Women with

  PTSD United

INformation, Resources, and Support for Women with PTSD


The science of sleep:  In order to properly sleep, one needs to consume tryptophan (an amino acid) from an outside source to start the process. The tryptophan is then converted to 5-HTP, which is then converted into serotonin. The serotonin then converts to melatonin, which makes the body’s biological clock run smoothly and determine when it is time to go to sleep and when it’s time to venture out of bed. It is the master clock, if you will, making us sleepy-or alert-at the proper times, because melatonin produced is released in higher amounts the darker it is, while the amount lessens with more light. Since tryptophan is the only amino acid that can convert to serotonin, it is also the only one that can ultimately up your melatonin.


​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​PTSD and Sleep (Excess or Lack Thereof)

Stress from a traumatic event (or events) can often lead to a variety of sleep problems. When one’s body is over-stimulated, the brain is flooded with neurochemicals that keep us awake (such as epinephrine and adrenaline) making it difficult to wind down at the end of the day. The neurochemicals stay in the brain and can interrupt your normal sleep cycle. The result can be insomnia, bad dreams, and daytime fatigue caused by sleep disturbance. Symptoms of PTSD and co-occurring disorders or diseases that may impact sleep patterns are:

  • Medication Side-Effects (Hormone drugs, pseudoephedrine,beta-blockers and anti-depressants- many medications affect sleep patterns in one way or another)
  • Not Enough Exposure to Natural Daylight
  • Too Much Exposure to Artificial Light in the Evening
  • Lack of Physical Activity or Sedentary Lifestyle
  • Poor Diet | Nutritional Deficiencies
  • Eating at Night, Indigestion
  • Excess Caffeine or Stimulant Consumption
  • Anxiety, Stress
  • Depression
  • Apnea, Asthma, Other Breathing Problems
  • Heart Disease
  • Hormonal Imbalances, Perimenopause - Menopause





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​​The following are sleep problems commonly seen in those with PTSD/CPTSD:

·         Flashbacks and troubling thoughts can make falling asleep difficult. The victim might feel the need to maintain a high level of vigilance, which can make sleep elusive. For those who experience violent situations, nighttime and darkness can, in and of themselves, bring about added anxiety and restlessness.
         Taking naps during the day might be helpful, but, if overdone, can also interfere with efforts to sleep through the night. Once asleep, nightmares can frighten a survivor back to consciousness, and getting back to sleep can be very difficult. Research has shown that somewhere around 50-70% (or more) of those with PTSD have nightmares. Not only are trauma survivors more likely to have nightmares, those who do may have them quite often. Some survivors may have nightmares several times a week. Sleep walking/talking/eating, night sweats, lucid dreaming (you are aware that you are dreaming), and REM Sleep Behavior Disorder (dreams are acted out) have also been reported.
·         Delayed Sleep Phase Disorder has been found to commonly occur for those with PTSD. This is when one is unable to fall asleep until late at night and therefore wakes later in the day than is expected for a “normal” sleep schedule.
         Many survivors use alcohol or illicit drugs to numb the emotional and physical pain following trauma. These substances can not only impact the healing process, they can also exacerbate sleep problems.
         Medications to target symptoms of PTSD can affect sleep patterns by increasing or decreasing tiredness levels. *Talk to a physician about the possible effects that a medication may have on sleep.
·          Those with PTSD have higher rates of depression, which is itself often associated with poor sleep.

 
Promoting Good Sleep Patterns
Environmental Modifications:

 Improve the Feng Shui.  Feng shui is more than just decorating your space in a visually appealing way; it’s a full philosophy that instructs on how to arrange your room, furniture, office, etc. to maximize good energy flow throughout living spaces. Here are a few tips for improving the Feng shui of your bedroom to help you get the most of a good night’s rest:

