Sleep, Stress, and the Veteran Brain

4-23-2025

By Dr. Howard Friedman, MD | Veteran | U.S. Army Medical Corps | Internal Medicine | HHOM LLC

Explore how chronic stress and disrupted sleep impact the veteran brain—and why understanding this connection is key to healing, recovery, and reclaiming control.

The mind stands guard long after war,

Where sleep once healed, it paces more.

The brain, rewired by years of fight,

Now dims the day and blurs the night.

But still within, a spark remains—

To rest, repair, release the chains.

---Dr. Howard Friedman MD

They sell us strength in powdered form, A promise brewed in wellness warm. Yet truth is patient, layered, deep. Not found in pills or bottled sleep. Your cells don't need a magic shield, But habits in the daily field. Yet truth is patient, layered, deep. Not found in pills or bottled sleep.

They sell us strength in powdered form, A promise brewed in wellness warm. Yet truth is patient, layered, deep. Not found in pills or bottled sleep. Your cells don't need a magic shield, But habits in the daily field. Yet truth is patient, layered, deep. Not found in pills or bottled sleep. -Dr. Howard Friedman MD

When we talk about the veteran brain, we're talking about something shaped by a unique blend of experience, exposure, and endurance. Veterans often carry the weight of trauma—whether in the form of PTSD, depression, anxiety, traumatic brain injury (TBI), or chronic stress. These conditions do more than just occupy space on a diagnostic chart—they affect the very architecture of the brain, altering the amygdala, hippocampus, and prefrontal cortex. These are the regions responsible for memory, emotion, judgment, and regulation. They’re also the centers where neurotransmitter levels can be disrupted—where the “off switches” don’t work the way they should, keeping the body in a state of constant alert.

It’s important to remember that the brain is the seat of our identity. It’s where our experiences are interpreted and where our reality is built. Your sight, your hearing, your perceptions—they’re all filtered through the intricate workings of your brain. You are, in a very real sense, your brain. And yet, there’s another layer: the mind. We can’t image the mind on an MRI, nor can we find it on a CT scan. It’s not a structure—it’s an experience. Thoughts arise from somewhere—some say the brain, others say the mind—and in that space lies one of the greatest mysteries of human existence. This blog won’t try to unravel questions of consciousness, the super-mind, or the metaphysical. But it’s worth acknowledging that the brain is both machinery and mystery, running basic systems like heartbeat and breath—even in the absence of conscious awareness.

Sleep is one of the most essential yet least understood of the brain’s restorative functions. We’ve mapped sleep into stages, charted the importance of REM, and tracked circadian rhythms, but the fundamental why behind sleep remains elusive. What we do know is that sleep resets and recharges the brain. A good night’s sleep can leave you feeling fully powered, like a battery at 100%. Other days, you might wake up with less energy—60%, maybe even 40%—because of disrupted sleep cycles, stress, or hormonal imbalances. Your brain, much like the rest of your body, performs best when it's well-rested. Interestingly, some older antidepressants—prescribed decades before we understood their full mechanisms—turned out to work in part because they increased REM sleep. In other words, improving sleep improved mental health.

Now let’s talk about stress. I consider stress an inflammatory condition—not just emotionally, but physiologically. Inflammation is at the root of nearly every major chronic illness: heart disease, diabetes, cancer. Stress literally reshapes the brain. It enlarges the amygdala—the fear and emotional response center—while shrinking the hippocampus, which is crucial for memory and learning. It disrupts the sleep-wake cycle, impairs cognition, and makes it harder to enter restorative sleep. Chronic stress erodes not just peace of mind, but physical health.

So maybe the real message here is simple: take care of your brain, veterans. You've carried more than most will ever understand. Prioritize your sleep. Find moments of stillness. Allow yourself to rest and recover, not just physically but neurologically. Be at peace. Because when your brain is healthy, you’re more than functional—you’re free.

—Dr. Howard Friedman, MD

Board-Certified | Internal Medicine | Veteran | U.S. Army Medical Corps

Founder of Howard’s House of Medicine (HHOM LLC)

https://www.hhomllc.com

---

Frequently Asked Questions:

Question: How does chronic stress affect a veteran’s brain?

Answer: Chronic stress can reshape the brain by enlarging the amygdala (the emotional response center) and shrinking the hippocampus (which handles memory and learning). This imbalance affects emotional regulation, memory, sleep quality, and long-term health outcomes.

Question: Why is sleep so important for mental health and recovery?

Answer: Sleep resets and restores the brain. Deep and REM sleep improve memory, mood, and neurological repair. Disrupted sleep—especially common in veterans with PTSD—can worsen mental health, increase inflammation, and impair cognitive function over time.

Question: What can veterans do to support brain health and reduce stress?

Answer: Veterans can prioritize brain health by establishing healthy sleep routines, practicing stress-reduction techniques like mindfulness or exercise, and seeking medical support when needed. At HHOM LLC, Dr. Friedman offers medical insight grounded in both neuroscience and firsthand military experience.