MILITARY
READINESS
Comprehensive
Approach Needed
to Address Service
Member Fatigue
and Manage Related
Efforts
Report to the Committee on Armed
Services, House of Representatives
March 2024
GAO-24-105917
United States Government Accountability Office
United States Government Accountability Office
Highlights of GAO-24-105917, a report to the
Committee on Armed Services, House of
Representatives
March 2024
MILITARY READINESS
Comprehensive Approach Needed to Address Service
Member Fatigue
and Manage Related Efforts
What GAO Found
Many service members are not getting the Department of Defense (DOD)
recommended 7 or more hours of sleep each day. The department’s overarching
fatigue-related guidance emphasizes service members obtain at least 7 hours of
sleep for optimal performance and readiness. For over a decade, DOD surveys
have found that the majority of service members report sleeping 6 or fewer hours
per night. Respondents to GAO’s nongeneralizable survey cited similar issues.
For example, many respondents are sleeping too little, and roughly half of
respondents have poor sleep quality regardless of quantity. Survey respondents
provided examples of how sleep deprivation has affected their work, from nearly
colliding with another aircraft to falling asleep on the job.
Service Members on How Sleep Deprivation Has Affected Their Work
DOD and the services have taken steps to address fatigue-related issues, such
as developing guidance on fatigue management, but DOD faces oversight and
enterprise-wide collaboration challenges in managing fatigue.
• Oversight structure limitations. DOD has not identified and delegated
sufficient oversight authority at the department level, and the military services
have not assigned leadership to oversee service-level efforts. Without an
assessment of DOD’s oversight structure and assigning DOD and service-
level leadership, DOD will be hindered in its efforts to limit and manage
fatigue across the department.
• Fragmented fatigue-related research. GAO identified nearly 130 fatigue-
related research projects the Army, Navy, Marine Corps, and Air Force
conducted from 2017 to 2023. Forty-eight of these projects studied the use of
wearable devices to track sleep data among other uses, with many of them
using the same type of technology or even the same model. Establishing a
list of all fatigue-related research will help DOD gain visibility and reduce any
fragmentation that may exist, potentially leading to cost savings.
Wearable Device Use Across Services for Fatigue-Related Research, 2017—2023
View GAO-24-105917. For more information,
contact
Diana Maurer at (202) 512-9627 or
MaurerD
@gao.gov.
Why GAO Did This Study
Fatigue caused by inadequate sleep
can negatively affect a service
member’s performance and has
contributed to accidents resulting in
deaths and hundreds of millions of
dollars in damage to ships, vehicles,
and aircraft. DOD recognizes that
impairment from
fatigue can be
equivalent to the effects of alcohol
intoxication and significantly
increases the risk of physical injury.
House Report 117
-118, which
accompanied a bill for the National
Defense Authorization Act for Fiscal
Year 2022, include
s a provision for
GAO to review DOD’s efforts to limit
sleep deprivation and manage fatigue
across the military services
. Among
other things, this report assesses
the
extent to which (1) service members
are getting adequate sleep
and (2)
DOD has addressed and managed
se
rvice member fatigue.
GAO analyzed fatigue
-related policies
and
guidance; interviewed cognizant
officials; and surveyed service
members from selected occupations
,
including pilots
, aviation maintenance
personnel
, missileers, and motor
vehicle operators.
Wh
at GAO Recommends
GAO is making
nine
recommendations
, including that
DOD
conducts an assessment of its
fatigue
-related oversight structure,
assign
s DOD leadership, and creates
and maintains a list of all
fatigue-
related research projects, and that
the
military services assign fatigue-
related leadership.
DOD generally
concurred with
the recommendations.
Page i GAO-24-105917 Military Readiness
Letter 1
Background 4
Many Service Members Not Getting DOD Recommended 7 or
More Hours of Sleep Each Day 9
DOD Has Taken Steps to Address Fatigue, but Faces Challenges
with Oversight and Enterprise-Wide Collaboration 18
Prior DOD Fatigue-Related Recommendations Remain
Unimplemented 30
Conclusions 37
Recommendations for Executive Action 38
Agency Comments 39
Appendix I Objectives, Scope, and Methodology 41
Appendix II Reflections from GAO Survey Respondents 46
Appendix III GAO Survey of Selected Military Occupations 48
Appendix IV GAO Contact and Staff Acknowledgments 58
Related GAO Products 59
Tables
Table 1: Military Service Responsibilities set forth in DOD
Instruction 1010.10 to Help Prevent and Mitigate the
Effects of Fatigue 5
Table 2: Examples of Department of Defense Occupation-Specific
Sleep, Rest, and Duty Hour Requirements and Guidelines 6
Contents
Page ii GAO-24-105917 Military Readiness
Figures
Figure 1: GAO Selected Military Occupations, by Service 9
Figure 2: GAO Survey Officer Respondents on Hours and Quality
of Sleep, per 24-Hour Cycle 13
Figure 3: Survey Responses on the Effects of Sleep Deprivation 15
Figure 4: Examples of Steps DOD and the Services Have Taken
to Address Fatigue 19
Figure 5: Wearable Device Use Across Military Services for
Selected Fatigue-Related Research, 2017—2023, by
Brand 25
Figure 6: DOD-Identified Recommendations and Related
Strategies to Mitigate Fatigue and Improve Sleep among
Service Members, 2021 DOD Study on Sleep Deprivation
and Readiness 31
Figure 7: Survey Responses on Actions the Military Can Take to
Limit or Manage Sleep Deprivation 46
Figure 8: Survey Responses on Additional Thoughts About Sleep
Deprivation 47
Abbreviations
CREW Command Readiness, Endurance, and Watchstanding
DOD Department of Defense
OHWS Optimizing the Human Weapon System
OWL Optimized Watchbill Logistics
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Page 1 GAO-24-105917 Military Readiness
441 G St. N.W.
Washington, DC 20548
March 26, 2024
The Honorable Mike Rogers
Chairman
The Honorable Adam Smith
Ranking Member
Committee on Armed Services
House of Representatives
Fatigue caused by inadequate sleep can negatively affect a service
member’s military performance and has contributed to accidents resulting
in service member deaths and hundreds of millions of dollars in damage
to Department of Defense (DOD) ships, vehicles, and aircraft, according
to our prior work and the National Commission on Aviation Safety.
1
Fatigue can cause a reduced ability to execute complex cognitive tasks,
communicate effectively, quickly make appropriate decisions, and sustain
a level of alertness required to carry out assigned duties, according to a
2021 DOD study on sleep deprivation and readiness.
2
The DOD study
pointed out that, among active-duty personnel, fatigue appeared to be
more the rule than the exception—rates of individuals sleeping less than
7 hours per night in the military were roughly twice of those in the civilian
population.
1
See, for example, GAO, Military Vehicles: Army and Marine Corps Should Take
Additional Actions to Mitigate and Prevent Training Accidents, GAO-21-361 (Washington,
D.C.: July 7, 2021) and Navy Readiness: Additional Efforts Are Needed to Manage
Fatigue, Reduce Crewing Shortfalls, and Implement Training, GAO-21-366 (Washington,
D.C.: May 27, 2021). Also, see National Commission on Military Aviation Safety, Report to
the President and Congress of the United States (Dec. 1, 2020). While officials told us the
terms sleep deprivation and fatigue are often used interchangeably, sleep deprivation
differs from fatigue in some respects. According to Department of Defense Instruction
1010.10, sleep deprivation is defined as obtaining inadequate sleep to support adequate
daytime alertness. Department of Defense Instruction 1010.10, Health Promotion and
Disease Prevention (Apr. 28, 2014) (incorporating change 3, effective May 16, 2022).
According to the National Institute of Health and the National Institute for Occupational
Safety and Health, fatigue is defined as a feeling of weariness, tiredness, or lack of
energy, and it can be physical or mental. Sleep deprivation is a contributing factor to
fatigue. For the purposes of this report, we will be focusing on sleep deprivation and
referring to that as fatigue.
2
Department of Defense, Report to Congressional Armed Services Committees, Study on
Effects of Sleep Deprivation on Readiness of Members of the Armed Forces,
(Washington, D.C.: March 2021). DOD conducted this study in response to section 749 of
the National Defense Authorization Act for Fiscal Year 2020. Pub. L. No. 116-92, § 749
(2019).
Letter
Page 2 GAO-24-105917 Military Readiness
DOD recognizes that impairment from fatigue can be equivalent to the
effects of alcohol intoxication and significantly increases the risk of
physical injury. The 2021 DOD study noted that leadership plays a
significant role in limiting fatigue and called for DOD to promote a culture
shift with regard to prioritizing adequate sleep in the military.
Our prior work has examined fatigue on Navy surface ships. In May 2021,
we found that sailors were not receiving adequate sleep and the Navy
lacked quality information on sailor fatigue and factors that caused a lack
of sleep.
3
We made four fatigue-related recommendations, and in
October 2023 we reported the Navy had implemented one of our four
fatigue-related recommendations.
4
We found, for example, the Navy
issued an instruction in September 2022 requiring systemic collection of
quality and timely fatigue data from sailors that are accessible to
operational commanders to support underway decision-making.
5
The
Navy continues to work to address other recommendations we made.
6
House Report 117-118, which accompanied a bill for the National
Defense Authorization Act for Fiscal Year 2022, includes a provision for
us to undertake a comprehensive review of DOD’s efforts to limit sleep
deprivation and manage fatigue across the military services.
7
This report
assesses the extent to which (1) service members are getting adequate
sleep, (2) DOD has addressed and managed service member fatigue,
and (3) DOD has implemented fatigue-related recommendations from its
2021 study on sleep deprivation and readiness.
To address these objectives, we reviewed DOD and service guidance
related to sleep and rest to determine the DOD and service
recommended minimum amount of hours of sleep per night and rest
3
GAO, Navy Readiness: Additional Efforts Are Needed to Manage Fatigue, Reduce
Crewing Shortfalls, and Implement Training, GAO-21-366 (Washington, D.C.: May 27,
2021).
4
GAO, Navy Readiness: Challenges to Addressing Sailor Fatigue in the Surface Fleet
Continue, GAO-24-106819 (Washington, D.C.: Oct. 11, 2023).
5
Commander, U.S. Fleet Forces Command Instruction 5100.10A; Commander, U.S.
Naval Forces Europe and Africa Instruction 5100.1D; and Commander, U.S. Pacific Fleet
Instruction 5100.6A, Fleet Safety and Occupational Health Program (Sept. 12, 2022).
6
The Navy is working to address recommendations to use collected data on sailor fatigue
to identify, monitor, and evaluate factors that contribute to fatigue and inadequate sleep,
and to take actions to address the factors causing sailor fatigue and inadequate sleep.
7
H.R. Rep. No. 117-118, at 183 (2021).
Page 3 GAO-24-105917 Military Readiness
requirements and guidelines. We also reviewed DOD and service
documentation, including health and safety-related surveys and reports,
that included findings on the quantity and quality of service member
sleep. We surveyed service members from several selected military
occupations across the Air Force, Army, Navy, and Marine Corps with a
high potential to be affected by fatigue: fixed-wing and rotary-wing pilots;
remotely piloted aircraft pilots; aviation maintenance personnel; motor
vehicle operators; and on-alert operations, such as nuclear missileers and
watch floor officers.
8
Specifically, we surveyed a nongeneralizable sample of service members
in these occupations to gain insight into their sleep habits, factors that
contribute to fatigue, and mitigations to manage fatigue.
9
We analyzed
DOD, service, and occupation-specific policies, guidance, studies, and
program documentation related to fatigue to understand the department’s
approach to manage fatigue and limit sleep deprivation. We also
interviewed officials from the Office of the Secretary of Defense, including
from the offices of the Under Secretary of Defense for Personnel and
Readiness and the Assistant Secretary of Defense for Health Affairs, as
well as officials from service headquarters, service safety centers, and
major commands for the occupations selected in our review.
We conducted this performance audit from March 2022 to March 2024 in
accordance with generally accepted government auditing standards.
Those standards require that we plan and perform the audit to obtain
sufficient, appropriate evidence to provide a reasonable basis for our
findings and conclusions based on our audit objectives. We believe that
the evidence obtained provides a reasonable basis for our findings and
conclusions based on our audit objectives.
8
These military occupations were surveyed, except for Army on-alert operations. For this
group, we met with Army watch-floor officers. Additionally, our survey’s selected
occupations originally included Navy fixed-wing fighter and remote pilots. However, due to
data discrepancies that we were unable to reconcile with the Navy, we were unable to
survey them.
9
We received responses from 245 in-scope service members from the 1,720 selected in
our stratified random sample, for an unweighted response rate of 14.2 percent. See
Appendix I for more details.
Page 4 GAO-24-105917 Military Readiness
Collectively, DOD and the services have several policies related to sleep
and rest. The guidance generally emphasizes the importance of service
members obtaining at least 7 hours of sleep for optimal performance and
readiness.
10
DOD and the services have also issued policies and
guidance requiring or recommending service members being given
opportunities to rest—time where they are off duty and not performing
work, including not performing administrative tasks.
