10 Sleep tips for PTSD sufferers

Mark Grant MA

Sleeping problems are one of the most common symptoms of PTSD, affecting over 80% of sufferers. The two main symptoms of PTSD which interfere with sleep are hyperarousal and worry. Remember that PTSD originates out of a survival response, to ‘fight or flight.’ Where there seems to be no escape the nervous system may also enter a state of shut-down or numbing, a not-feeling state designed to protect the organism from the pain that is coming. As unpleasant as the symptoms of PTSD may be, at some point in your life they were adaptive.

Before we look at how to address sleeping problems associated with PTSD it’s important to consider whether the trauma is truly over and safety and security has been re-established. If you still feel under threat in some way, it will be very hard to experience the relaxation that is necessary for sleep. Threat can come in many forms; if your trauma resulted in litigation which is on-going, then the trauma is not really over and your fight-flight response is not going to let you lie down easily. Or if you suffered multiple trauma over many years, particularly in early childhood, then your nervous system may be adapted to a world that cannot be trusted to be safe, no matter how apparently okay your life is now. With these provisos in place here are 10 tips for managing insomnia associated with PTSD.

Accept that sleeping problems are a normal part of PTSD.

If you have suffered chronic or severe trauma, possibly involving other problems such as chronic pain, your sleep is bound to be affected because your nervous system is in a constant state of stress. You may find that your sleep routine is erratic, punctuated by nightmares and night-waking and non-restful sleep.  This is normal – it’s just your nervous system doing what it is designed to do – stay alert and protect you. Don’t get upset with yourself for not being able to sleep normally. Don’t force yourself to sleep normally.

Be safe

Given that PTSD is triggered by experiences that made you feel unsafe, it is important to do everything you can to create a sense of safety in your current life. Safety encompasses physical, mental and emotional experience.  It’s more than just ensuring the front door of your home is locked. It’s having someone you trust to confide in. It’s having a space where you feel secure, maybe your bedroom, maybe the couch in the spare room. So, who, when or what makes you feel safe? Make sure you regularly visit that person or place. One PTSD sufferer I treated recently found sleeping in the back of his 4WD while waiting to pick up his children from school was a place where he could sleep soundly (he would drive to the pick-up about an hour ahead of time).

If you can’t think of anywhere you can go you can also create a safe place in your mind by remembering or imagining a place where you can relax and not worry. Even if your life has been so terrible that there seems to have been no such thing, you must have seen a movie or TV show that depicted an ideal family that evoked feelings of pleasure in you – that will do. The Night watchman session on the sleep app is also designed to help facilitate a sense of safety. My other app, ‘Anxiety Release based on EMDR’, also has a guided exercise which will help you to develop a safe place if you find this too hard to do on your own.

Get away.

Related to safety, sometimes getting away from your normal everyday environment for a while can help restore sleep. Many of my clients with PTSD-related insomnia report sleeping better when they are on holiday and away from their everyday routines and triggers. One PTSD/chronic pain sufferer slept 9 hours on the second night of a cruise holiday, compared with his normal at home sleep of 4 hours. Another slept soundly when he visited a friend at his farm in the country. So, go camping, take a cruise, visit a relative or even just try sleeping in a different room or location. Just being away from the everyday triggers can have a huge impact on your stress levels and your sleep.

Tame your nightmares

Nightmares and night-waking are also quite common with PTSD. There are no well-researched methods for alleviating nightmares associated with PTSD. But there are 3 things you can do to address nightmares;

1. Get treatment for the trauma that is causing them
2. American psychotherapist Belleruth Naparstek describes a Nightmare Reprocessing technique where you identify a negative and a positive assumption about yourself in relation to the content of the nightmare, change the ending of the dream, and then replay the dream with the new ending each night after listening to 5 or 10 minutes of relaxing guided imagery.
3. There is emerging research to suggest that a synthetic cannabinoid used to treat nausea in chemotherapy patients called Nabilone, can help alleviate nightmares associated with PTSD

Obviously, you should consult your physician if you wish to treat your nightmares pharmaceutically.

