Disturbed sleep is a major symptom of Post-Traumatic Stress Disorder (PTSD). Traumatized people struggle with the transitions into and out of sleep, as well as nightmares that can be traumatic in themselves. Lack of sleep further destabilizes the nervous system, making it harder to cope with and heal from other effects of trauma.
Trying to fall asleep with PTSD can feel like edging carefully between an ocean of flashbacks and a cliff of sleeplessness. The ongoing sense of emergency creates physical tension and racing thoughts. Relaxing feels like letting down a necessary guard against outer threats and inner revelations.
Getting up in the morning can also be a difficult journey, shaking off nightmares in preparation for another day. Transitions are hard, especially when they involve vulnerability.
Time for rest
Whether you sleep or not, night can be a time for rest, contemplation, and listening inside. You might be sleeping more than you think, micro-naps with dreams that continue where wakefulness left off. As a passenger on a long car trip, I once dreamed that I was lying awake in bed.
It can take time for the underlying irritated nervous system to calm down, and to find what sleep conditions work best for you. Meanwhile, simple interventions can alleviate the extra layer of anxiety about not sleeping well and ease nightmares.
Acknowledge what is
The first step is to acknowledge the current situation with sleep, both positive and negative. Perhaps you fall asleep easily, even if you wake often during the night. Perhaps you have chronic insomnia at night, but find time for refreshing naps. Perhaps your sleep is frustratingly rare and fragmented, and yet you still find ways to move through your days.
Become mindful about your relationship with sleep and the factors that affect it. When is your sleep better and worse? Experiment to see what works best for you. Some people find the recommendations of sleep hygiene helpful, which include a regular bedtime and wake time, a quiet, dark room, and only staying in bed for sleep.
Not everyone has control over their schedule or sleep environment. Some people find that reading or checking email in bed helps with the transitions into and out of sleep. Listening to familiar music at bedtime can help calm the nervous system for sleep. Earplugs might shield against noise, or they might feel like reckless interference with sensing for danger. For some people, small amounts of caffeine keep them up for hours, while for others caffeine acts as a sedative. The key is to make informed choices and understand how they affect you.
A soothing drink at bedtime such as chamomile or valerian tea can help prepare your body for sleep. Melatonin can help regulate your circadian cycles. Over-the-counter or prescription sedatives can bring relief when sleep is out of reach. A doctor can also check into the possibility of sleep apnea or other treatable medical conditions.
Orient to the present
Survivors of sexual assault may still wake suddenly at the time of night the assault(s) occurred, or “inexplicably” resist going to bed until after that time. Beds and bedrooms may feel triggering and unsafe, the opposite of a safe haven. Combat veterans and other survivors of violent trauma often sleep lightly and wake suddenly in response to noise.
When awakened suddenly, orient yourself to the present by reminding yourself where you are and what the date is. It might help to turn on the light and look around, or have a night light you can focus on.
Remind yourself that it ended and you are not confronting an emergency in this moment. The body insistently reviews past trauma, searching for resolution. Each spike of anxiety and return to calm reminds you that resolution already occurred.
Connect with your body
Whether you have been startled awake or cannot fall asleep, it is natural to respond with frustration at yourself and the situation. Take some time to notice your physical and emotional responses, and say hello to them.
- “Hello, quickly beating heart.”
- “Hello, something in me angry at noisy people.”
- “Hello, something in me ashamed of what happened two decades ago.”
Feel breath flowing in and out of your body. Notice the support of your bed, and how your body responds to it. Say hello to any tension you notice in your shoulders, or in your jaw. Wiggle your fingers and toes, and notice your adult length, here in bed, in the present.
Listen for requests
Is there anything that could be more comfortable? Hold the question gently, and sense for answers that float up. They might be new and unexpected, or part of an ongoing theme. You might want more light, or thicker curtains. Something to eat or drink. More blankets, or fewer. A different pillow. To get up and write (but not send) a scathing letter. To stop thinking about that problem entirely for a while.
Receive the answers with openness, and let them know you hear them. As a separate step decide whether to take any action. It can be hard to get out of bed in the middle of the night, even if it would be easier to go to sleep afterward. Perhaps something in you needs reminding that adults are allowed to get up when it suits them.
Some sleep environment issues can be addressed with others during the day. Whether it’s a neighbor gardening at 5am, a housemate slamming doors, or a loudly beeping garbage truck, people respond surprisingly well to a polite request tinged with desperation for sleep.
Nightmares make sleep less restful, and add dread to the thought of going to sleep. They can be ever-changing scenes with an emotional punch of helplessness and terror, repetitive flashbacks to trauma, or a tangle of both.
Script your dreams
Anne Germain’s research on Imagery Scripting (pdf) shows that imagining (not just thinking about) what you want to dream can replace nightmares with more pleasant dreams.
Either imagine a better ending for a repeating nightmare, or create a whole new dream. If you start with an existing nightmare, choose one that is upsetting, but not devastating, to keep this process manageable. Have fun with scripting your new dream. What would be a wonderful, yummy outcome? How do you want to feel when you wake up?
One possibility is to imagine that a guardian comes into your dreams to protect you. The guardian could be God, Kuan Yin, your older brother, an imaginary aunt, or your favorite superhero. Vividly imagine your caring, competent guardian standing ready to take action on your behalf. Feel their warm presence supporting you.
Close your eyes and imagine your new dream. Make it as dreamlike and vivid as possible, using all your senses. Practice at least once a day, more if possible.
Difficulties with sleep can reinforce feelings of helplessness and powerlessness from the past. When we can acknowledge our present reality, explore how to encourage sleep, advocate for ourselves, and re-script our nightmares, we reinforce present resourcefulness in place of past helplessness.
The CDC’s sleep hygiene recommendations.
Anne Germain’s presentation: Treating Nightmares with Imagery Scripting & Rehearsal (pdf).