The department’s overarching fatigue-related guidance is contained in
DOD Instruction 1010.10, which the department updated in May 2022.
11
The instruction states it is DOD policy to create a culture that views sleep
patterns as a key indicator of readiness, to promote healthy sleep-wake
cycles in operational and nonoperational environments, and to develop
sleep strategies to maximize performance and alertness throughout DOD
that are based on scientific evidence.
12
The instruction tasks the services
with taking specific steps to help prevent and mitigate the effects of
fatigue among service members by encouraging specific behavioral
strategies to improve sleep, promoting a healthy sleep environment, and
prioritizing time for sleep. For a list of service responsibilities, see table 1.
10
See, e.g., DOD Instruction 1010.10; Department of the Army Pamphlet 40-11, Army
Public Health Program (May 18, 2020); Air Force Instruction 21-101, Aircraft and
Equipment Maintenance Management (Jan. 16, 2020); and Commander, Naval Surface
Force, U.S. Pacific Fleet and Commander, Naval Surface Force Atlantic Instruction
3120.2A, Comprehensive Crew Endurance Management Policy (Dec. 11, 2020). While the
minimum amount of sleep recommended in DOD guidance is 7 hours, the majority of DOD
and military service guidance and policies we reviewed require or recommend 8 hours of
sleep.
11
DOD Instruction 1010.10. Other DOD instructions also recognize the importance of
sleep. For example, DOD Instruction 6490.05, Maintenance of Psychological Health in
Military Operations, establishes requirements to prevent, identify, and manage adverse
combat and operational stress reactions. Sleep is considered a protective factor against
combat operational stress, and sleep restriction is considered a risk factor for symptoms of
combat operational stress. The military departments are to implement policies and
programs to enhance readiness, contribute to combat effectiveness, enhance the physical
and mental health of military personnel, and prevent or minimize adverse effects
associated with combat and operational stress.
12
DOD considers circadian rhythm—the body’s internal resting or wakefulness schedule
over the course of a day— when creating policy related to sleep. For example, watchbills
are schedules for when sailors stand watch. Circadian rhythm watchbills are designed so
that sailors stand watch and sleep at the same time each day, allowing the body to follow
its natural biological processes on a 24-hour cycle.
Background
DOD and Service Fatigue-
Related Policy and
Guidance
Page 5 GAO-24-105917 Military Readiness
Table 1: Military Service Responsibilities set forth in DOD Instruction 1010.10 to Help Prevent and Mitigate the Effects of
Fatigue
planned naps when mission requirements result in unavoidable periods of sleep deprivation
prevention programs and practices in accordance with the instruction and the total force fitness framework
b
applicable to DOD
Source: Department of Defense (DOD) Instruction 1010.10, Health Promotion and Disease Prevention (Apr. 28, 2014) (incorporating change 3, effective May 16, 2022). | GAO-24-105917
a
These responsibilities are to be implemented as mission requirements permit.
b
Total Force Fitness is a framework intended to help maintain service members’ well-being and
sustain their ability to carry out missions.
DOD Instruction 1010.10 also states it is DOD policy to use the Total
Force Fitness framework as the methodology for understanding,
assessing, and optimizing service members’ ability to meet mission
requirements. This framework was implemented in 2009 as a key
readiness component to help maintain service members’ well-being and
sustain their ability to carry out missions.
13
The framework includes eight
domains of health and performance, and sleep is embedded across
several domains, including the physical, psychological, and medical
dimensions, according to a Chairman of the Joint Chiefs of Staff
instruction.
14
Since 2014, the services have had the responsibility to
implement, maintain, fund, monitor, and evaluate related programs and
practices in accordance with the Total Force Fitness framework.
13
Guidance on Total Force Fitness is set forth in Chairman of the Joint Chiefs of Staff
Instruction (CJCSI) 3405.01, Chairman’s Total Force Fitness Framework (Sept. 1, 2011)
(current as of Sept. 23, 2013).
14
The eight domains of health and performance are: physical, environmental, medical and
dental, nutritional, spiritual, psychological, behavioral, and social. CJCSI 3405.01.
Page 6 GAO-24-105917 Military Readiness
In addition, DOD and the services have issued guidance documents that
address fatigue for service members in specific occupations. For
example, the Navy and Air Force have issued guidance directed at
service members serving as aircrew (i.e., pilots and other service
members working on airplanes while they are in flight).
15
The Navy and
Air Force guidance for aircrew set requirements for free time and include
time for meals, transportation, and an opportunity for at least 8 hours of
uninterrupted sleep. Other occupations have similar requirements or
guidelines. For example, operators of government-owned motor vehicles,
Army Corps of Engineers equipment operators, and Air Force
maintenance personnel have mandated rest periods and limits in the
amounts of hours they can work. See table 2 for examples.
Table 2: Examples of Department of Defense Occupation-Specific Sleep, Rest, and Duty Hour Requirements and Guidelines
Occupation
Requirement or Guideline
Army Corps of Engineers
Equipment Operators
Operators shall not exceed 12 hours of duty time in any 24-hour period, including time worked at
another occupation; operators also require a minimum of 8 consecutive hours of rest between
shifts in a 24-hour period.
Army Air Traffic Controllers
An 8-hour continuous shift is standard, and the maximum duty day is not to exceed 10 hours for
nonstandard shifts. Air Traffic controllers have a 40–hour work week; however, they may have a
maximum 50-hour work week for a period not to exceed 60 days. They are given an
uninterrupted 8-hour rest period prior to each shift and must be relieved of all duties for 24
consecutive hours at least once during each 7-day period.
Air Force Maintenance
Personnel
Maintenance personnel receive a rest period after each shift, including during exercises or
inspections. A rest period is a block of time that gives a person the opportunity for 8 hours of
uninterrupted sleep in a 24-hour period.
Navy and Air Force Aircrew
Aircrew typically receive a 12-hour rest opportunity prior to beginning the flight duty period. This
crew rest is free time and includes time for meals, transportation, and an opportunity for at least 8
hours of uninterrupted sleep.
Army Assault Helicopter
Battalions
Helicopter units establishing a main command post implement a sleep plan within 4 hours of
occupation of the command post.
Munitions and Missile
Maintenance Management
Personnel handling, loading, or performing maintenance actions on nuclear or conventional
weapon systems or explosives may not exceed 12 hours of continuous duty followed by a period
which provides at least 8 hours of uninterrupted rest before starting the next duty shift.
Vehicle Operators
Vehicle operators must have the opportunity for 8 consecutive hours of rest during any 24-hour
period.
Army and Marine Corps Vehicle
Operators
Vehicle operators shall be provided at least 8 consecutive hours of rest during any 24-hour
period. Vehicle operators will not drive more than 10 hours in a duty period (including rest and
meal breaks). Mission-essential shifts longer than 10 hours require specific risk-mitigations.
15
Commander, Naval Air Forces (CNAF) Manual 3710.7, NATOPS General Flight and
Operating Instructions Manual (July 15, 2017) and Air Force Manual (AFMAN) 11-202,
vol. 3, Flight Operations (Jan. 10, 2022).
Page 7 GAO-24-105917 Military Readiness
Occupation
Requirement or Guideline
Navy Surface Force Sailors
Surface Force sailors must be given the opportunity to obtain a minimum of 7.5 hours of sleep in
a 24-hour day, either by one uninterrupted 7.5-hour period or an uninterrupted 6-hour period with
an uninterrupted 1.5-hour nap.
Sources: Army Corps of Engineers Engineer Manual 385-1-1, Safety and Health Requirements (Nov. 30, 2014); Army Regulation 95-2, Air Traffic Control, Airfield/Heliport, and Airspace Operations (Mar.
31, 2016); Air Force Instruction 21-101, Aircraft and Equipment Maintenance Management (Jan. 16, 2020); Air Force Manual 11-202, vol. 3, Flight Operations (Jan 10, 2022); Commander, Naval Air
Forces (CNAF) Manual 3710.7, NATOPS General Flight and Operating Instructions Manual (July 15, 2017); Army Field Manual 3-04.113, Utility and Cargo Helicopter Operations (Dec. 2007); Air Force
Manual 21-200, Munitions and Missile Maintenance Management (Aug. 9, 2018) (certified current, May 9, 2022); Army Regulation 385-10, The Army Safety and Occupational Health Program (July 24,
2023); Marine Corps Order 5100.29C, Marine Corps Safety Management System, Vol. 3, Marine Corps Traffic Safety Program (Oct. 15, 2020); Commander, Naval Surface Force, U.S. Pacific Fleet, and
Commander, Naval Surface Force Atlantic Instruction 3120.2A, Comprehensive Crew Endurance Management Policy (Dec. 11, 2020). | GAO-24-105917
Fatigue management stretches across DOD and the services in multiple
domains—including health, risk, and readiness—and multiple entities at
the DOD and service-level have fatigue-related responsibilities to manage
fatigue, conduct research, and develop mitigations and potential
solutions. For example:
The Office of the Under Secretary of Defense for Personnel and
Readiness. This office oversees the implementation of DOD Instruction
1010.10, which contains the department’s overarching fatigue-related
guidance. The Office of the Under Secretary of Defense for Personnel
and Readiness also authored the 2021 DOD study on sleep deprivation
and readiness.
The Office of the Assistant Secretary of Defense for Health Affairs.
This office supports the Assistant Secretary of Defense for Health Affairs
in their role as the principal advisor to the Secretary of Defense for all
DOD health and force health protection policies, programs, and activities,
including those related to sleep and fatigue.
Defense Health Agency. This organization is a joint Combat Support
Agency that works with the Army, Navy, and Air Force medical services.
The organization provides support for medical research, development,
education, and training, as well as public health, including support related
to sleep and fatigue.
Military Research Centers. The military departments conduct research
on approaches and technologies to help optimize human performance,
including managing and limiting service member fatigue.
16
16
These centers include the Defense Centers for Public Health-Aberdeen (formerly U.S.
Army Public Health Center); the Air Force Medical Service, Air Force Research
Laboratory, 711
th
Human Performance Wing; and the Navy Bureau of Medicine and
Surgery, Navy Medical Research Command, Naval Health Research Center.
DOD Organizations
Involved in Managing
Service Member Fatigue
Page 8 GAO-24-105917 Military Readiness
Force Safety and Occupational Health. This office develops
Occupational Safety and Health policy and provides oversight of the DOD
components, in accordance with DOD’s policy to protect DOD personnel
from accidental death, injury, or occupational illness, including incidents
related to fatigue.
17
The office has reported that DOD is focusing on
human fatigue issues and sleep deprivation monitoring as a leading
indicator of mishaps.
18
Defense Safety Oversight Council. This organization is chaired by the
Under Secretary of Defense for Personnel and Readiness to provide
governance on DOD-wide efforts to reduce mishaps, incidents, and
occupational illnesses and injuries—which would include those resulting
from fatigue.
Joint Safety Council. The council focuses on mitigating safety risks and
reducing mishaps in operational and training settings. The council advises
the Secretary of Defense through the Defense Safety Oversight Council
on the safety of military operations and related regulations and policy
reforms.
A variety of characteristics specific to military occupations may contribute
to service member fatigue, including extended shifts, night operations,
high noise environments, operating heavy equipment, and high
operational tempo. We used these characteristics to select six general
military occupations across the services with the potential to be affected
by fatigue for our review (see fig. 1). We surveyed or met with service
members in each of these occupations to gain insight into their sleep
habits, factors that contribute to fatigue, and mitigations to manage
fatigue.
17
Department of Defense Instruction 6055.01, DOD Safety and Occupational Health
(SOH) Program (Oct. 14, 2014) (incorporating change 3, effective Apr. 21, 2021) and
Department of Defense, Study on Effects of Sleep Deprivation on Readiness of Members
of the Armed Forces (March 2021).
18
A DOD mishap is an unplanned event or series of events that results in: damage to
DOD property, occupational illness to DOD personnel, injury to on- or off- duty DOD
military personnel, injury to on-duty DOD civilian personnel, damage to public or private
property, or injury or illness to non-DOD personnel caused by DOD activities. Department
of Defense Instruction 6055.07, Mishap Notification, Investigation, Reporting, and Record
Keeping (June 6, 2011) (incorporating change 2, June 11, 2019).
Information on Selected
Military Occupations
Page 9 GAO-24-105917 Military Readiness
Figure 1: GAO Selected Military Occupations, by Service
Note: We had originally included Navy fixed-wing fighter and remote pilots in our selected
occupations to survey. However, due to data discrepancies that we were unable to reconcile with the
Navy, we were unable to survey them. The service and military occupations shown were surveyed,
except for Army on-alert operations. For this group, we met with Army watch-floor officers.
DOD and the services have administered and reported the results of
surveys on service member fatigue for over a decade, consistently finding
that service members report not getting the DOD recommended 7 or
more hours of sleep each day or report getting poor quality of sleep.
DOD-wide surveys. DOD administers surveys related to health and
safety behaviors to all active-duty service members on an annual and
Many Service
Members Not Getting
DOD Recommended
7 or More Hours of
Sleep Each Day
DOD and Service Surveys
Show Service Members
Are Not Getting Enough
Sleep
Page 10 GAO-24-105917 Military Readiness
periodic basis.
