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Combat-related insomnia is taking a toll on U.S. veterans returning from Afghanistan and Iraq. A report from Van Winkle’s cited it as the most unnoticed, under-prevented, and untreated injury that service members face — a major problem when the best treatment for post-traumatic stress disorder is sleep.

According to a review produced by two doctors at the University of Pittsburgh, service members who suffer from insomnia while deployed are at greater risk of suffering from depression, developing PTSD, and even contemplating or committing suicide.

“If we don’t treat sleep disorders, we can’t treat PTSD. We have to attack them together,” said Dr. Vincent Mysliwiec, chief of pulmonary, critical care medicine and sleep medicine service at Madigan Healthcare System in Tacoma, Washington, at the 2015 SLEEP conference.