“If I stay awake I won’t have nightmares”. “If I keep busy, I won’t think about the bad things that have happened to me”. “I can’t close my eyes, because If I do something bad will happen”. “If I stay awake, I will see if anything is about to happen to me”.

These are just a few of the thoughts that may resonate with a person (adult or child) who has been diagnosed with Post Traumatic Stress Disorder (PTSD) and whose sense of safety in the world has been shaken. There are as many cognitive combinations as there are individuals. Most of these cognitive distortions were born out of necessity for safety and remain as protective mechanisms long after the original trauma or traumas occurred. Over time these mechanisms begin to hamper the persons ability to rest and/or sleep. In essence the person lives in a state of hyper arousal which affects many areas of functioning and quality of life. When sleep is disrupted a persons mood, ability to concentrate and remember, judgement, ability to attend and learn, sex drive, balance and coordination, health, weight, collagen production in the skin and tissue repair, and overall safety are impacted.

Sleep distress and PTSD go hand in hand. Sleep is often the first area to be affected when a person is under stress and where trauma symptoms begin to manifest. Sleep is an essential component for healthy functioning and it must be addressed early in treatment. This said, it is also an area which can take a long while to re-adjust. Recommended interventions include; changing your sleeping area, creating and keeping a bedtime routine/ sleep and wake schedule, ensuring that high energy activities are not engaged in 2 hours prior to bedtime, using a sleep mask, listening to soothing music, warm tea, aromatherapy, maintaining a darkened electronic free sleep area, and/or relaxation strategies, engaging in a quiet activity (such as reading) until you can fall asleep, limiting caffeine , alcohol, chocolate, and tobacco intake, and ensuring you get enough sun during daylight hours. In the event that sleep disturbance is on-going talking with your family physician about your symptoms and the possibility of ruling out health related issues, engaging in a sleep study, medication management, and/or referrals for counseling support is a helpful place to start.

In reference to PTSD specifically, while all of the above are important a primary component is increasing the persons sense of safety. This may include, ensuring that doors and windows are locked, utilizing an alarm system, nighttime routines with support, reminders, and structure. For children, it is important to reassure them that they are safe, that you are there, talk to them about how to access you during the night, and reinforce the above.

Perspective: If you or a loved one are experiencing sleep distress it is important to pay attention.It is a genuine indicator that something is amiss. It does not mean that a trauma has occurred or that a diagnosis of PTSD is appropriate. It will be important to review what has been occurring in your environments and monitor the impact of stressors. For children, changes in sleep which are not considered developmentally appropriate or include on-going attempts to avoid sleep, nightmares, refusal to go to bed, bed wetting, statements regarding being afraid, or attempts to avoid certain places, people, activities, or feelings, are indicators that your child is attempting to manage and /or avoid difficult feelings. It is important to understand their developmental needs, to check in often, to help them identify and express any feelings of stress regarding changes in their/ your environments or events in your lives, to establish solid sleep and wake routines, to aide in the sense of normalcy, predictability, and safety and to access support (in the form of counseling) if the problem becomes a pattern and is not corrected through attempts to increase feelings of predictability and safety.

Resources: The Center for Disease Control (CDC) reports (Per The National Heart, Lung, and Blood Institute the following guidelines for sleep at each developmental level. Newborns need 16-18 hours of sleep each say, Pre-school-aged children need 11-12 hours a day, School -aged children need at a minimum 10 hours a day, Adolescents require 9-10 hours, and adults (including the elderly) need 7-8 hour a day. You may find these guidelines at, http://www.cdc.gov/sleep/about_sleep/how_much_sleep.htm

The Department of Veterans Affairs publishes many articles in the areas of PTSD and Sleep. You may find resources at http://www.ptsd.va

Agreement of Use: In consideration for your use of and access to the Perspective on Trauma Blog, you agree that LaDonna Remy MSW, LICSW is not liable to you for any action or non-action you may take in reliance upon information from the blog. Please note, it is not possible to provide informed (personalized care) through blog content. It is your responsibility to seek individual clinical care from your own provider, who will know or learn your specific circumstances, should care be needed.

Professional Disclaimer: It is important to recognize that all information contained in the Perspective on Trauma Blog is informational, and is not intended as a substitute for clinical care. It is not possible to provide informed care through web content, as an informed treatment relationship cannot be formed. If you or a loved one is in need of care, it is important that you access this care from your own care provider.

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