19
Estimates from DOD’s periodic survey—the Health
Related Behaviors survey—remained consistent, showing that between
2005 and 2018, the most recent data available, approximately one-third of
service members reported sleeping 7 or 8 hours per night, while the
majority of service members reported sleeping 6 or fewer hours per night,
and approximately one-third of service members rate their sleep as fairly
bad or very bad.
20
19
Annual surveys include the Periodic Health Assessment, which is an annual screening
tool to evaluate individual medical readiness of service members. It includes a self-
reported health status that contains questions regarding sleep health. Healthcare
providers use the survey responses to care for service members. Periodic surveys include
the Health Related Behaviors Survey, which anonymously gathers data to understand the
health, health-related behaviors, and well-being of service members, including their sleep
health.
20
RAND Corporation, 2018 Department of Defense Health Related Behaviors Survey
(HRBS). Results for the Active Component. (Santa Monica, CA: RAND Corporation,
2021). RAND Corporation, 2015 Department of Defense Health Related Behaviors Survey
(HRBS) (Santa Monica, CA: RAND Corporation, 2018). ICF International, 2011
Department of Defense Health Related Behaviors Survey of Active Duty Military
Personnel (Fairfax, VA: ICF International, 2013). Research Triangle Institute International
(RTI International), 2008 Department of Defense Survey of Health Related Behaviors
Among Active Duty Personnel. A Component of the Defense Lifestyle Assessment
Program (DLAP) (Research Triangle Park, NC: RTI International, 2009). Research
Triangle Institute International (RTI International), 2005 Department of Defense Survey of
Health Related Behaviors Among Active Duty Personnel. A Component of the Defense
Lifestyle Assessment Program (DLAP) (Research Triangle Park, NC: RTI International,
2006).
Page 11 GAO-24-105917 Military Readiness
Service-specific surveys. The services also administer surveys on an
annual and periodic basis. One annual survey—the Azimuth Check,
reported in the Army’s Health of the Force report—found that over the
past 5 years between 34 and 39 percent of active-duty soldiers who
completed the survey reported 7 or more hours of sleep per night during
the work week, while the majority reported 6 hours or fewer.
21
Some of
the services’ other surveys identified factors affecting sleep, such as
uncomfortable mattresses and workload.
22
The services also conduct
periodic surveys of service members in combat environments, and a 2012
joint Army and Marine Corps team found that about 27 percent of
deployed soldiers responding to the survey reported having high or very
high concern that they are not getting enough sleep. The 2012 survey
also found that about 6 percent of deployed soldiers responding to the
survey reported making a mistake or having an accident due to
sleepiness.
Service safety surveys. The Army, Navy, Marine Corps, and Air Force
administer safety surveys that include questions on crew rest policies,
rest, and fatigue. Our analysis of Navy, Marine Corps, and Air Force
safety survey results found that fatigue is frequently cited by service
members in response to a question asking about causes of the next
incident or mishap in their unit (see sidebar).
Our analysis of responses from a nongeneralizable sample of 190 officers
we surveyed from selected military occupations that have a high
likelihood of experiencing fatigue found that many respondents are
21
Defense Centers for Public Health-Aberdeen, 2022 Health of the Force: Create a
Healthier Force for Tomorrow, (2022). U.S. Army Public Health Center, 2021 Health of the
Force: Create a Healthier Force for Tomorrow, (2021). U.S. Army Public Health Center,
2020 Health of the Force: Create a Healthier Force for Tomorrow, (2020). U.S. Army
Public Health Center, 2019 Health of the Force: Create a Healthier Force for Tomorrow,
(2019). U.S. Army Public Health Center, 2018 Health of the Force: Create a Healthier
Force for Tomorrow, (2018).
22
Commander, Naval Surface Forces, Commander, Naval Surface Force, U.S. Pacific
Fleet (N05), Afloat Safety Climate Assessment Survey FY22 Insights, (Coronado, CA,
2022). Commander, Naval Surface Forces, On Surface Warfare: Summary of 2022 Officer
Surveys.
Safety Surveys Identify Fatigue
Safety surveys are designed to identify and
correct conditions and human factors to
prevent future mishaps. The Army, Navy,
Marine Corps, and Air Force administer safety
surveys when command leadership changes
and communicate findings to the new
command leadership. These surveys include
open-ended questions that focus on safety,
climate, and culture, such as:
• “the next mishap / near-miss in my
organization will be caused by,” and
• “the most significant action(s) my
organization can take to improve safety
is/are.”
Since 2017, service members have often
identified fatigue as a concern within their unit.
In several instances, respondents for safety
surveys administered by the Navy and Marine
Corps cited fatigue as one of the top five
concerns from which the next mishap will
occur.
Source: Military service documentation. I GAO-24-105917
GAO Survey Results
Identify Inadequate Sleep
for Service Members and
Other Fatigue Issues
Page 12 GAO-24-105917 Military Readiness
sleeping too little, and roughly half of respondents have poor sleep quality
regardless of quantity.
23
More specifically, we found that the majority of respondents, roughly 67
percent (127 of 190), reported sleeping 6 to 7 hours per night, while 26
percent of respondents (50 of 190) reported sleeping less than 6 hours
per night, as shown in figure 2. Additionally, 46 percent of respondents
(87 of 190) rated the quality of their sleep during the work week as
moderately poor and 4 percent (eight of 190) rated it as extremely poor,
as shown in figure 2.
23
We conducted an analysis of the 245 survey responses to identify sources of
nonresponse bias that could lead to potential misrepresentations in the interpretation of
the results. We identified differences in both response rates and distributions for all
subpopulations we examined and found officers had a significantly higher response rate
(22.2 percent) and were overrepresented when compared to enlisted service members.
Because the response rate for enlisted service members was so low (6.4 percent), we
chose to use responses only from officers in summarized results to avoid potential
misrepresentations. Additionally, the number of responses reported may vary due to skip
patterns in the questionnaire or respondents choosing not to answer a particular question
(item nonresponse).
Page 13 GAO-24-105917 Military Readiness
Figure 2: GAO Survey Officer Respondents on Hours and Quality of Sleep, per 24-
Hour Cycle
Note: GAO survey results are from a nongeneralizable sample of officers in occupations selected
because they have a high likelihood of experiencing fatigue.
Page 14 GAO-24-105917 Military Readiness
Respondents to our survey identified several factors that negatively
influence sleep during their work week, including primary duty
requirements, collateral duty requirements, and high pace of operations
(see sidebar). Respondents also identified medical issues, such as sleep
apnea, that affect their ability to get enough sleep.
Moreover, we found the sleep environment is difficult to manage when
service members are deployed. Twenty-one percent (38 out of 181) of
respondents had been deployed within the past 6 months of taking our
survey. These respondents reported the issues of temperature, exposure
to light, and bedding as most interruptive of sleep while on deployment.
For example, one survey respondent stated, “The mattresses are not
comfortable, and external noise from the console or your crew partner
(e.g., alarms, phone calls, fans to keep equipment cool) can keep/wake
you up.”
Survey respondents provided a range of examples of how sleep
deprivation has affected their work (see fig. 3). See appendix II for
additional responses from our survey.
Reflections From Survey Respondents on
Collateral Duties
“Combine [primary duties] with the plethora of
duties and programs a UAS [Unmanned
Aircraft System] Warrant Officer is responsible
for and you are generally sleep deprived
always.”
– Army remote pilot
“Collateral duties in addition to flying
significantly increase workload for most pilots,
myself included. Sleep policies apply
specifically to the night before flying events.
Days where the pilot is not flying are
effectively unregulated in terms of crew day
and crew rest. The result is planned periods of
sleep deprivation in order to accomplish tasks
that accumulate due to the need to adhere to
the letter of policies regarding crew day and
crew rest when flying.”
– Marine Corps fighter pilot
“Sleep deprivation has an underlying cause
from the workload Marine pilots are faced
with. There are so many programs that are
mandated for each squadron to support and
not enough personnel, causing military trained
pilots to be working in positions that take them
out of the cockpit and study material.”
– Marine Corps helicopter pilot
“Being required to complete tasks during or
immediately following an alert week makes it
extremely difficult to perform well on a task.
The tasks are usually doable, however, the
quality of the output is easily affected by alert
related duties and or sleep deprivation from
lack of a concrete schedule.”
– Air Force missileer
Source: GAO survey, selected written responses. I
GAO-24-105917
Note: Our analysis includes written responses from a
nongeneralizable sample of officers and enlisted service
members we surveyed from selected military occupations that
have a high likelihood of experiencing fatigue.
Page 15 GAO-24-105917 Military Readiness
Figure 3: Survey Responses on the Effects of Sleep Deprivation
Note: Our analysis includes written responses from a nongeneralizable sample of officers and
enlisted service members we surveyed from selected military occupations that have a high likelihood
of experiencing fatigue.
Page 16 GAO-24-105917 Military Readiness
DOD has long recognized the harmful effects of poor or inadequate sleep.
In 2021, DOD conducted a study on the effects of sleep deprivation on
readiness and reported its results to the congressional armed services
committees (see sidebar). In the study, DOD stated sleeping less than 7
hours per night can have significant effects on cognitive, emotional, and
physical capabilities that directly affect military performance. These
effects include deficits in marksmanship, physical training, decision-
making, and risk-taking behavior. DOD and the services recognize that
impairment from sleep deprivation can be equivalent to the effects of
alcohol intoxication and significantly increases the risk of physical injury.
For example, Navy guidance cautions that getting less daily sleep than
the minimum requirement can rapidly and significantly degrade alertness
and performance, which can lead to mishaps and numerous negative
health outcomes.
24
Navy data show that sailor effectiveness declines after
prolonged periods without sleep, equating to impairment levels
comparable to intoxication.
The services also recognize that sleep deprivation affects medical and
force readiness and has financial implications. For example, Navy
guidance states that less than 6 hours of sleep per night can lead to
24
Commander, Naval Surface Force, U.S. Pacific Fleet and Commander, Naval Surface
Force Atlantic Instruction 3120.2A, Comprehensive Crew Endurance Management Policy
(Dec. 11, 2020).
DOD Recognizes the
Risks of Sleep Deprivation
2021 Department of Defense (DOD) Study
on Effects of Sleep Deprivation on
Readiness
The National Defense Authorization Act for
Fiscal Year 2020 required DOD to complete a
study that included: 1) a standardized
definition of sleep deprivation; 2) an
assessment of the prevalence of sleep
deprivation; 3) an assessment of whether
there may be a relationship between sleep
deprivation and medical conditions such as
Traumatic Brain Injury, Post-Traumatic Stress
Disorder, and depression; and 4)
recommendations.
In March 2021 DOD provided a report on the
results of its study to the Congressional
Armed Services Committees, noting that
sleep may be the most important biological
factor that determines service member health
and combat readiness. DOD recommended
that the department establish policy to
promote a culture shift to prioritize adequate
sleep in the military and identified a number of
strategies to mitigate the risk of sleep
deprivation and improve sleep among service
members.
Source: DOD, Report to Congressional Armed Services
Committees: Study on Effects of Sleep Deprivation on
Readiness of Members of the Armed Forces (March 2021). I
GAO-24-105917
Page 17 GAO-24-105917 Military Readiness
service members being more prone to systemic heat injuries.
25
Army
Holistic Health and Fitness system documentation outlines that chronic
sleep deprivation contributes to medically nondeployable status of service
members.
26
The services have also reported that lack of sleep can lead to mishaps—
incidents that result in death, injury, illness or property damage. Mishaps
can range from an aircraft crash to an ankle sprain at work. For example:
• The Army has found that fatigue, lack of rest, or lack of sleep was a
cause in 8 percent of tactical vehicle accidents between fiscal years
2010 to 2019.
27
• The Naval Safety Center found that between 2015 and 2019 there
were 489 reported instances of fatigued-driving related fatalities,
serious injuries, and property damage involving Marines and sailors.
• In 2017, the Navy had four significant mishaps at sea, including two
collisions that resulted in the loss of 17 sailors’ lives and hundreds of
millions of dollars in damage to Navy ships, which the Navy attributed
partly to sailor overwork and fatigue.
28
According to Navy guidance,
after sailors have been awake for 18 hours, their performance,
efficiency, and decision-making ability rapidly decline to 75 percent of
baseline effectiveness or less, and accident rates increase for almost
every activity.
29
25
Office of the Chief of Naval Operations Instruction 5100.19F, Navy Safety and
Occupational Health Program Manual for Forces Afloat (May 9, 2019).
26
The U.S. Army Holistic Health and Fitness Operating Concept, The U.S. Army’s System
for Enhancing Soldier Readiness and Lethality in the 21st Century (Oct. 1, 2020).
27
In 2021, we found that the Army and Marine Corps reported 3,753 tactical vehicle
accidents (e.g., tanks, trucks) from noncombat scenarios resulting in 123 service member
deaths from fiscal years 2010 to 2019. GAO, Military Vehicles: Army and Marine Corps
Should Take Additional Actions to Mitigate and Prevent Training Accidents, GAO-21-361
(Washington, D.C.: July 7, 2021).
