[Issue #9] Fight, Flight, or Sleep [Part 1]
How and why PTSD/trauma can make restful sleep difficult and sometimes, impossible
While this post is labeled “part one”, it will not be a continuous, weekly themed series but a sub-series which I’ll come back to throughout other essays and curious emerging ideas.
“I don’t feel old. I don’t feel anything till noon. That’s when it’s time for my nap.”
— Bob Hope
Would you, for science, go off into a dark cave (you can take a friend) where there is no light and stay there for about 32 days, no flashlight, no music, to study human sleep?
Me, either!
But, had researchers Dr. Nathaniel Kleitman and Dr. Bruce Richardson (out of the University of Chicago), in 1938, not committed to doing this exact science experiment on sleep, we may not have the knowledge and data that has helped bring us modern-day humans awareness of our own sleep patterns and (usually) our unhealthy lack of appropriate sleep.
Richardson and Kleitman set up inside Mammoth Cave, Kentucky, carried out this experiment and where they slept on high-raised hospital beds they took apart and put together. They brought with them a lot of measuring devices and writing utensils and set to work.
Their hypothesis when they went in?
Would a human (they) still run on the same rhythm if no longer exposed to daylight? How dependent are we humans really on the cycles of the Earth?
It turns out, most living species (and plants!) have an internal clock. We’ve coined it the circadian rhythm, which derives from Latin; circa meaning “approximate” and dian, a derivative of diam, meaning “day”. Take away the sun and we humans still have a pretty good idea of when to sleep and when to wake.
We’ll get into the sleep disturbances and disruptions caused by PTSD and complex trauma shortly, but it’s important to have a solid foundational understanding of sleep first.
Because I aim for brevity and a common language throughout the publication, let’s define sleep. Merriam-Webster defines sleep like this:
…”the natural, easily reversible periodic state of many living things that is marked by the absence of wakefulness and by the loss of consciousness of one's surroundings, is accompanied by a typical body posture (such as lying down with the eyes closed), the occurrence of dreaming, and changes in brain activity and physiological functioning, is made up of cycles of non-REM sleep and REM sleep, and is usually considered essential to the restoration and recovery of vital bodily and mental functions.”
Wow.
That’s quite the definition for something so universal!
The dictionary links to other definitions related to sleep, REM and non-REM sleep. The human REM cycles are what constellates the most vivid and dramatic dreaming stages. Dreaming has been studied and we now know that dreaming is an important function of human sleep.
If each human is born with a circadian rhythm, how does that rhythm get hi-jacked and abused to the point of no return, the point of non-REM sleep, almost every night? Can people suffering from trauma and PTSD find a way to acquire restful and necessary REM sleep?
It all goes back to our internal and visceral fight, flight, freeze response. We explored this natural response to threats in a previous article, Eyes Wide Always: A layman's exploration into the physiology and neurobiology of PTSD: Hypervigilance if you’re unfamiliar and want a better grasp.
Frontiers in Psychology published a study in 2021, “Disturbed Sleep in PTSD: Thinking Beyond Nightmares”, and the introduction gives us a great basis to learn more about how normal human sleep functions are impacted by PTSD and complex trauma (which I’ve edited for ease of reading, length, and clarity, read the full study here):
The majority of patients with PTSD, about 50–70%, suffer from recurrent distressing nightmares…These can be exact replications or more symbolic representations of traumatic experiences, and primarily occur during rapid eye movement sleep (REMS).
Insomnia symptoms, reported by ~70% of patients, are often related to increased autonomic [central nervous system/fight or flight response] arousal and fear of sleep: fear of loss of control and/or of having nightmares.
PTSD is also associated with obstructive sleep apnea (OSA), concerning 40–90% of PTSD patients….
In addition, multiple studies found a high proportion (around 33%) of periodic limb movement disorder (PLMD) in PTSD patients. The limb movements during sleep are associated with arousals/awakenings.
Also relatively prevalent in PTSD are periods of sleep paralysis, typically occurring during (REM) sleep-wake transitions, which are often accompanied by distressing experiences, referred to as hypnagogic or hypnopompic hallucinations.
Although the exact frequency is unclear, PTSD is also linked to remarkable disruptive nocturnal behaviors, including abnormal vocalizations and complex body movements. These parasomnias are generally thought to occur during non-REMS (confusional arousals, night terrors, sleepwalking), but may also take place during REMS…
I had a sleep study done about 3 years ago now and it was illuminating to see the results. I stayed overnight for one night at a sleep clinic with a local hospital. It came to light that I never really got to a place of “long” REM sleep and that I have limb movement, vocal noises, moments of wakefulness (too many to get healthy sleep). I knew I didn’t feel “rested” when I woke up (does anyone?) but I didn’t know how bad it was.
