by Penny Boreham
“the innocent sleep,
Sleep that knits up the ravell’d sleave of care,
The death of each day’s life, sore labor’s bath,
Balm of hurt minds, great nature’s second course, chief nourisher in life’s feast.”
(Macbeth by Shakespeare)
Trauma and Sleep Disturbance: a vicious circle
It can seem like a vicious circle of the worst and most agonising kind – you are suffering from post-traumatic stress disorder (PTSD) and, as a result, you find your sleep disturbed and then you are denied the healing and beneficial qualities of sleep itself. Your whole system is then further disturbed, your symptoms are exacerbated, and so it goes on…
Professor Matthew Walker, who works in the sleep and neuroimaging lab at the University of Berkeley in California, reports that sleep actually contributes hugely to helping your system get over PTSD.
“The dream stage of sleep, based on its unique neurochemical composition, provides us with a form of overnight therapy, a soothing balm that removes the sharp edges from the prior day’s emotional experience….we know that during REM sleep, there is a sharp decrease in levels of norepinephrine, a brain chemical associated with stress.”
The research that scientists, like Professor Walker, are doing into the nature of sleep and also into the relationship between sleep and PTSD is helping us learn more about both sleep problems and the symptoms of trauma held in the body.
Historically, sleep problems have been viewed as a secondary symptom of PTSD but recent research has suggested that sleep problems may be central to the PTSD syndrome. When we experience trauma in our bodies we are in a constant state of hyper arousal and overstimulation. Our brain is flooded with neurochemicals, such as epinephrine and adrenaline, which then makes us struggle to wind down at the end of the day and also actively keeps us awake.
In our managing director, Benjamin Fry’s new book, “How I f***ed Up my life and made it mean something” (which will be published in April) he writes of the hideous impact of disturbed sleep during his nervous breakdown.
“This is really when all semblance of normality began to leave my life, mind and body. Sleep, I have come to reflect, is a thing like money and love in as much as you can’t really appreciate its value until you lose it. I began to wake up earlier and earlier in the morning, initially with a murmur, latterly with a start, then finally like a gunshot had exploded in my head. The worse it got, the more of an issue it became; the more of an issue it became, the more I worried about it; the more I worried, the less I slept. It got to the point where each morning I would wake up and the first thing I would do was look at my watch; then, seeing something like 3.15am, I would immediately panic that I was losing my capacity to function in the world, and the panic would untimely rip me wide awake. Then I would spend agonising hours in bed, trying to contain my tortured mind sufficiently to let me go back to sleep. I would budget an hour for a full-on worry attack, believing that this would then let me calm down enough to rest again. I didn’t do anything helpful or constructive like get up or move around. I just lay there in the dark wrestling with my mind, thinking that this time I might get somewhere”.
How trauma effects our sleeping patterns
Those who have PTSD are also much more likely to experience depression. PTSD and depression have been shown to have slightly different but extreme effects on our sleep patterns.
The flashbacks experienced after trauma can make falling asleep difficult. Those who are suffering from trauma are also hyper vigilant, which of course also effects their sleep and means that the very process of falling asleep is frightening and represents a loss of control. For those who have experienced violent situations, night time and darkness can bring about added anxiety and restlessness. On top of this, many people who have experienced trauma use alcohol and other drugs to numb the pain they feel following such experiences and these drugs can also exacerbate sleep problems.
Once someone is finally asleep, nightmares can frighten them back to consciousness, and then getting back to sleep becomes an issue again. People are also afraid to fall asleep and experience another nightmare.
Nightmares
Research has shown that well over fifty percent of people suffering from PTSD complain of recurrent and persistent nightmares. Nightmares following trauma, and in particularly in the case of those who are diagnosed with PTSD, are in some ways different from nightmares in general. They seem to occur earlier in the night and during different stages of sleep, and they are more likely to have body movements with them
The different stages of sleep
When you sleep, you go through 90-minute sleep cycles. First of all, you move into light sleep which is stage one or two – this cleanses the mind of memories that you don’t need. If you disrupt light sleep, you really struggle to remember what happened the previous day and become disoriented. In the next stage you go into deep sleep, which has a lot to do with the release of growth hormones and the repair of bodily damage. If you disrupt deep sleep, people become very unhealthy, very quickly. Then, after a little bit of deep sleep, you drift into REM (rapid eye movement) state, which is close to being awake, and that’s when you start to dream. By the time the first dream has finished, about 90 minutes will have elapsed. That sleep cycle is then repeated several times throughout the night.
Research into REM and NON REM sleep in PTSD and Depression
Numerous studies have shown that disturbed REM or non-REM sleep contributes to stress and trauma responses and increases the chances of longer term psychiatric problems in those who are experiencing profound symptoms of trauma.
The type of REM sleep experienced with PTSD appears to be of a disturbed pattern in itself, and the eye movements that characterise REM sleep are also abnormal.
There has been even more research done into the relationship between sleep and clinical depression. The more severe the depression, the earlier the first REM begins. Sometimes it starts as early as 45 minutes into sleep. That means these sleepers’ first cycle of non REM sleep amounts to about half the usual time and therefore those suffering from depression don’t get enough deep sleep to support their bodies health and growth.
So people suffering from clinical depression are also losing the large spurt of human growth hormone during the first deep sleep.
Similar to those diagnosed with PTSD, patients suffering from depression have also been shown to have abnormal eye movements during the REM sleep, they are apparently either too sparse or too dense. In fact, they are sometimes so frequent that they are called “eye movement storms”.
The way forward
Recent research into the precise quality of these phases of sleep and how they present differently in people suffering from PTSD and depression can help clinicians understand the central relationship between sleep and the experience of trauma more fully, how they interrelate, and also contribute to the development of more appropriate treatments. As sleep and PTSD and depression are so closely interwoven, and it is becoming apparent that we should no longer think of sleep problems as secondary symptoms but as central to the diagnosis itself, it once again highlights how working with trauma and depression through the body in a holistic way is of utmost importance.
Those who experience our therapies at Khiron House do find that normal sleep patterns are restored as their whole nervous system calms down.Someone who is going through the residential programme at the moment told me that the his sleep patterns improved in tandem with the therapeutic work he has been doing. He says he feels it was the combination of the unearthing of the underlying attachment issues (that had made him less resilient to emotional trauma) and the handing over to ‘the wisdom of his body’ (through somatic experiencing therapies and breathwork) that allowed him to express and release the bound energy in his body.
Just as abnormal patterns of sleep are a dreadful symptom of the experience of trauma in the body, so returning to normal patterns and regaining that “balm of hurt minds, great nature’s second course” can be huge and life enhancing signs of a return to a robust and resilient place in the world.
“And if tonight my soul may find her peace in sleep, and sink in good oblivion, and in the morning wake like a new-opened flower then I have been dipped again in God, and new-created” Shadows by D.H. Lawrence.
This is part of our series of blogs which are telling the story of trauma treatment, how it has developed and is still developing every day. In this series our expert practitioners will be sharing their knowledge with you, we will be finding out what recent scientific breakthroughs are teaching us all about the nervous system, and we will be keeping you in touch with the latest news about the life transforming therapies that are becoming more sophisticated and responsive every day.
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