28
We have reported that the Navy has since acted to address sailor fatigue, resize surface
ship crews to handle workload, and improve training in the surface fleet. See GAO, Navy
Readiness: Additional Efforts Are Needed to Manage Fatigue, Reduce Crewing Shortfalls,
and Implement Training, GAO-21-366 (Washington, D.C.: May 27, 2021) and GAO, Navy
Readiness: Challenges to Addressing Sailor Fatigue in the Surface Fleet Continue,
GAO-24-106819 (Washington, D.C.: Oct. 11, 2023).
29
Commander, Naval Surface Force, U.S. Pacific Fleet and Commander, Naval Surface
Force Atlantic Instruction 3120.2A, Comprehensive Crew Endurance Management Policy
(Dec. 11, 2020).
Page 18 GAO-24-105917 Military Readiness
More recently, as required by the National Defense Authorization Act for
Fiscal Year 2022, DOD established the Suicide Prevention and Response
Independent Review Committee to conduct a comprehensive review of
suicide prevention and response programs and found that sleep
disruption was a risk factor for suicide. The committee issued a report,
and among its 127 recommendations, seven are related to sleep,
including providing education on healthy sleep habits during military
training and regularly scheduled unit formations. The report also had a
high-priority recommendation that duty schedules allow for 8 hours of
sleep and minimize the frequency of shift changes.
30
DOD and the services have taken steps to address fatigue, such as
conducting research and implementing strategies to limit sleep
deprivation. However, we found challenges with DOD’s approach to
overseeing and leading the department’s fatigue related efforts,
fragmented fatigue-related research efforts, and information sharing
across the department.
DOD and the services have taken several steps to address fatigue. These
steps, as shown in figure 4, include developing policies and guidance on
sleep and fatigue management, conducting research, implementing
several strategies to limit and manage sleep deprivation, educating and
training service members, and analyzing fatigue-related mishap data.
30
A Secretary of Defense memorandum related to the report’s recommendations directed
commanders at all levels to promote mission readiness through healthy sleep throughout
the department, in accordance with DOD Instruction 1010.10, among other things.
Secretary of Defense Memorandum, Next Steps on Suicide Prevention in the Military
(Mar. 16, 2023).
DOD Has Taken
Steps to Address
Fatigue, but Faces
Challenges with
Oversight and
Enterprise-Wide
Collaboration
DOD and the Services
Have Taken Steps to
Address Fatigue
Page 19 GAO-24-105917 Military Readiness
Figure 4: Examples of Steps DOD and the Services Have Taken to Address Fatigue
a
Department of Defense Instruction 1010.10, Health Promotion and Disease Prevention (Apr. 28,
2014) (incorporating change 3, effective May 16, 2022).
b
Army Field Manual FM 7-22, Holistic Health and Fitness (Oct. 8, 2020).
c
We reported in 2018 that DOD needs to improve its approach for collecting and analyzing data on
military aviation mishaps to manage risks, and recommended that the Office of the Under Secretary
of Defense for Personnel and Readiness ensure standardized aviation mishap data elements are
collected by the military safety centers. See GAO, Military Aviation Mishaps: DOD Needs to Improve
Its Approach for Collecting and Analyzing Data to Manage Risks, GAO-18-586R (Washington, D.C.:
Aug. 15, 2018).
Page 20 GAO-24-105917 Military Readiness
DOD faces challenges with overseeing and leading the department’s
fatigue-related efforts, and overseeing the services’ implementation of
their responsibilities related to preventing and mitigating the effects of
fatigue. We also identified areas where some fatigue-related efforts were
fragmented across the department and where DOD could better facilitate
collaboration between DOD entities and stakeholders.
We found challenges with DOD’s approach to overseeing and leading the
department’s fatigue-related efforts, including challenges with (1)
organizational authority, (2) the framework used to implement and
oversee fatigue-related efforts, and (3) overseeing the services’
implementation of their responsibilities to help prevent and mitigate the
effects of fatigue.
First, we identified challenges with organizational authority for overseeing
and leading the implementation of DOD’s overarching fatigue-related
guidance. DOD Instruction 1010.10 assigns responsibility to oversee the
implementation of the instruction, which includes provisions related to
fatigue prevention and mitigation, to the Under Secretary of Defense for
Personnel and Readiness. Personnel and Readiness officials told us that
primary oversight and leadership responsibility for the Instruction had
been delegated to the Office of the Assistant Secretary of Defense for
Health Affairs (Health Affairs). However, our analysis found that sleep is
related to other efforts in domains other than health, and Health Affairs
does not have organizational authority over all the domains we identified.
For example, Health Affairs does not have organizational authority over
the Office of the Assistant Secretary of Defense for Readiness, which has
offices for Force Safety and Occupational Health and Force Education
and Training, and sleep relates to responsibilities in both offices.
Similarly, Health Affairs also does not have organizational authority over
the Office of the Assistant Secretary of Defense for Human Resource
Activity, which oversees the Defense Suicide Prevention Office. The
Defense Suicide Prevention Office provides resources to service
members on preventing sleep deprivation, as sleep deprivation is
considered a risk factor for suicide. Additionally, Health Affairs officials
with whom we spoke did not have details on how they would carry out
their delegated responsibilities in coordination with these offices.
DOD Faces Oversight and
Enterprise-Wide
Collaboration Challenges
in Leading Fatigue-
Related Efforts
Oversight Challenges
Page 21 GAO-24-105917 Military Readiness
Second, we identified challenges with the framework used to implement
and oversee the department’s fatigue-related guidance.
31
In May 2022,
DOD issued an update to DOD Instruction 1010.10 to (1) identify Total
Force Fitness as the framework to understand, assess, and optimize
service members’ well-being and (2) promote healthy sleep-wake cycles
in operational and nonoperational environments.
32
DOD officials told us
they use Total Force Fitness as the primary method to implement the
added fatigue-related requirements to help prevent and mitigate the
effects of sleep deprivation among service members. However, DOD has
reported on, and officials on this review acknowledged, challenges with
the implementation of Total Force Fitness, including insufficient guidance
and unclear authority and responsibilities to implement the programs
under the framework (see sidebar).
33
DOD and service officials we spoke
to were either unaware of who or which office had fatigue-related
responsibilities or believed another official or office had assumed fatigue
responsibilities when they had not. For example, officials were unclear if
sleep was related to medical or force readiness, or both, and officials in
both domains were divided on the interpretation.
Third, we identified challenges with overseeing the services’ individual
fatigue-related responsibilities, as outlined in DOD Instruction 1010.10.
Specifically, Health Affairs officials told us they have not been able to
identify service-level officials, including service points of contact,
responsible for or aware of the services’ implementation of the
responsibilities set forth in DOD Instruction 1010.10. Over the course of
this review, we were also unable to identify service officials responsible
for these fatigue-related responsibilities.
Officials from each of the four services we spoke to in the safety or health
domains were unaware of the DOD instruction or the responsibilities it
sets forth. The instruction directs DOD component heads to help prevent
and mitigate the effects of fatigue among service members by promoting
31
DOD Instruction 1010.10.
32
Started in 2009, DOD’s Total Force Fitness is a framework intended to maintain service
members’ well-being and to sustain their ability to carry out missions. The framework
includes eight domains, and sleep is embedded across several domains, according to
program documentation. The eight domains are: physical, environment, medical and
dental, nutritional, spiritual, psychological, social, and financial.
33
Defense Systems Technical Area Tasks, Booz Allen Hamilton, Total Force Fitness
Capabilities-Based Assessment Final Report, a report prepared at the request of the
Office of the Under Secretary for Defense for Acquisition, Technology and Logistics,
Department of Defense (Apr. 27, 2017).
Challenges with the Department of
Defense (DOD) Total Force Fitness
Framework
In 2017, DOD commissioned a report to
examine Total Force Fitness. The report
found it could not determine the degree of
execution of Total Force Fitness and that
DOD lacked sufficient guidance to implement
the programs.
Following that report, DOD made more than
two dozen recommendations to improve Total
Force Fitness; however, DOD could not
provide us a status update on those
recommendations, and we could not
determine how many, if any, had been
addressed. For example, one
recommendation was to create a DOD
directive to establish policy, assign
responsibilities, and delegate authority to
DOD components for Total Force Fitness
implementation. However, 6 years later the
directive is still not complete, and officials did
not have an estimate for its completion.
Source: GAO analysis of DOD documentation. I
GAO-24-105917
Page 22 GAO-24-105917 Military Readiness
and encouraging service members to obtain adequate sleep through a
variety of means, including using mobile applications to track sleep and
promoting a healthy sleep environment. DOD Instruction 1010.10 also
directs component heads to prioritize time for sleep and fatigue
prevention as mission requirements permit by incorporating at least 7
hours of sleep per every 24-hour period into duty schedules, training
plans, and battle plans, and allowing additional sleep for service members
during preparation and periods before a mission, among other things.
It is DOD policy to enhance mission readiness, unit performance, and the
health and fitness of service members by creating a culture that views
sleep patterns as a key indicator of readiness.
34
In addition to the
responsibilities set forth in DOD Instruction 1010.10, Standards for
Internal Control in the Federal Government call for agency management
to establish an organizational structure, assign responsibility, and
delegate authority to achieve the entity’s objectives.
35
However, we found DOD has not assessed DOD’s oversight structure for
fatigue-related efforts to identify an office or an individual with sufficient
authority, sufficient staffing and resources, and committed leadership to
oversee the implementation of DOD Instruction 1010.10 and other DOD-
wide fatigue-related efforts, and does not have plans to do so. DOD and
service officials acknowledged the need to assess the department’s
approach to overseeing and managing fatigue-related efforts and
ultimately determine an institutional owner of fatigue-related issues and
programmatic solutions. Further, we found the services have not
assigned leadership for implementing DOD Instruction 1010.10. Officials
from the Office of the Under Secretary of Defense for Personnel and
Readiness told us that without clear service leadership they have had
difficulty ensuring implementation of the sleep policy and monitoring the
services’ efforts.
Without an assessment of DOD’s oversight structure for fatigue-related
efforts and assignment of DOD and service leadership, these efforts may
not be given the necessary authority, staffing and resources, and
committed leadership to ensure the department has a culture that views
34
DOD Instruction 1010.10.
35
GAO, Standards for Internal Control in the Federal Government, GAO-14-704G
(Washington, D.C.: September 2014).
Page 23 GAO-24-105917 Military Readiness
sleep patterns as a key indicator of readiness and implements efforts
across the department to effectively limit service member fatigue.
Based on our analysis of information obtained from the services, we
identified nearly 130 fatigue-related research projects the Army, Navy,
Marine Corps, and Air Force conducted between 2017 and 2023. These
projects were primarily focused on medical or physiological issues;
environmental solutions, such as blackout curtains; the use of wearable
technology to track sleep data; and the use of scheduling tools, such as
software programs, that can model work schedules to account for or
identify any risk of fatigue.
Some of the projects we identified were joint efforts between services and
between different organizations within a service. For example:
• Optimizing the Human Weapon System (OHWS): An Army, Navy,
Marine Corps, Air Force, and U.S. Special Operations Command
program that analyzes biometric data from wearable devices, such as
sleep patterns and heart rate variability. Project officials use this data
to flag individuals who may need supporting services and prompt
wellness checks from health officials embedded within a unit.
• Command Readiness, Endurance, and Watchstanding (CREW):
According to officials, while CREW is part of the larger OHWS effort, it
is a Navy program that collects biometric sleep, activity, and health
data through the use of wearable devices to provide near real-time
information to the sailor, to those who manage schedules for sailors
standing watch, and to ship leadership. The Navy’s Naval Health
Research Center—in collaboration with the Naval Surface Force and
the Marine Corps, among others—has used this program with 15
afloat commands, enrolling thousands of sailors in the program.
However, we also identified instances of fragmentation among DOD and
service fatigue-related research projects.
36
We found multiple
organizations within DOD involved in the same broad area researching
sleep and fatigue. These organizations are spread across the
department, from those at the DOD-level—such as the Defense Health
36
Fragmentation refers to those circumstances in which more than one federal agency or
more than one organization within an agency is involved in the same broad area, and
opportunities exist to improve those efforts. GAO, 2023 Annual Report: Additional
Opportunities to Reduce Fragmentation, Overlap, and Duplication and Achieve Billions in
Financial Benefits, GAO-23-106089 (Washington, D.C.: June 14, 2023).
Fragmented Fatigue-Related
Research
Page 24 GAO-24-105917 Military Readiness
Agency—to those at multiple levels within each service, including
commands to units. These organizations are also spread across multiple
domains, including health and safety.
Officials we spoke with were knowledgeable of large fatigue research
projects, such as the Navy’s CREW, but many were generally unaware of
smaller-scale fatigue research projects and their findings. Officials stated
that there is a need for different research focuses given the differences in
population and environment, such as studying fatigue associated with
service members in Alaska experiencing all daylight in contrast to
studying fatigue associated with submariners experiencing a lack of
daylight. However, officials also emphasized that such research is
occurring independently with little cohesion or information sharing and
referenced service stovepipes when discussing fatigue-related research
efforts.