As the study above illustrates, PTSD jams up all our internal systems. It’s like having your very own monkey throwing wrenches all over the place, uninvited.
I used to get nightmares much more frequently than I do now. I remember when I got home from Iraq waking up sweating, yelling in the middle of the night, having these awful dreams about shit no one should have to even visualize, let alone remember. I had many of those re-enactment dreams. I had a lot of insomnia and did a lot of drugs and drank too much just to take the edge off.
Not getting good sleep is not good for anyone. Not me, not my wife, not my kids, not my friends, not my trauma brain. No one wins without good sleep.
Being able to sleep well is coupled with a strong sense of safety and security. For me, I equate the calm it takes for me to get restful sleep with stopping in the middle of a convoy op. Sounds terrifying to leave myself and everyone around me wide open to harm and danger. If I’m sleeping, who’s watching?
The military, during training, teaches us we don’t need sleep and we are the masters of our minds and bodies. If you’re falling asleep in class (due to a chronic and purposeful state of sleep starvation), the entire class (called a “team” to make us feel cohesive and together) gets called out by men mocking giants, dragging us out to the concrete pad conveniently placed and demanding us to do physical exercise. The response to our tiredness was not a compassionate mirroring and understanding. It was a gaslit ambush nestled between our individual needs and our team’s needs (or later, our “country’s”). We needed a nap, not a fucking 30 minute run around the parking lot chanting something something hoo-rah.
We, in the West, parade our lack of sleep around like a fucking trophy and it is killing us.
I can tell you, in countries (there are very, very few) where naps (siestas) are still built into the workdays, those men, on average, tend to live to 90. American men, on average, live to 721.
What would you give up to gain 18 years of your life back, and for those 18 years to be filled with health, joy, vitality, happiness, adventure?
And what would you do to give those around you a better, more curious, more emotionally regulated experience when they’re with you? What would you do to have that same experience yourself?
Getting better sleep isn’t that easy for anyone, let alone those of us suffering from complex trauma and PTSD. The first step is typically talking with your doctor and making an attempt for a sleep study. If that’s not possible, there’s so many books on sleep, you could build a bed with them, though I highly recommend “Why We Sleep” by Matthew Walker, PhD.
Recommendations across various studies I’ve read on the subject include:
Meditation before or in bed
Deep breathing exercises
Visualization exercises
Reading for relaxation
Listening to music that soothes and relaxes
A cool environment
Not being directly beneath a fan or having air blow directly on you
Using apps on technology (tablet, phone, computer, TV, etc) that follow sunrise and sunset, or apps that limit the amount of blue light your are exposed to during the evening and night time hours
Don’t have caffeine too late in the day (around 2pm for most people)
Take naps
Aim for at least 8 hours of sleep per night, every night
Try not to eat at least 2 hours before bed
I’d love to tell you how each of the above has worked for me and what wonderous changes they’ve bestowed upon my infinitely fucked up sleep, but alas, I cannot. I really ought to take my own advice here and take advantage of this list. I know from previous attempts, these things do work.
Our youngest son (he just turned 9) is a mover and he’s always been that way. He moves so much, he has a special wiggle chair at school to keep him out of trouble and more focused on the task at hand (what amazing modern day wonders for our children!) and bedtime can be a difficult time to wind down. If that’s the case, I’ll put my hand on his chest or belly (or he’ll put my hand there himself which is my favorite) and we’ll do a deep breathing exercise that involves visualizing. He likes to visualize a happy cat or puppy (he loves animals) and do breaths deep enough to feel my hand move while his eyes are closed.
He’s done the deep breathing thing on his own since he was a baby, so it was easy for me to leverage an already natural coping and soothing skill and use it to build on with him. And it works every time. He doesn’t argue about doing it, I think he enjoys the warmth of those few minutes. So do I. And I’m grateful that while I seem to miss the opportunities of my own sleep hygiene, I can at least take a measured approach to teach purposeful sleep hygiene and routine with our children and lend them skills they can use on their own.
Which of these works for you? Let me know in a comment below (it’s free to signup!) because I’d really enjoy getting to know my readers! I have hopes of producing content geared towards questions and inquiries, so please do not be shy! There is nothing but love and, hopefully in the near future, community here (but I can’t have a community all by myself).
taken from “Why We Sleep”, page 70 [Kindle version].
So sweet about your 9 year old son! Sleep is a tricky one. I've struggled with it since I can remember.