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 that it didn’t hurt, but Hood has not stopped apologising.

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 per cent of Army troops who have been back from Iraq for a year said they struggled nearly every day with feeling tired. About 34 per cent said they had difficulty falling asleep, staying asleep or sleeping too much nearly every day. About one-third of the total US adult population reports 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 per cent 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 organise 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 air strikes 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.”

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 that 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 per cent of them struggle with substance abuse, said Dr Tasha Souter, medical director of the Trauma Recovery Programme 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.”

In time, Hood tried to avoid sleep, like this recent Friday. This period of wakefulness began the day before, when he rose at noon Thursday after about three hours of bad sleep. He dreamed that he was in the middle of a chemical attack and awoke wondering why he wasn’t wearing his chemical suit. It took a few minutes of looking around the bedroom and hearing Gibson’s voice to bring him back.

The dream was veined with the fear he felt during one incident in Iraq. Sirens went off indicating a possible chemical attack. Hood couldn’t make it back to the bunker, so he was lying face-down in a gutter. He couldn’t get his gas mask to seal. Twenty minutes later, the all-clear siren finally sounded.He was trying to banish the chemical attack nightmare from his thoughts when he showed up at the 7pm weekly meeting of the American Combat Veterans of War in Oceanside. As group members went around the conference table describing work and medical issues, Rider, the Vietnam veteran, looked over at Hood. “You look great, by the way,” Rider said. “Do you feel better?”

Hood wondered whether it was his new haircut. “No,” he told Rider. “No, not really.”

Ray Metcalf, a 74-year-old Korean War veteran with a Santa Claus beard, approached Hood and another young Iraq War veteran during a smoke break and asked, “Do you have bad dreams?”

As the young men nodded, Metcalf recounted a nightmare he had a few weeks ago about getting shot down in a helicopter in Korea. Metcalf told them he read in a booklet on post-traumatic stress disorder that it’s best to get out of bed if you can’t sleep. He recommended going into the living room to watch a movie.

Hood listened intently.

“Sleep deprivation ... is an ongoing discussion,” said Rider, who helped found the combat group in 2001.

Hood left the veterans meeting about 9pm and drove back to the house he rents with Gibson. He took a shower and then they went to rent some DVDs. They spent a few hours talking about an argument they had earlier in the day about the care he was receiving from the Department of Veterans Affairs.

About 5am Hood and Gibson looked over their DVD choices. Hood was hoping he could tire out his mind so he would not have nightmares when he finally crashed. They settled on the science fiction movie “Jumper”.

“Was there something I wanted to get?” he said suddenly.

“Medicine?” Gibson offered.

“Yeah, but that’s not what it was,” Hood said, his face screwed up in frustration.She clicked the remote control, and the 55-inch flat screen television filled with images of World War II as one of the previews came on. The men were in uniform, carrying guns, heading inexorably to some wintry battle.

Hood covered his face with both hands. Gibson hit fast forward on the remote.

He peeled his hands away from his face a few minutes later as the opening scenes of “Jumper” began. He picked at a slice of chocolate cake on his lap and began playing a computer game in which he tried to take over spaceships.

About 5:30am, Hood was starting to fade. When he took a break from the game to focus on the movie, his eyelids dropped closed for nearly a minute. He quickly blinked them open. A few minutes later, his eyelids dropped again.

About 6am, he took a smoke break and walked back into the living room triumphantly. “This is what I was looking for: caffeine tablets!”

He chugged the tablet and Red Bulls.

Gibson was struggling to keep up with Hood. He stroked her hair and told her he didn’t mind if she went to sleep. She crawled into bed at 6:10am.

Hood stayed in the living room and started another video game. He began shooting down planes over a snowy mountain landscape. “Nice kill”, a voice in the game said.

At 6:50am, he popped a second caffeine pill and washed it down with Pepsi. As he stood outside smoking again, he started to think about one of the most horrifying incidents of his second tour.

“I’ll try anything,” Hood said. “I’m almost at the point where I’d be willing to give a body part for one good night’s sleep, no nightmares, the type of sleep where you wake up feeling renewed.”—Dawn/ The LAT-WP News Service (c) Los Angeles Times