Fragmentation is particularly apparent in fatigue-related research using
wearable devices. We found multiple organizations within DOD engaged
in studying the use of wearable technology to track service member
sleep, including device accuracy and reliability; applicability in scheduling;
and data transfer, storage, and analysis. We identified 48 projects that
used wearable technology to collect sleep data between 2017 and 2023.
While most of these projects had different research goals or involved
different military occupations and settings, many of these projects used
the same type of technology or even the same model (see fig. 5).
Page 25 GAO-24-105917 Military Readiness
Figure 5: Wearable Device Use Across Military Services for Selected Fatigue-
Related Research, 2017—2023, by Brand
Note: We asked the Department of Defense (DOD) and the services to provide a list of fatigue-related
research projects between 2017 and 2023. Some of the project descriptions provided included the
names of wearable brands and others did not. We reviewed this information along with other related
Page 26 GAO-24-105917 Military Readiness
service documentation and interviews with officials to determine a list of wearable brands, but this list
is not comprehensive of all wearable brands used in DOD and service fatigue-related research
between 2017 and 2023. If officials did not specify the wearable model version in documentation
provided to us, we did not include the version in the figure. According to Navy officials, some of the
wearables are to be evaluated by the Navy in the future as part of a project that has had incremental
funding between 2017 and 2023. Since the project has received funding, we included these
wearables in the figure. Funding information was not available for every project shown. For the Navy
and Marine Corps projects that included funding information, we allocated the wearable to the service
that funded the project. While some of the Walter Reed Army Institute of Research projects received
funding from the Defense Health Agency Military Operational Medical Research Program, Joint
Program Committee-5, we allocated the wearable to the Army. Walter Reed Army Institute of
Research officials stated that they could not identify the Oura Ring generation currently in use and
that is possible that all three generations are in use. Therefore, we included Oura Ring Generations 1,
2, and 3 in the figure for the Army.
We were able to collect cost information for 29 of the 48 wearables
projects we identified in our analysis.
37
For these 29 projects the Army,
Navy, Marine Corps, and Air Force spent approximately $25 million.
Moving forward, DOD plans to make significant investments in wearable
device programs, with plans to spend hundreds of millions on them over
the next four years. In a July 2023 report to Congress, DOD estimated the
Defense Health Agency will invest roughly $337 million over six wearable
device-related programs from fiscal years 2021 to 2027.
38
Standards for Internal Control in the Federal Government states that
management should perform ongoing monitoring—including evaluations
across agency functional areas—as part of the normal course of
operations to enable the entity to plan, execute, control, and assess the
organization in achieving its objectives.
We found there is fragmentation among the services’ fatigue-related
research efforts in part because DOD leadership does not monitor these
37
We were unable to collect cost information for every project we identified. Furthermore,
for any joint projects that we identified, we have only partial costs. Additionally, project
costs include more than the cost of the wearable. Project costs generally include all
aspects of a project, according to officials from all four services. Further, Walter Reed
Army Institute of Research officials said in many of the projects provided by them,
particularly lab-based studies, the wearables are only a small part of the overall design
and contribute a small amount to the overall cost, as the wearable is used as a check for
eligibility in the study, providing objective verification that participants were sleeping as
they had reported prior to a lab experiment.
38
Department of Defense, Report to the Committee on Armed Services of the House of
Representatives, Use of Fitness Wearables to Measure and Promote Readiness,
(Washington, D.C.: July 2023). According to officials, the $337 million is not aligned solely
with fatigue-related research that uses wearables. Other efforts include infection prediction
and combat causality care. Furthermore, according to officials, this funding includes efforts
to understand the underpinnings of wearable data transfer, efforts to safeguard data, and
privacy protections.
Page 27 GAO-24-105917 Military Readiness
efforts, such as by creating and maintaining a comprehensive list of
fatigue-related research projects. DOD officials were unable to provide us
with a list of the department’s fatigue-related projects since 2017. Instead,
officials referred us to various service organizations to obtain information
and compile our own list of any fatigue-related research. DOD officials
acknowledged that they lack a comprehensive inventory needed to allow
the department to understand and identify projects that are currently in
place and reveal redundancies, determine gaps, identify cost saving
opportunities, and identify methods to show program impacts.
Establishing a comprehensive list of fatigue-related research projects will
help ensure visibility, encourage collaboration, and leverage lessons
learned from fatigue-related projects, as well as help reduce any
fragmentation that may exist, potentially leading to cost savings.
DOD has not facilitated collaboration across the numerous key
stakeholders involved in DOD’s efforts to limit sleep deprivation and
manage fatigue across the services. Our analysis of information received
from DOD officials indicates that fatigue-related research efforts stretch
across multiple domains including health, safety, and readiness, and
involve an array of diverse technical disciplines ranging from medical
researchers to developers of cutting-edge technology. This research is
occurring in various offices and commands across the military
departments.
We identified some informal networking across these entities to share
fatigue-related research efforts, as well as several working groups broadly
focused on human performance and optimization efforts, joint medical
initiatives, or suicide prevention. However, according to officials, there is
not a working group dedicated to sleep or fatigue that exists to regularly
gather these numerous key stakeholders. Officials told us it is often
necessary to individually engage senior leadership to compete for
resources and attention for new or improved technology, processes, and
mitigations to manage fatigue.
We identified challenges in transitioning fatigue-related programs and
projects with demonstrated or validated results to full implementation.
According to officials, such challenges include difficulty with coordination
and scalability, a lack of identified program offices and associated
funding, and gathering attention of senior leadership. Officials from
several services reported that it is even more difficult for many of the
offices conducting fatigue research to solicit resources when they are
considered nonmedical. For example:
Collaboration Challenges
Page 28 GAO-24-105917 Military Readiness
• An Army official told us that the Optimizing the Human Weapons
System program, discussed above, is unlikely to be scaled to higher
echelons due to costs. According to Army documentation, the
program has demonstrated an ability to preemptively detect personnel
hazards. In one instance, according to a program official, program
analysts detected an irregular sleep pattern from the wearable device
worn by a soldier deployed to Afghanistan. This analysis prompted a
wellness check by health officials embedded in the unit, and the
soldier was found to be having suicidal thoughts, allowing Army health
personnel to connect the service member with lifesaving resources.
An Army official stated that, for this program to be prioritized for
funding, it would likely need to capture the interest of those at the
highest leadership of DOD, who consider many competing priorities.
• Officials told us the CREW program, discussed above, and the
Optimized Watchbill Logistics (OWL) program show promise for their
ability to identify fatigue issues and mitigate risks in real time, but both
are limited from further expansion due to a lack of dedicated funding.
The OWL program is a schedule management system with fatigue
risk predictive features that can use the biometric data collected by
CREW wearables to assist with sailor workload planning and
operational fatigue management.
39
Officials confirmed that CREW has
been assessed with fifteen afloat commands. OWL has been installed
on nine ships, and their integrated capability was demonstrated during
a summer 2023 training exercise. However, CREW and OWL are pilot
programs which currently do not have dedicated long-term funding.
• The Navy’s 2022 Naval Surface Forces, Afloat Safety Climate
Assessment Survey found that uncomfortable mattresses onboard
Navy ships is the second leading cause of inadequate sleep and
fatigue cited by sailors.
40
However, Navy officials told us that this
problem does not have a Navy resource sponsor willing to examine it
further and fund mattress improvements across the fleet. Moreover,
multiple attempts to secure funding through the Defense Health
Agency have also been unsuccessful because the Defense Health
Agency does not view mattresses as a medical issue, according to
Navy officials.
39
The Navy expected CREW to reach initial operating capability in late 2023. OWL
reached this milestone in 2022. The Navy expects to complete testing of these efforts in
2024.
40
Commander, Naval Surface Forces, Afloat Safety Climate Assessment Survey FY22
Insights (Dec. 15, 2022) (CUI).
Page 29 GAO-24-105917 Military Readiness
Our work on leading practices to enhance interagency collaboration
states that stakeholder participants from relevant agencies should be
included in cases in which no single organization has the authority,
resources, or skills necessary to address a crosscutting challenge.
41
These stakeholders should include individuals with the authority to make
decisions on behalf of involved agencies, and those stakeholders with the
diverse perspectives, knowledge, skills, and abilities to improve
outcomes.
42
However, we found that DOD has not established a cross-domain
working group dedicated to sharing and communicating fatigue research
and related information department-wide. DOD and service officials
across our selected military occupations stated they do not participate in
fatigue-related working groups, one adding that the department’s fatigue-
related research efforts and related programs would benefit from a
dedicated working group. By establishing a cross-domain working group,
the department would be better positioned to collaborate on fatigue-
related research projects, engage senior leadership on fatigue mitigations
to influence management priorities, and improve coordination for the
introduction of new or improved technology to manage fatigue.
41
GAO, Government Performance Management: Leading Practices to Enhance
Interagency Collaboration and Address Crosscutting Challenges, GAO-23-105520
(Washington, D.C.: May 24, 2023).
42
We have previously reported that DOD leverages working groups comprised of military
service and DOD officials to collaborate and share information, engage senior leadership,
recommend priority areas for risk mitigation, monitor risk management actions, develop
tools and processes to address long-term barriers, and build and monitor implementation
plans. See GAO, Defense Industrial Base: DOD Should Take Actions to Strengthen Its
Risk Mitigation Approach, GAO-22-104154 (Washington, D.C.: July 7, 2022).
Page 30 GAO-24-105917 Military Readiness
In its 2021 study on sleep deprivation and readiness, DOD made seven
recommendations to mitigate fatigue and improve sleep among service
members (see fig. 6).
43
While the services are taking some actions to
address fatigue as discussed above, DOD officials told us they do not
have plans to implement and monitor the recommendations from the
study, and officials were not able to provide an updated status on each of
the recommendations.
44
Over the course of our review, DOD and service
officials, as well as respondents to our survey, reported they would
benefit from DOD implementing changes or strategies similar to those
recommended in the 2021 DOD study.
43
Department of Defense, Study on Effects of Sleep Deprivation on Readiness of
Members of the Armed Forces (March 2021). Section 749 of the National Defense
Authorization Act for Fiscal Year 2020 required DOD to complete a report that provided 1)
a standardized definition of sleep deprivation; 2) an assessment of the prevalence of sleep
deprivation; 3) an assessment of whether there may be a relationship between sleep
deprivation and medical conditions such as traumatic brain injury, post-traumatic stress
disorder, and depression; and 4) recommendations. Pub. L. No. 116-92, § 749 (2019).
The DOD study identified seven recommendations and 11 associated strategies to
mitigate the risk of sleep deprivation and to improve sleep among service members.
44
The Suicide Prevention and Response Independent Review Committee also made
recommendations related to sleep. For example, it recommended that the department
ensure duty schedules allow for 8 hours of sleep and minimize the frequency of shift
changes, and that the department provide education in healthy sleep habits during training
and unit formations—similar to the 2021 DOD study on sleep deprivation and readiness.
An implementation memorandum following the report directed commanders at all levels to
promote mission readiness through healthy sleep throughout the department, in
accordance with DOD Instruction 1010.10. Officials with sleep-related responsibilities
whom we spoke with during this review did not have information on how the department
will implement or monitor these sleep-related recommendations from the Suicide
Prevention and Response Independent Review Committee.
Prior DOD Fatigue-
Related
Recommendations
Remain
Unimplemented
Page 31 GAO-24-105917 Military Readiness
Figure 6: DOD-Identified Recommendations and Related Strategies to Mitigate Fatigue and Improve Sleep among Service
Members, 2021 DOD Study on Sleep Deprivation and Readiness
Page 32 GAO-24-105917 Military Readiness
DOD recommendation: Adopt duty schedules to ensure 8 hours of
sleep. DOD stated in its study that due to the sustained high tempo of
operations during the past 2 decades, daily duty requirements have taken
priority over service members obtaining enough sleep to perform at
optimal levels. The report stated that a commitment to promote and
encourage service members to obtain adequate sleep is a vital tool to
mitigate associated operational and readiness risks.
Similarly, over the course of our review, officials told us they believe a
policy change that prioritizes sleep, such as adopting schedules to ensure
8 hours of sleep, would help change the DOD culture to value sleep
rather than view sleep deprivation as part of being in the military and
sleep as something for the weak. For example, one missileer we spoke
with told us that he regularly remained awake for the duration of his 24-to-
36-hour shift to ensure he was doing his job the best. This statement is in
direct contradiction with research findings and trainings from the services,
which state that lack of sleep affects the brain the same way as being
drunk and routinely getting 5 to 6 hours of sleep per night is like
performing with a blood alcohol level of 0.08 percent, which is like being
drunk on duty.
The services have publications that recognize the need for cultural
change related to sleep. For example, Navy and Marine Corps doctrine
from 2010 states that leaders must attack existing military cultural norms
that place a high value on the apparent ability to function without sleep.
45
A 2020 Army program document notes that engaged leaders must set a
personal example and foster an environment conducive to changing the
culture of health and fitness in the Army.
In written comments to our survey, some respondents stated duty
schedules that ensured sufficient sleep would be beneficial and noted that
long duty days prevent them from obtaining enough sleep.