Free Sleeping

Many experts recommend setting a regular schedule for going to sleep and night-waking. To be honest I have not found this terribly easy or practical for chronic PTSD sufferers. If you can great, but otherwise it may be less stressful just to accept the reality that you are going to sleep abnormally until your PTSD is better under control. In my book ‘Change Your Brain Change Your Pain’ I describe a strategy called Free Sleeping where you stop trying to sleep normally and just sleep whenever and wherever you can. Its based on the idea that sleeping 8 hours straight is actually a modern invention designed to accommodate human being to the 40-hour working week. The trick is to pay attention to your body and look for those windows of opportunity where your nervous system is ready for sleep and take them. Sleep is also like a meal, when it is interrupted you simply return to it where you left off and the sleep cycle continues. So instead of forcing yourself to sleep normally why not accept that you are going to sleep in chunks of 1, 2 or 3 hours at various times of night and day and just sleep where and when you can, schedule permitting? You can get your 7 or 8 hours of sleep, it just won’t be all at once, like your ancestors.

Exercise

Moderate to strenuous physical activity during the day will help burn off some of that excess energy and make you more relaxed and able to sleep. Regular physical exercise or activity has been found to improve sleep quality and duration.  Because of the hyperarousal associated with PTSD you have to exercise every day because the benefits take a while to build up over time. It’s especially important to exercise the day after a bad nights sleep when you may feel tired and unmotivated. Exercise obviously has other benefits in terms of physical and mental health. Many of my PTSD clients report finding going to the gym a form of time out when the only thing they have to worry about is how many calories they are burnings etc.

Use distraction.

Paying attention to a distracting stimuli helps shut down the bad thoughts long enough for your mind to enter a sleep state. Experts advise against watching TV before going to sleep, but many of my PTSD clients cannot fall asleep without the distraction of late-night TV or their smart-phone. However, the blue wavelength light of electronic devices acts as a stimulant and is counter-productive to sleep. A preferable alternative is reading or listening to audio-books or podcasts on your smart-phone. Nature sounds such as ocean waves or white noise can also be helpful although they may not be as effective as quieting down overthinking.

Manage stress.

Sleep and stress and like night and day. If there are bad things happening in your waking life (illness, instability, aggression, unresolved trauma, etc) then, of course, it’s going to affect your sleep. As overwhelming as these circumstances might seem, consider whether you are doing everything you can to manage those stressful circumstances? Eg; if you have PTSD are you getting counselling? If you have a chronic illness are you seeing a therapist to help manage the emotional effects of that?

If there are things you should be doing to help you feel stronger, healthier, more able to cope are you doing them? If not, why not? What are you afraid of? What might you be telling yourself that inhibits you taking better care of yourself? Is the price you are paying for inaction worth whatever benefits it brings? Note; avoidance can be an adaptive strategy temporarily, but over time the benefits are often outweighed by the costs. See also the ‘stress release’ session on this app.

Take control of your night-waking.

Try setting your alarm clock for just before the time you usually experience night-waking. Deliberately waking yourself up disrupts the negative sleep patterns that your brain has developed and creates the conditions where you can develop a more normal sleep routine.  It’s often actually easier to fall asleep after waking up in a different phase of the sleep cycle than when you are awoken by a nightmare or heart palpitations. Even if this doesn’t appear to be working at first, try and stick to it for a week and give your sleep pattern a chance to change. It might be the week from hell but it will be worth it if you can get a better night’s sleep.

Sleep Hygiene

Sleep Hygiene is about removing environmental obstacles to sleep. Eg; making sure you have a dark room with a comfortable mattress, the right temperature etc. Good sleep hygiene will not resolve your sleeping problems but it will at least make sure you are maximizing the conditions for sleep. See the Sleep Hygiene page for more details.