  • Keep your bed easily accessible and approachable from all sides.
  • Make the energy in the room fresh and help it flow by keeping the air pure, preferably with open windows. Also try to have several windows to allow in natural light.
  • Have the bed positioned in such a way that you can see the door. Not being able to see the entrance to your bedroom can create a feeling of anxiety.
  • Keep the room neat and clean with a balanced look and feel. Clutter and trash stresses you out and represents unfinished business, which can prevent you from really resting well in your room. (On that note, it can also affect your sex life.)
  • Use lighting to Your Advantage.   In order to fall asleep, the body requires certain cues to trigger the release of melatonin – the hormone that naturally causes the body to sleep when it's dark and to awaken when it's light. The most basic way to do this is to reduce your exposure to artificial light in the evening hours. If you tend to have every light on in the house at night and you watch TV in the bedroom, it may be messing with your natural circadian rhythm. Instead, turn the TV off and don't watch it in the bedroom at night. Ideally, no TV or computer should be in the bedroom and the bedroom should be used only for the “2 S's” - sleep and sex. . While it often helps to sleep in a dark room, if keeping a nightlight on helps bring about a more safe feeling, then consider keeping the room dimly lit.
  • Be Comfortable:  Many things impact physical comfort during sleep. Choose the right mattress, bedding, and pillow for maximum comfort level. Temperature of the room while you sleep can affect how deep or how long one is able to sleep. If you have breathing problems – allergies, asthma or other respiratory conditions, use hypo-allergenic bedding and wash it weekly.
  • Be aware of noise. Minimize disturbing noises. If external noises are beyond your control (a busy street outside the window, a neighbor’s barking dog), cover them up with the sound of a bedside fan, a white noise machine, or other sounds that help us sleep. Some people need to sleep in complete silence; while on the other hand, some need a little background noise. For many (myself included), the dripping of the faucet, the hum of electricity, the sound of themselves breathing, or the blankets rustling as they toss and turn stresses them out and keeps them awake. So what’s the deal? Technically speaking, white noise is a consistent noise that comes out evenly across all hearable frequencies. When you get jarred awake or bothered by a noise at night, it’s not really the noise itself, but the abrupt inconsistency in the noise that you hear. The fact of the matter is you still hear when you sleep, and white noise can mask those inconsistencies. The scientific aspect set aside, it’s just plain soothing, filling out the silence that makes you feel trapped with racing thoughts or excess energy. There are even white noise machines that can be purchased for specifically this purpose.
  • Create an environment in which you feel safe.  While the bedroom is optimal, it may not be possible to rest there for reasons specific to each person (e.g. if you experienced violence in that room or a room similar).
  • It may also help to have a friend or family member stay in the room, or perhaps in a nearby room, while you are sleeping.
  • Use Aromatherapy.  Aromatherapy has a number of different uses, but is perhaps used most often for relaxing or creating a sense of drowsiness. Numerous studies have resulted in science giving a nod to the validity of aromatherapy. The essential oil of lavender (not fragrance oil!) can be added to your nightly bath to relax and calm you, or you can simply open the bottle and inhale a bit of it right before bedtime. It helps gently ease stress and relax. If you find yourself having a hard time drifting off at night, try making a lavender sleep sachet to stash under your pillow or on a bedside table to help you relax and drift off, apply essential oil of lavender to your pillow, or spritz some on your bedding occasionally.