46
For example,
one respondent stated there is not enough time in the day to do
everything required and to fit in a proper sleep cycle. Another responded
that the amount of administrative requirements outside of primary duties
45
Marine Corps Reference Publication 6-11C and Navy Tactics, Techniques, and
Procedures 1-15M, Combat and Operational Stress Control (Dec. 20, 2010).
46
Our analysis includes written responses from a nongeneralizable sample of officers and
enlisted service members we surveyed from selected military occupations that have a high
likelihood of experiencing fatigue.
Reflections from Survey Respondents on
Scheduling
"The constant change in my shift work
schedule makes it difficult to get adequate
sleep, this is in spite of my unit having good
sleep policies in theory."
– Army helicopter pilot
"Routinely scheduled for brief times for flights
that begin at 0730 followed by a brief time of
1730 for a night flight in the same week
without adequate time to adjust my sleep
cycle. These brief times mean that sometimes
I am waking up at 0630 to make the brief
while the same week there are days I won't
leave work until 0230. Because I technically
work days with the occasional night flight, I
am then expected to switch back to the day
schedule. This leads to copious amounts of
caffeine to stay awake and function during
work followed by difficulty sleeping and
readjusting to an early morning schedule."
– Marine Corps helicopter pilot
"I am currently on alert and have pulled 3
night shifts. Immediately after I pull a 8-12
hour night shift, I continue to assist with
mission requirements until the late afternoon,
which takes me off the night shift schedule
and interrupts my sleep. This requires me to
continue to do my job while sleep deprived.”
– Air Force missileer
“During the course of [work travel], we
regularly either fail to schedule any days off,
or the days off templated on the schedule
ALWAYS turn into work days. After several
weeks, this causes a significant amount of
fatigue and is dangerous when flying.”
– Army helicopter pilot
Source: GAO survey, selected written responses. I
GAO-24-105917
Note: Our analysis includes written responses from a
nongeneralizable sample of officers and enlisted service
members we surveyed from selected military occupations that
have a high likelihood of experiencing fatigue.
Page 33 GAO-24-105917 Military Readiness
placed on the average Marine make it unrealistic to be able to truly
manage a work life balance and consistently get a good night of sleep.
DOD recommendation: Establish unit-level sleep trainer positions.
DOD stated in its study that unit-level sleep trainers would facilitate sleep
plans, monitor individual sleep performance, and train members of their
units on behavioral strategies for minimizing and mitigating sleep
deprivation. These sleep trainers would promote the use of strategies to
mitigate sleep deprivation throughout units and advise commands on
ensuring that service members receive adequate opportunity for sleep.
Army officials told us that the Army includes sleep education and training
as part of its Holistic Health and Fitness system, which focuses on five
readiness domains, including physical, mental, spiritual, nutritional, and
sleep. The program embeds Holistic Health and Fitness performance
teams in brigades, including specialists in sleep, nutrition, physical
therapy, athletic training, strength, and cognitive performance. According
to Army officials, the effort began with 28 brigades in fiscal year 2021 and
will add 10-15 brigades every subsequent year totaling 110 Holistic
Health and Fitness brigades by fiscal year 2029.
Very few of our survey respondents were familiar with sleep trainers.
Nearly 85 percent of our survey respondents (160 of 190) said that their
unit does not have a sleep trainer. If they did, unit-level sleep trainers
could advise the command about changes that might help service
members obtain more sleep. For example, in written comments to the
survey, a survey respondent stated that additional duties and mandatory
attendance at presentations that take place during resting hours (i.e., off
shift) lead to fatigue. A unit-level sleep trainer could communicate this to
the command, which could lead to changing the times for the mandatory
presentations to allow for more sleep.
DOD recommendation: Implement training in sleep leadership. DOD
stated in its study that the first step toward reducing and mitigating the
impact of sleep deprivation in the military should be commanders at all
levels committing to sleep leadership. DOD added that sleep leadership
should be emphasized as a core competency in readiness, with
consideration given to evaluating leaders based on whether the service
members in their stewardship receive sufficient sleep hours per night.
Reflections from Survey Respondents on
Sleep Trainers
"Having a sleep trainer or sleep education
program should be a thing for missile
squadrons. We've recently had people fall
asleep at the console in the capsule, and
others being sleep deprived out in the field
because they don't manage their sleep shifts
effectively. I think having some kind of
education or a sleep planner/trainer would be
beneficial, so people aren't stressed out about
pushing past their limits and staying up during
their shift and planning better about getting
sleep."
– Air Force missileer
Source: GAO survey, selected written responses. I
GAO-24-105917
Note: Our analysis includes written responses from a
nongeneralizable sample of officers and enlisted service
members we surveyed from selected military occupations that
have a high likelihood of experiencing fatigue.
Page 34 GAO-24-105917 Military Readiness
Similarly, over the course of our review, officials also told us that training
in sleep leadership is beneficial. For example, officials from the Walter
Reed Army Institute of Research told us the Army will need to train
leaders to disseminate sleep-related information to their units to get any
real change on how soldiers view sleep. The officials told us they have
provided information on sleep leadership that was included in a module
for leadership training, and Army training officials told us the information
has been beneficial. Navy officials stated similarly that sailors often do not
know they are sleeping poorly and do not know how to improve their
sleep hygiene. To help sailors, the Commanders of the Naval Surface
Forces, U.S. Pacific Fleet and Atlantic issued a force-wide fatigue and
crew endurance management policy and followed it up with training that
was incorporated into curricula for the Navy Leadership Education Course
and Naval Education and Training Command.
47
One-third of survey respondents reported that their leadership makes a
sleep a priority only to a slight extent or not at all (59 of 190), and several
respondents stated that improved sleep leadership would positively affect
them.
DOD recommendation: Provide education and other resources to
decrease caffeine use. DOD stated in its study that although potential
short-term benefits exist when using caffeine as a countermeasure for the
effects of total and partial sleep deprivation, it cannot replace the need for
sleep. The report also stated that overuse of caffeine may increase levels
of sleep deprivation.
Similarly, over the course of our review, officials told us that most service
members use caffeine to overcome fatigue, but noted that it has
limitations, particularly when used regularly. In addition, DOD researchers
have been calling for service member education on proper caffeine use,
including information on the safe amounts of caffeine and consumption
timelines. For example, the Consortium for Health and Military
Performance at the Uniformed Services University of the Health Sciences
reported that research suggests caffeine is relatively safe when used
appropriately, but service members need clear guidance on how to best
use caffeine during training, missions, and in everyday activities to
maintain optimal performance.
47
Commander, Naval Surface Force, U.S. Pacific Fleet and Commander, Naval Surface
Force Atlantic Instruction 3120.2A, Comprehensive Crew Endurance Management Policy
(Dec. 11, 2020).
Reflections from Survey Respondents on
Sleep Leadership
“Good leadership and management will
limit/manage sleep deprivation. Bad
leadership will overtax your aircrew and lead
to a mishap.”
– Marine Corps helicopter pilot
"In my training as a helicopter pilot, sleep
deprivation is well advertised. It is readily
apparent that a lack of sleep degrades
performance. When aircrew advertise they are
reaching a limit, does the command
acknowledge that and talk about what can be
done? Or does it simply say get it done
anyways. In my opinion, if aircrew are
constantly sleep deprived, the first question
should be how in touch is the command with
its aircrew and what is leadership asking them
to do."
– Marine Corps helicopter pilot
“Leadership needs to continue to empower
their people to drive for adequate sleep cycles
and educating them on how to achieve this."
– Air Force remote pilot
Source: GAO survey, selected written responses. I
GAO-24-105917
Note: Our analysis includes written responses from a
nongeneralizable sample of officers and enlisted service
members we surveyed from selected military occupations that
have a high likelihood of experiencing fatigue.
Page 35 GAO-24-105917 Military Readiness
Our survey found nearly 92 percent of respondents (173 of 189) said they
used allowable stimulants, such as caffeine, to address or reduce the
effects of sleep deprivation, and of those respondents nearly 80 percent
(139 of 173) said doing so was beneficial. In written comments to the
survey, a respondent stated he is worried about the caffeine dependency
exhibited by most service members, and they would benefit from
education on the best ways to use caffeine.
DOD recommendation: Adopt existing research-based strategies to
address travel-related circadian rhythm disruption. DOD stated in its
study that research literature includes specific, well-established
techniques to mitigate effects of travel-related circadian rhythm
disturbances, and it noted that units deploying across six or more time
zones should allow at least 2 weeks of adaptation time.
DOD researchers told us they have been working on developing
countermeasures to prevent and reverse travel-related circadian rhythm
disruption to maximize human performance, and researchers from the
Walter Reed Army Institute of Research have developed infographics for
service members with strategies for minimizing fatigue when traveling
across multiple time zones.
Service members in our review noted that significant travel across
multiple time zones has affected their ability to get enough sleep during
the work week and sometimes leads to working multiple shifts in 1 day. In
fact, one service member told us that after crossing multiple time zones
on an international trip, he reported to his duty station to begin a shift 3
hours after arriving in country, with no time to rest or gain adequate sleep.
DOD recommendation: Expand use of brief behavioral interventions
and mobile applications for sleep disruption. DOD stated in its study
that addressing sleep-related issues in primary care settings through
behavioral interventions may restore a regular sleep cycle for service
members who are experiencing chronic partial sleep deprivation. Doing
so may also prevent the onset of depression or anxiety symptoms among
service members who may hesitate to seek mental health treatment. The
report also stated that military leaders should actively promote existing
sleep management mobile applications developed by DOD and the
Department of Veterans Affairs and suggested service members should
Reflections from Survey Respondents on
Sleep Education
“Include a sleep education block in [initial
training and continuing education] courses or
conducting a sleep study for maintainers."
– Air Force aircraft maintainer
“Provide education on the importance of sleep
and strategies to have more restful sleep."
– Maine Corps aircraft maintainer
"Continued education about the benefits of
sleep in a more ""preventative medicine""
mindset.”
– Air Force fighter pilot
Source: GAO survey, selected written responses. I
GAO-24-105917
Note: Our analysis includes written responses from a
nongeneralizable sample of officers and enlisted service
members we surveyed from selected military occupations that
have a high likelihood of experiencing fatigue.
Page 36 GAO-24-105917 Military Readiness
not leave basic training without the applications installed on their
smartphones.
48
Over the course of our review, officials told us they are using the
smartphone application 2B-Alert, which facilitates fatigue management in
operational environments. The application uses established sleep/wake
patterns to predict caffeine effectiveness, tactical nap effectiveness, and
performance. They believe this application will be beneficial in reducing
fatigue among service members. Mobile applications are oftentimes used
in conjunction with wearable devices, and DOD officials told us there are
many research efforts across the department looking at wearable
devices, as discussed above.
Our survey found 55 percent of respondents (89 of 163) whose units did
not collect sleep data said that unit collection of sleep data would be
beneficial. In written comments to the survey, a respondent stated it
would be helpful to have sleep trackers (i.e., wearable devices). The
respondent also stated that it would be beneficial to make access to
behavioral health and sleep study health easier, faster, and less impactful
to careers.
DOD recommendation: Establish a clearinghouse for military sleep-
related resources. DOD stated in its study that a clearinghouse for
military sleep-related resources should be established, disseminated, and
available to front-line military leadership.
Over the course of our review, officials told us that fatigue researchers in
DOD are a small group, and although formal coordination is limited, there
is informal interaction to share fatigue resources and related information
which is helpful. For example, in February 2020 the Office of Naval
Research hosted a meeting talking about sleep science, which fostered
collaboration across DOD. According to officials, it was evident that there
was a need to consolidate information into one place to improve
communication and collaboration. The recommended clearinghouse
could help facilitate this collaboration on sleep-related resources and
48
Mobile applications can be used for sleep management to help track sleep or promote
relaxation. The DOD report specifically mentions the following mobile applications:
Breath2Relax, Tactical Breather, Military Meditation Coach, CTJ-I Coach, DreamEZ, and
2B-Alert.
Page 37 GAO-24-105917 Military Readiness
training. We have also previously reported that sharing information and
best practices is beneficial to sustaining military readiness.
49
Despite broad agreement among key officials and service members on
the efficacy of DOD’s fatigue-related recommendations to limit sleep
deprivation and manage fatigue and the services taking related efforts,
DOD officials stated that DOD has no plans to begin implementing the
recommendations. Standards for Internal Control in the Federal
Government state that management should complete and document
corrective actions to remediate internal control deficiencies, including
those resulting from audit findings, on a timely basis. The remediation
process is completed only after action has been taken that 1) corrects
identified deficiencies, 2) produces improvements, or (3) demonstrates
the findings and recommendations do not warrant management action.
We found that DOD has not established time frames for conducting
follow-on actions, coordinated with all stakeholders, or identified key
officials responsible for implementing the study’s recommendations.
Alternatively, DOD has not explained why implementing each of the
study’s recommendations is not appropriate. Without implementing the
recommendations or explaining why doing so is not appropriate, the
department will miss opportunities to make meaningful changes to the
department’s culture around sleep.
