training component of some programs in the United States had changed completely based on your studies.

[Dr. Anne Germain]

No, but that's my goal.

Some changes have been made, mainly…

in the air force.

We are making various efforts to manage fatigue to protect sleep to ensure that pilots and their team are well rested when they are on a mission. Everyone has a war fighter's sleep kit now. Military personnel get one as soon as they are deployed. If they've heard about them, some of them have two or three.

However, we are seeing this mainly in the United States Air Force. It's happening within other units in other branches. As you said, it really depends a lot on the leaders. If the senior officers think it's important to protect the sleep of their soldiers or troops in order to preserve mental health, they take care of it.

It's really hard in French.

Across the different branches it really is dependent on the unit and the leadership because when leadership changes, not necessarily regularly, the priority changes as well.

We have found ourselves having similar discussions over and over again. I don't mind, I think it's part of our mission to disseminate information and educate people. The reality of different units is so different from one deployment to another. Even when they're back home, the kind of work they have to do that we've had to work on, on an almost individual basis, is to see how we take what we know and adapt it to their reality.

I think there are guiding principles to what we do, but we haven't had the kind of penetration and dissemination that I would like to see happen. We're working our heart out on it.

[Jean-François Larose, NDP, Repentigny, QC]

Is there some resistance also?

[Dr. Anne Germain]

I don't know that it's resistance, as much as there are so many demands and so many things that people have to address. Sometimes, unless sleep is already on their list, it's one more thing to attend to, and their priority is always the training, the preparation, and safety of their troops. Whether or not sleep makes it into one of the priorities, it's acknowledged as an important component. Whether or not they can implement some changes is really dependent on other kinds of demands, the resources and support they have, to be able to do that.

I would expect to see the same thing in the Canadian Armed Forces.

[Jean-François Larose, NDP, Repentigny, QC]

Let's talk about program follow-up, with respect to the family bond. Because follow-up needs to be done afterwards. Are you looking at the possibility of designing kits in that respect?

[Dr. Anne Germain]

Yes. We are currently studying families where at least one member of the couple has completed United States military service or is still active in the army or one of the units. We are seeing that family members are having trouble sleeping, be it either spouse or even the children. Their sleep structures don't correspond to what we expect to see in families whose biological rhythms are regular, which shows that military service affects the entire family. Everyone has to adjust because everyone is affected by military service.

This area of research and practice has been neglected. We are just starting to look into spouses and children. We are also well aware that grandparents, uncles and aunts can also have sleepless nights thinking about their loved ones in Afghanistan or on other missions. We are starting to look at all that, but we haven't made much progress in the past few years.

[Jean-François Larose, NDP, Repentigny, QC]

Thank you very much.

[The Chair, Conservative, Peter Kent]

Mr. Williamson.

[John Williamson, Conservative, New Brunswick Southwest, NB]

Thank you, Chair.

Dr. Germain, I have a follow-up question to some of the questions Mr. Allen was asking with respect to the sleep deployment cycles. I certainly understand the impact if someone is not well, but what would account for the variation when service members are at home, not deployed? Is that just training? Is that just the body rhythm? What would explain that?

[Dr. Anne Germain]

I think it's the training, what kind of job people have, probably partly social aspects, as well, and high demand, I think, would account for this.

In this particular study, they didn't measure what kind of factors can contribute to shorter sleep duration.

[John Williamson, Conservative, New Brunswick Southwest, NB]

Right.

Now, when you say “study”, which one are you referring to? I don't have the page number here. Was it Luxton et al, or Krueger and Friedman, or...?

[Dr. Anne Germain]

Krueger and Friedman was the civilian population, over 10,000 civilians. The data that they compared it to...or that I used to compare it to was what we see in military samples.

The other one is a study by Amber Seelig and her colleagues, looking at the likelihood of people starting to report sleep problems during deployment. There's an increase of about 20% when people deploy. That stays pretty high, or about the same, when people come home. Sleep duration goes down by about 30 minutes. When you think that people sleep about six hours, 30 minutes is a big proportion of sleep.

[John Williamson, Conservative, New Brunswick Southwest, NB]

Yes.

Was there any sense, from the study looking at those who had been deployed, of the duration that it was over? Is this, for example, immediately afterwards for some period?

[Dr. Anne Germain]

This particular study looked at people who had been back for, I believe, three to nine months. This is just an example of the studies. Most of the studies that have been done so far have looked at people from three months to a year post-deployment, or further than a year.

We do know that even five years after deployment, if people have sleep problems when they come home, they tend to still have sleep problems five years later.

[John Williamson, Conservative, New Brunswick Southwest, NB]

Interesting.

On the previous page, adapted from Seelig 2010, the graph on the right shows sleep duration in hours. We're talking here of service members, and this says non-deployed.

[Dr. Anne Germain]

Seelig is all people who had deployed and then came home, or during and after deployment.

[John Williamson, Conservative, New Brunswick Southwest, NB]

Right. Okay.

Would the non-deployed be those who had never been deployed?

[Dr. Anne Germain]

At all.

[John Williamson, Conservative, New Brunswick Southwest, NB]

Not at all. Okay.

Thank you, Mr. Chair. Those are all the questions I have.

[The Chair, Conservative, Peter Kent]

Thank you.

Mr. Brahmi.