Insomnia and PTSD go together like a mosquito bite and itching but with far worse results. Insomnia is not only a consequence of traumatic events but, left untreated, can result in such chronic medical conditions as mood disorders, chronic fatigue syndrome, and even fibromyalgia, a painful condition affecting joints and tissues throughout the body.
There are roughly 4 types of insomnia:
1) Early awakening
2) Inability to fall asleep
3) Repetitive waking throughout the sleep cycle (usually every 90 min)
4) Unsatisfactory sleep
There can be other physical or disease processes that interfere with sleep so the first step with insomnia is to get a medical exam to determine if there are any conditions, such as sleep apnea (poor breathing during sleep) that are resulting in awakening or unsatisfactory sleep (waking up tired).
With PTSD the two most common types of sleep disorder I’ve seen are the inability to fall asleep or waking approximately every 90 minutes. These are so common that if I have a patient walk in with those symptoms there is a high likelihood that they have suffered past traumatic events.
The answer is simple. REM (rapid eye movement) sleep occurs approximately every 90 minutes. In this stage of sleep the brain processes memories and emotions. That is what the brain is hardwired to do and why people normally wake up feeling refreshed.
But if the memories are too scary and overwhelming or if the conscious mind is not ready to assimilate the information a person will shut down the REM process by popping prematurely out of sleep. Similarly with sleep inhibition or the inability to fall asleep, the mind is unconsciously resisting the process of assimilation or digestion of overwhelming experiences.
For these reasons, sleep can start to feel like a very overwhelming experience and can snowball into its own traumatic situation. Insomnia breeds its own special kind of anxiety. A secondary trauma develops: the fear of not being able to sleep.
What to do?
Here are three steps to getting back to a restful night even while healing from trauma:
1) Unwind the fear about falling asleep. If you are awake use your time productively. Do some yoga postures and relaxation exercises. Or read something that is “good for you” like history, medical information or a religious text. The mind wants to shut down out of boredom after a while, just like in school. Do not read Stephen King or the latest murder mystery! Tell yourself that you will not be awake forever and allow yourself to be awake if you need to be. You can always nap tomorrow. The more anxious you are about being anxious the less chance sleep will come.
2) Develop excellent sleep hygiene. Sleep in a dark room without computers, tv’s etc. Turn off bright lights at least 2 hours before bed (yes that includes all media screens). Abstain from caffeine and sugar for 6 hours before bed. Develop a routine. Etc.
3) Most important: Start addressing your traumas! Your unconscious mind wants you to heal and will keep throwing up traumatic dreams and memories until you get the point and deal with them. Seriously. The best cure for insomnia is curing your PTSD. Find a great counselor or program and get to work!
The alternatives to not addressing insomnia are unbearable. Pills only work for so long. If you resolve the underlying issues be they physical or psychological you will be well on your road to healing and back to the land of Bedfordshire in no time.