SAN DIEGO — By the time the sun began to rise one recent Friday over his Mira Mesa neighborhood, Mitch Hood had been up for about 18 hours.
He punched a caffeine tablet out of a blister pack and washed it down with two cans of Red Bull. He finished it off with a gulp of Pepsi.
He figured this would keep him awake four more hours. Then, he jumped back into his video game.
Hood, 25, spent two tours with the Marines in Iraq. Now, like many other veterans and millions of civilians, he faces a new enemy: sleep.
"I'm afraid I'm going to have nightmares and I'm going to get stuck there," he said. "I try with all my strength not to sleep."
When he eventually crashes and sleep overtakes him, Hood relives combat, or sometimes his mind creates new horror-filled scenarios. Once, he punched his fiancee, Natalya Gibson, while having a nightmare. She insisted it didn't hurt, but Hood has not stopped apologizing.
Sleep and wakefulness issues were the most common health problems described by recently returned soldiers, researchers at Walter Reed Army Medical Center found in a study published last year.
About 36% of Army troops who have been back from Iraq for a year said they struggled nearly every day with feeling tired. About 34% said they had difficulty falling asleep, staying asleep or sleeping too much nearly every day. About one-third of the total U.S. adult population report sleep problems, but studies have shown that such problems are much more common in combat veterans than in other young adults, said Steve Woodward, a sleep expert at the Department of Veterans Affairs center on post-traumatic stress disorder. About 70% of veterans being treated for the disorder have sleep problems, he said.
Sleep is a vulnerable state, Woodward said. "When animals are exposed to a severe threat . . . the basic adaptation is to wake up more frequently," he said.
Bill Rider, a 63-year-old Vietnam veteran, knows the signs. He's seen Hood and others like him in group meetings he helps organize in Oceanside for combat veterans of different generations.
Some veterans have told him of how they long for sleep, bingeing on alcohol for sedation. Others, like Hood, fear it. Rider has seen veterans stay up for 72 hours and work themselves into a delirious, manic state.
"I gave up my tranquillity, as many of the other warriors did, so the rest of America can have theirs," he said.
Thinking about Hood, he said, "That was me 30 years ago."
During his tours in Iraq in 2003 and 2004, Hood dug trenches and hauled 100-pound cables as a field wireman in Marine Wing Communications Squadron 38 out of Marine Corps Air Station Miramar. The pressure was always on during those assignments, he said, because the communication lines were essential for airstrikes and medical evacuations.
There were days when "I'd be lucky to get four hours of sleep," said Hood, who still wears his dog tags and has a Grim Reaper tattoo. "It got to the point where we had to choose between bathing ourselves and sleep, between sleeping or eating."
During his first tour, he was worried about a chemical attack. On the second, he was always scanning for roadside bombs.
In 2004, Hood returned to San Diego from Iraq and left the Marines two years later with an honorable discharge. He is now an online student, studying computer science. A few months ago, he found out he had a herniated spinal disc and sciatica, forcing him to use a cane. Hood thinks the pain probably makes his sleep less restful, but the main problems are the terrifying dreams that begin almost immediately after he closes his eyes.
A doctor has prescribed a low-dose antidepressant called trazodone, which has a sedative effect. "I use it here and there," Hood said. But "it basically sticks me in an eight-hour nightmare fest, so that's not a solution for me."
Doctors know it can also be risky to prescribe sleeping pills to veterans with post-traumatic stress disorder because up to 60% of them struggle with substance abuse, said Dr. Tasha Souter, medical director of the Trauma Recovery Program at the VA Palo Alto Health Care System. Some doctors have had some good results prescribing Ambien, which is less addictive, and the hypertension drug prazosin, which can reduce nightmares.
But there is no panacea. "Sleep problems are one of the most difficult symptoms of PTSD to treat," Souter said. "It's not uncommon for veteran patients to have 20, 30 years of difficulty sleeping."
When Hood first came back to Miramar, he didn't notice his sleep problems.
"We'd party until 2 a.m., stay up until 4 and then get up for reveille at 5:30," he said. Once they started cutting back on the partying, "we were in the barracks staring at the wall because we couldn't sleep."