Fatigue and sleep deprivation among active-duty service members
continues to be more the rule than the exception. Impairment from fatigue
can be equivalent to the effects of alcohol intoxication and increases the
risk of collisions and mishaps.
Minimizing sleep deprivation and reducing fatigue for service members is
a significant undertaking that will involve structural and cultural changes
across the department. DOD and the military services have taken a
number of steps to address fatigue across the department, including
setting sleep and rest requirements and guidelines, conducting research,
and developing mitigation strategies. However, DOD has not assessed
DOD’s oversight structure for fatigue-related efforts to identify an office or
an individual with sufficient authority, sufficient staffing and resources,
and committed leadership to oversee the implementation of DOD’s
overarching sleep-related guidance, and the services have not assigned
49
GAO, Military Depots: DOD Can Benefit from Further Sharing of Best Practices and
Lessons Learned, GAO-20-116 (Washington, D.C.: Jan. 30, 2020).
Conclusions
Page 38 GAO-24-105917 Military Readiness
leadership to oversee service-level efforts. Without an assessment of
DOD’s oversight structure and assigning DOD and service-level
leadership, DOD cannot guarantee accountability for the numerous efforts
spanning the department.
In addition, we identified fragmentation in fatigue-related research
projects being conducted across the department, and DOD has not
facilitated collaboration across the numerous key stakeholders involved in
these and other efforts. Establishing a comprehensive list of fatigue-
related research will help DOD gain visibility and reduce any
fragmentation that may exist, potentially leading to cost savings.
Furthermore, establishing a cross-domain working group to share
information across stakeholders would improve coordination for
introducing and improving fatigue mitigation strategies.
In 2021, DOD conducted a study on sleep deprivation and made seven
recommendations to mitigate fatigue and improve sleep among service
members. A variety of DOD officials told us the department would benefit
from the mitigation strategies outlined in the recommendations, and
service members that responded to our survey agreed. However, while
the services have some related efforts, DOD has not addressed these
recommendations, either by implementing them or documenting why it
would not be appropriate to implement them. By not establishing time
frames for and responding to these recommendations or explaining why
doing so is not appropriate, DOD will miss opportunities to make
meaningful changes to the department’s culture around sleep.
We are making a total of nine recommendations, including five to DOD,
two to the Navy, and one each to the Army and Air Force.
The Secretary of Defense should ensure the Under Secretary of Defense
for Personnel and Readiness conducts an assessment of DOD’s
oversight structure for fatigue-related efforts. This assessment should
identify and delegate authority to an office with sufficient authority,
sufficient staffing and resources, and committed leadership to act as a
focal point for and oversee all DOD-wide fatigue-related efforts.
(Recommendation 1)
The Secretary of the Air Force should assign leadership responsible for
DOD component head responsibilities related to fatigue listed in DOD
Instruction 1010.10. (Recommendation 2)
Recommendations for
Executive Action
Page 39 GAO-24-105917 Military Readiness
The Secretary of the Army should assign leadership responsible for DOD
component head responsibilities related to fatigue listed in DOD
Instruction 1010.10. (Recommendation 3)
The Secretary of the Navy should assign Navy leadership responsible for
DOD component head responsibilities related to fatigue listed in DOD
Instruction 1010.10. (Recommendation 4)
The Secretary of the Navy should assign Marine Corps leadership
responsible for DOD component head responsibilities related to fatigue
listed in DOD Instruction 1010.10. (Recommendation 5)
The Secretary of Defense should ensure the office identified above to
oversee DOD-wide fatigue-related efforts creates and maintains a
comprehensive list of all fatigue-related research projects.
(Recommendation 6)
The Secretary of Defense should ensure the office identified above to
oversee DOD-wide fatigue-related efforts uses the comprehensive list of
all fatigue-related research projects to compare fatigue-related research
to reduce fragmentation among the initiatives. (Recommendation 7)
The Secretary of Defense should ensure the office identified above to
oversee DOD-wide fatigue-related efforts establishes a cross-domain
working group dedicated to sharing and communicating fatigue research
and related information department-wide. (Recommendation 8)
The Secretary of Defense should ensure the Under Secretary of Defense
for Personnel and Readiness (1) establishes well-defined time frames for
conducting follow-on actions, coordinating with all stakeholders, and
identifying key officials responsible for implementing the
recommendations of the 2021 DOD study on sleep deprivation and
readiness; or (2) documents the reasons that implementing the study’s
recommendations is not appropriate. (Recommendation 9)
We provided a draft of this report to DOD for review and comment.
According to a senior DOD official, the department generally concurred
with our recommendations, but DOD did not provide written comments on
our report. The department also provided technical comments which we
incorporated as appropriate.
We are sending copies of this report to the appropriate congressional
committees, the Secretary of Defense, the Secretaries of the Army, Navy,
Agency Comments
Page 40 GAO-24-105917 Military Readiness
and Air Force, and the Commandant of the Marine Corps. In addition, the
report is available at no charge on the GAO website at
http://www.gao.gov.
If you or your staff has any questions about this report, please contact
Diana Maurer at (202) 512-9627 or [email protected]. Contact points for
our Office of Congressional Relations and Public Affairs may be found on
the last page of this report. GAO staff that made key contributions to this
report are listed in appendix IV.
Diana Maurer
Director, Defense Capabilities and Management
Appendix I: Objectives, Scope, and
Methodology
Page 41 GAO-24-105917 Military Readiness
House Report 117-118, which accompanied a bill for the National
Defense Authorization Act for Fiscal Year 2022, includes a provision for
us to undertake a comprehensive review of Department of Defense
(DOD) efforts to limit sleep deprivation and manage fatigue across the
military services.
1
This report assesses the extent to which (1) service
members are getting adequate sleep, (2) DOD has addressed and
managed service member fatigue, and (3) DOD has implemented fatigue-
related recommendations from its 2021 study on sleep deprivation and
readiness.
To conduct the work for our reporting objectives, we selected several
military occupations across the services with a high potential to be
affected by fatigue: fixed- and rotary-wing pilots; remotely piloted aircraft
pilots; aviation maintenance personnel; motor vehicle operators; and on-
alert operations, such as nuclear missileers and watch floor officers.
2
To
identify these occupations, we conducted analysis of relevant research,
studies, and related articles on sleep deprivation induced fatigue—military
specific and general populations—and interviewed cognizant officials at
the Office of the Secretary of Defense, Army, Navy, Marine Corps, and
Air Force. Based on this analysis and discussions with the Office of the
Secretary of Defense and service officials, we identified a variety of
characteristics and occupations that may contribute to fatigue, including
extended shifts, night operations, high noise environments, operating
heavy equipment, and high operational tempo.
We surveyed or met with service members from the four services in these
occupations to gain insight into their sleep habits, factors that contribute
to fatigue, and mitigations to manage fatigue. First, we conducted a web-
based survey for a stratified random sample of service members in those
occupations. We analyzed occupational codes for data maintained by the
Defense Manpower Data Center, and we validated the occupational
codes with service commands. We then obtained service member
information from the Defense Manpower Data Center. We selected a
stratified random sample of 1,720 service members from the sample
frame of 87,326 service members that fell within the scope of the target
1
H.R. Rep. No. 117-118, at 183 (2021).
2
These military occupations were surveyed, except for Army on-alert operations. For this
group, we met with Army watch-floor officers. Additionally, our survey’s selected
occupations originally included Navy fixed-wing fighter and remote pilots. However, due to
data discrepancies that we were unable to reconcile with the Navy, we were unable to
survey them.
Appendix I: Objectives, Scope, and
Methodology
Appendix I: Objectives, Scope, and
Methodology
Page 42 GAO-24-105917 Military Readiness
population. We stratified the sample frame using military occupation
groups, service, and rank.
We developed and distributed a survey to selected service members
within each occupation. We designed the survey questions in
collaboration with a survey specialist and incorporated technical feedback
from a separate survey specialist. To ensure that the survey questions
were clear, comprehensible, and technically correct, we conducted pre-
tests of our draft survey with ten participants from a variety of services
and occupations. During each pretest, all of which were conducted by
phone, we tested whether (1) the instructions and questions were clear
and unambiguous, (2) the terms we used were accurate, and (3) pretest
participants could offer a potential solution to any problems identified. We
noted any potential problems identified through the pretests and modified
the questionnaire based on the feedback received. A full copy of the
survey questions is provided in appendix III.
We conducted the survey between July 2023 and September 2023. To
maximize our response rate, we sent multiple reminder emails to
encourage recipients to complete the survey and worked with the
services to correct or identify alternate emails for service members we
could not initially contact by email. In total, the combined survey received
responses from 245 service members from the 1,720 selected in our
sample, for an unweighted response rate of 14.2 percent. We conducted
an analysis of survey responses to identify sources of nonresponse bias
that could lead to potential misrepresentations in the interpretation of the
results. First, we examined the unweighted response rates for
subpopulations based on military occupation, service, and rank. Next, we
compared the distributions of the population and the in-scope
respondents to determine if significant differences existed.
We identified differences in both response rates and distributions for all
subpopulations we examined. Officers had a significantly higher response
rate, 22.2 percent (190 of 857), and were over-represented when
compared to enlisted service members. Because the response rate for
enlisted service members was so low, 6.4 percent (55 of 863), we chose
to use only responses from officers in summarized results to avoid
potential misrepresentations. The summarized results of officers are not
generalizable to the population of all officers in the target population. A
statistician conducted analyses and another statistician verified the
analyses. We calculated the frequency of responses to our closed-ended
survey questions and reviewed responses to the open-ended questions to
identify common themes. We also selected and included in our report
Appendix I: Objectives, Scope, and
Methodology
Page 43 GAO-24-105917 Military Readiness
examples of statements made by survey respondents—both officer and
enlisted—to provide illustrative examples of issues service members face
regarding sleep and fatigue.
To assess if service members are getting adequate sleep, we reviewed
DOD and service guidance related to sleep and rest to determine the
DOD- and service-recommended minimum amount of sleep per night and
rest requirements and guidelines. We reviewed DOD and service
documentation, including health and safety-related surveys and reports,
that included findings on the quantity and quality of service member
sleep. We identified this documentation via interviews with officials and
our review of citations from related reports. We also analyzed responses
from our survey to determine the quantity and quality of sleep for our
nongeneralizable sample of service members. We also reviewed the
2021 DOD study on sleep deprivation and readiness to gain an
understanding of risks of sleep deprivation.
3
Likewise, we interviewed
officials to gain an understanding of sleep and rest requirements and the
impacts of sleep deprivation.
To determine the extent to which DOD has addressed and managed
service member fatigue, we reviewed DOD and service documentation on
organizations involved in fatigue management, fatigue-related research
projects, and mitigation strategies to limit fatigue. We also reviewed and
analyzed written responses provided by DOD, service, and command
officials on fatigue management, including data collection and mitigation
strategies. We compiled a list of DOD and service fatigue-related
research projects to gain an understanding of the research purpose,
organizations involved in the research, mitigations being tested, and cost.
We compared the documentary and testimonial evidence we collected
with GAO’s Standards for Internal Control in the Federal Government.
4
Specifically, significant to this audit is the call for agency management to
establish an organizational structure, assign responsibility, and delegate
authority to achieve the entity’s objectives, and to periodically evaluate
the organizational structure. Likewise, significant to this audit is that
3
Department of Defense, Report to Congressional Armed Services Committees, Study on
Effects of Sleep Deprivation on Readiness of Members of the Armed Forces,
(Washington, D.C.: March 2021). DOD conducted this study in response to section 749 of
the National Defense Authorization Act for Fiscal Year 2020. Pub. L. No. 116-92, § 749
(2019).
4
GAO, Standards for Internal Control in the Federal Government, GAO-14-704G
(Washington, D.C.: September 2014).
Appendix I: Objectives, Scope, and
Methodology
Page 44 GAO-24-105917 Military Readiness
management should perform ongoing monitoring as part of the normal
course of operations and establish the organizational structure necessary
to enable the entity to plan, execute, control, and assess the organization
in achieving its objectives.
To determine the extent to which DOD has implemented sleep-related
recommendations from its 2021 DOD study on sleep deprivation and
readiness, we reviewed the report and the report’s 494 citations.
5
We
spoke with officials about the report and any plans related to
implementation of the report’s recommendations. We assessed the
documentary and testimonial evidence we collected against DOD and
service guidance on sleep and fatigue and compared it with GAO’s
Standards for Internal Control in the Federal Government.
6
Specifically,
significant to this audit was the internal control component related to the
completion and documentation of corrective actions to remediate
deficiencies.
We interviewed knowledgeable officials, and obtained documentation
where appropriate, from the following organizations:
• Office of the Under Secretary of Defense for Personnel and
Readiness
• Safety and Occupational Health
• Force Readiness
• Office of the Assistant Secretary of Defense for Health Affairs
• Health Services Policy and Oversight
• Defense Health Agency
• Joint Safety Council
• Joint Program Committee-5/Military Operational Medicine Research
Program
5
Department of Defense, Study on Effects of Sleep Deprivation on Readiness of Members
of the Armed Forces (March 2021). Section 749 of the National Defense Authorization Act
for Fiscal Year 2020 required DOD to complete a report that provided 1) a standardized
definition of sleep deprivation; 2) an assessment of the prevalence of sleep deprivation; 3)
an assessment of whether there may be a relationship between sleep deprivation and
medical conditions such as traumatic brain injury, post-traumatic stress disorder, and
depression; and 4) recommendations. Pub. L. No. 116-92, § 749 (2019).
6
GAO-14-704G.
Appendix I: Objectives, Scope, and
Methodology
Page 45 GAO-24-105917 Military Readiness
• Defense Manpower Data Center
• Army: Headquarters, U.S. Army Medical Command, Walter Reed
Army Institute of Research, U.S. Army Combat Readiness Center,
U.S. Army Training and Doctrine Command, U.S. Army Combat
Capabilities Development Command, Defense Centers for Public
Health-Aberdeen, U.S. Army Forces Command, U.S. Army Cyber
Command, U.S. Army Intelligence and Security Command
• Air Force: Headquarters, 711th Human Performance Wing, Signature
Tracking for Optimized Nutrition and Training Lab, Safety Center, Air
Combat Command, Global Strike Command
• Navy: Naval Health Research Center; Naval Postgraduate School,
Naval Information Forces, Naval Safety Command, Naval Air Systems
Command, Naval Air Force Atlantic Command, U.S. Pacific Fleet
• Marine Corps: Marine Corps Safety Division, Marine Forces
Command
• Office of the Senior Enlisted Advisor to the Chairman, Joint Chiefs of
Staff
• Office of People Analytics
We conducted this performance audit from March 2022 through March
2024 in accordance with generally accepted government auditing
standards. Those standards require that we plan and perform the audit to
obtain sufficient, appropriate evidence to provide a reasonable basis for
our findings and conclusions based on our audit objectives. We believe
that the evidence obtained provides a reasonable basis for our findings
and conclusions based on our audit objectives.
Appendix II: Reflections from GAO Survey
Respondents
Page 46 GAO-24-105917 Military Readiness
Figure 7: Survey Responses on Actions the Military Can Take to Limit or Manage Sleep Deprivation
Note: Our analysis includes written responses from a nongeneralizable sample of officers and
enlisted service members we surveyed from selected military occupations that have a high likelihood
of experiencing fatigue.
Appendix II: Reflections from GAO Survey
Respondents
Appendix II: Reflections from GAO Survey
Respondents
Page 47 GAO-24-105917 Military Readiness
Figure 8: Survey Responses on Additional Thoughts About Sleep Deprivation
Note: Our analysis includes written responses from a nongeneralizable sample of officers and
enlisted service members we surveyed from selected military occupations that have a high likelihood
of experiencing fatigue.
Appendix III: GAO Survey of Selected Military
Occupations
Page 48 GAO-24-105917 Military Readiness
We administered a web-based survey that included the questions listed
below to determine the extent to which service members are getting
enough quality sleep, to identify factors interfering with service member
sleep, and to learn about implementation of fatigue management policy
and guidance. We included a few open-ended survey questions and
analyzed the information by completing a content analysis. Although the
format has been modified for readability purposes, this appendix
accurately replicates the content of the web-based survey questions and
response options. Terms used in the survey were defined within the
question that first introduced them to the survey. For more information
about our methodology for designing and administering the survey, see
appendix I.
The U.S. Government Accountability Office (GAO), which is responsible
for reporting to Congress on federal programs, is studying the
Department of Defense’s efforts to limit sleep deprivation and manage
fatigue. GAO is conducting this survey to learn about service member
sleep-related fatigue across military occupations. For the purposes of this
survey, we will be focusing on fatigue caused by sleep deprivation.
Appendix III: GAO Survey of Selected
Military Occupations
Survey Intro and Screener
Page 49 GAO-24-105917 Military Readiness
Standards for Internal Control in the Federal Government We sent you this survey because you
are in an occupation or position that may be affected by sleep deprivation.
1. You have been selected for this survey because you are a [occupation].
2. Have you served in this position within the last 12 months?
o Yes
o No
If no, end survey
3. This survey will ask questions about your personal sleep habits, sleep rest
requirements, leadership and culture, sleep data collection, and strategies to address
fatigue. Your responses will provide valuable information to the Congress about service
member fatigue related to sleep deprivation. The results of this survey may help the military limit
fatigue caused by sleep deprivation.
Nothing that would identify you will be reported. Your responses will not be attributed to you
personally or to any specific unit. We will combine all responses and discuss the information in
an aggregate format in our report to Congress.
4. What is your current rank?
▼ E-1 (1) ... W-5 (24)
5. Over the last six months, which of the following best describes your usual work
pattern?
o Day only
o Night only
o Shift work
o Other (please specify)
6. What type of shift work best describes your usual work pattern over the last six
months?
o Forward-rotating shift (for example, 0600-1400 for three weeks then 1400-2200 for three
weeks, etc.)
o Backward rotating shift (for example, 1400-2200 for three weeks, then 0600-1400 for three
weeks, etc.)
o Other (please specify)
Question 6 was displayed only if the answer to question 5 was “Shift work.”
Page 50 GAO-24-105917 Military Readiness
7. Over the last six months, how many hours of sleep, on average, did you typically get
each day during your work week?
o 3 hours or fewer per 24 hour cycle
o 4-5 hours per 24 hour cycle
o 6-7 hours per 24 hour cycle
o 8 or more hours per 24 hour cycle
8. Over the last six months, which of the following best describes the quality of your
sleep during your work week?
o Extremely poor
o Moderately poor
o Moderately good
o Extremely good
9. Over the last six months, how often have the following operational factors affected
your ability to get enough sleep during your work week?
Never
Rarely
Sometimes
Often
Always
Don't know
High operating
tempo
o
o
o
o
o
o
Primary duty
requirements
o
o
o
o
o
o
Additional duty
requirements
(i.e., collateral
duties)
o
o
o
o
o
o
Shift work
o
o
o
o
o
o
Limited
extreme
operations (i.e.,
24 - 96 hours
continuous
operations)
o o o o o o
Not enough
personnel or
qualified
personnel
o
o
o
o
o
o
Page 51 GAO-24-105917 Military Readiness
Other
operational
factors (please
specify)
o
o
o
o
o
o
10. O
ver the last six months, how often have the following miscellaneous factors affect
ed
your
ability to get enough sleep during your work week?
Never
Rarely
Sometimes
Often
Always
Don't know
Medical
reasons
o
o
o
o
o
o
Personal
reasons
o
o
o
o
o
o
Other
miscellaneous
reasons
(please
specify)
o
o
o
o
o
o
11. Are you currently deployed? (Please include TDY five days or longer to another country
or on sea duty.)
o Yes
o No
12. O
ver the last six months, have you been deployed, or TDY five days or longer t
o
anot
her country, or on sea duty?
o Yes
o No
Q
uestion 12 was displayed if 11 was answered “No.”
Page 52 GAO-24-105917 Military Readiness
13. Over the last 6 months, how often have the following environmental factors affected
your sleep while you were deployed or TDY to another country or on sea duty?
Never
Rarely
Sometimes
Often
Always
Don't know
Temperature
o
o
o
o
o
o
Exposure to
light
o
o
o
o
o
o
Lack of
daylight
o
o
o
o
o
o
Noise
o
o
o
o
o
o
Bedding
o
o
o
o
o
o
This question was asked if respondents answered “Yes” to question 11 or question 12.
14. To what extent does your unit leadership make sleep a priority?
o Not at all
o To a slight extent
o To a moderate extent
o To a great extent
o Don't know
15. Are you aware of policies related to sleep that apply to you or your occupation?
o Yes
o No
16. Does your unit have minimum rest requirements for your occupation (i.e., time when
you are not required to actively perform tasks, including time provided for uninterrupted sleep)?
o Yes
o No
o Don't know
17. How often are the minimum rest requirements enforced in your unit?
o Never
o Rarely
Page 53 GAO-24-105917 Military Readiness
o Sometimes
o Often
o Always
o Don't know
Question 17 was displayed if question 16 was answered “Yes.”
18. In the last 12 months, have you had a briefing or training where sleep was discussed?
o Yes
o No
o Don't know
19. Does your unit currently have a sleep trainer (i.e., a person who facilitates sleep plans,
monitors individual sleep performance, and trains unit members on behavioral strategies for
minimizing and mitigating sleep deprivation)?
o Yes
o No
o Don't know
20. Do you report to your unit or command on how many hours you sleep?
o Yes
o No
21. How often do you report accurately?
o Never
o Rarely
o Sometimes
o Often
o Always
Question 21 was displayed if question 20 was answered “Yes.”
Page 54 GAO-24-105917 Military Readiness
22. Does your unit collect sleep data?
o Yes
o No
o Don't know
A question 22 answer of “Don’t know” would skip to question 25.
23. Does your unit use the sleep data it collects?
o Yes
o No
o Don't know
Question 23 was displayed if question 22 was answered “Yes.”
24. Do you think it would be beneficial for your unit to collect sleep data?
o Yes
o No
Question 24 was displayed if question 22 was answered “No.”
25. Do you have any of the following concerns regarding your sleep data being
collected?
Yes, a great
concern
Yes, a moderate
concern
Yes, a slight
concern
Not a concern
Privacy concerns
over collection of
sleep data
o
o
o
o
Discomfort with
wearing a sleep
tracking device
o
o
o
o
Operational
security
prohibiting use of
data wearables in
certain situations
(i.e., operational
missions, secure
facilities, etc.)
o o o o
Other (please
specify)
o
o
o
o
Page 55 GAO-24-105917 Military Readiness
26. Have you ever been asked to participate in a military study that incorporated
wearables (i.e., Garmin or Polar watches, Fitbits, Oura rings, etc.) to track your sleep habits?
(Note, a study could include a survey, a report, a pilot, or an initiative)
o Yes
o No
If “No,” skip to question 29.
27. What was the study?
28. How was the sleep data that was collected on you used?
29. Have you ever experienced sleep deprivation during your work week that has affected
your work?
o Yes
o No
If question 29 answer is “No,” skip to question 32.
30. Over the past six months, how often has sleep deprivation affected your work?
o Never
o Rarely
o Sometimes
o Often
o Always
o Don't know
Page 56 GAO-24-105917 Military Readiness
31. Please provide an example(s) of how sleep deprivation has affected your work:
32. In thinking about your unit, how satisfied or dissatisfied are you with the following
aspects of your work environment?
Ve
ry
dissatisfied
Somewhat
dissatisfied
Neither
satisfied nor
dissatisfied
Somewhat
satisfied
Very
satisfied
Don't know
Unit
leadership
attitude
towards
sleep
o o o o o o
Training and
education on
sleep
o
o
o
o
o
o
Rest or
sleep
opportunities
o
o
o
o
o
o
33. O
ver the last six months, have you used any of the following strategies during your
work week to address or reduce the effects of sleep deprivat
ion?
P
lease answer “Yes” only if you used the strategy more than once over the entire six-m
onth
per
i
od.
Yes
No
Environmental solutions (i.e., black-
out curtains, mattresses, chill pads)
o
o
Allowable stimulants (i.e., coffee,
caffeine pills, energy drinks)
o
o
Medications used to induce, extend,
or improve the quality of sleep, and to
reduce wakefulness during sleep
o
o
Wearable technology (i.e., Garmin or
Polar watches, Fitbits, Oura rings,
etc.)
o
o
Tactical napping (i.e., a strategy used
nap when long blocks of sleep are
impractical)
o
o
Sleep banking (i.e., a strategy that
extends sleep periods to “bank” extra
energy, stamina, and focus)
o
o
Training and education (i.e., training
and education on impact of sleep
deprivation, or strategies to achieve
quality sleep)
o
o
Page 57 GAO-24-105917 Military Readiness
34. For each of the strategies you used, was the strategy beneficial in addressing or
reducing the effects of sleep deprivation? (Yes/No)
Only the options the respondent answered “Yes” to in question 33 would appear here.
35. For
each of the strategies you did NOT use, do you think the strategy w
ould be
beneficial in addressing or reducing the effects of sleep deprivation? (Yes/No) Only the
opti
ons the respondent answered “No” to in question 33 would appear here.
36. What
else, if anything, can the military do to limit or manage sleep deprivation?
37. Is t
here anything else we should know about sleep deprivation in your position or
unit that this survey has not addressed?
Appendix IV: GAO Contact and Staff
Acknowledgments
Page 58 GAO-24-105917 Military Readiness
Diana Maurer, 202-512-9627 or [email protected]
In addition to the contact listed above, Chris Watson (Assistant Director),
Laura Czohara (Analyst-in-Charge), James Ashley, John Bornmann,
Alexandra Gonzalez, Samuel Harbaugh, Amie Lesser, Amanda Manning,
Cary Russell (retired), Benjamin Sclafani, Michael Silver, Emily Wilson,
and Elizabeth Wood made key contributions to this report.
Appendix IV: GAO Contact and Staff
Acknowledgments
GAO Contact
Staff
Acknowledgments
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Page 59 GAO-24-105917 Military Readiness
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