Personal Habits

  • Exercise early in the day and on a regular basis. Studies find moderate aerobic activity can improve insomniacs’ sleep quality, as well as give you more energy when you’re awake. For best results, exercise at least three hours before bedtime so the body has sufficient time to wind down before hitting the sack. (Having sex or masturbating before bed can help you fall asleep as well.)
  • Do some leg exercises. We know; we told you not to exercise before bed. But apparently some easy leg lifts, squats, or your leg exercise of choice can help divert blood flow to the legs and away from the brain. This can help quiet the mind, making it easier to slip into dreamland.
  • Bathe or Shower Before Bed. Stepping from warm water into that pre-cooled bedroom will cause body temperatures to drop slightly, which can trigger sleepy feelings by slowing down metabolic activity. A soothing and relaxing Epsom Salt bath works magic (another option to obtain Magnesium if you prefer not to supplement). Add a few drops of your favorite essential oil (lavender is great) to get the soothing benefits of aromatherapy as well. Light some candles and turn on some relaxing music to really relax.
  • Schedule “worry time” during the day. Spend 15 minutes during the day addressing problems (journaling is a good way to start) so they don’t sneak up when your head hits the pillow. If a particular event or stressor is keeping you up at night — and it has a clear end date — the problem may resolve itself naturally.
  • Vent stresses. If designated worry time earlier in the day didn’t fully do the trick, spend some extra time writing down anxieties before bed. Loose-leaf paper works, but if you scrawl your sorrows in a journal or notebook, you can literally close the book on your worries (at least until morning).
  • Limit caffeine. It’s tempting to reach for coffee when we’re tired after a poor night’s sleep, but drinking caffeine can make it harder for us to fall asleep at night, creating a vicious cycle. Can’t quit cold turkey? Try limiting caffeine intake to earlier in the day so it’s out of your system by bedtime.
  • Nap the right way. Just 10 to 20 minutes of napping during the day can help us feel rested (and improve our creativity and memory, to boot!). But try to avoid napping after 3:00 or 4:00pm, as this can make it harder to fall asleep at bedtime.
  • Get outside. Increasing natural light exposure during the day promotes healthy melatonin balance, which can help us get to sleep later in the day. Being in nature decreases stressors and anxiety, which promotes healthy sleep.
  • Seriously: Count some sheep. It might not work for everybody, but focusing on one thing can help the brain settle down, making sleep more possible. Not a fan of our wooly friends? Focusing on your breath (in, out, in, out) is also an effective way to chill out.
  • Engage in a relaxing, non-alerting activity at bedtime such as reading or listening to music. There are links to phone apps and radio stations that are specifically sleep-time music below.  
  • Stick to a Schedule, Establish a Ritual, and Keep a Diary. Humans are funny creatures of habit, and our bodies usually work quite well when something is done ritualistically. For example, exercising randomly every few days won’t do much, but exercising every day for 30 minutes will over time make a huge difference. The same thing goes for sleep. Establish a calming ritual that you do every night before crawling in bed, and you will probably find it easier to transition from being awake to being sleep. The ritual is also a time to relax and let go of stress and thoughts that crowd your head and keep you up.
  • Have someone kind give you a massage.   :)
  • Get Acupuncture.  Acupuncture is one of the main components in traditional Chinese medicine (TMC), and one of the oldest healing practices in the world. It is thought that stimulating specific points corrects the balance of energy or the life force by opening up channels called meridians, which close off when stress inflames and contracts vessels. The thin needles, upon insertion, open up these blocked channels and allow your brain to better understand that it’s time to go to sleep. It also signals the release of neuro-endocrine chemicals (like tryptophan/melatonin) to help you fall asleep and to stay asleep.


 
Yoga and Meditation
Meditate: Take some time before you crawl in bed to meditate and clear your mind of cluttering thoughts. Thinking too much, as we all know, can keep you awake for hours as you churn over the same thoughts again and again. Getting a good night’s rest is not just about your body-with how complex our thinking process is, our minds need just as much help (if not more) to get ready for bed.
     Visualize yourself asleep. Imagine yourself drifting in a blissful slumber while practicing deep breathing and progressive muscle relaxation. Starting at one end of the body and working up or down, clench and then release each section of muscles for instant all-over relaxation
     Do some gentle yoga or stretching, not vigorous power or ashtanga yoga, which could energize you instead. Try easy yoga stretches in bed followed by simple meditation. Close your eyes and, for 5 to 10 minutes, pay attention to nothing but your breathing.

Yoga for Insomnia and Stress:

http://www.stylecraze.com/articles/yoga-poses-to-cure-insomnia/

http://www.huffingtonpost.com/2011/07/06/6-yoga-poses-for-depressi_n_890836.html#s303652title=Legs_Up_The

http://www.oprah.com/health/Yoga-for-Insomnia-Yoga-to-Help-You-Sleep

 

Diet, Vitamins, and Supplements

  • Magnesium and Calcium:  Magnesium is one of the most vital minerals, and yet most of us are lacking it. You can thank increasingly poor diets for this one. Magnesium plays a huge role in the functioning of GABA receptors, which is the primary neurotransmitter that calms your central nervous system, relaxes you, and can help prepare you for sleep. GABA won’t necessarily make you drift off to sleep magically, but you can be pretty sure you’re going to have a hard time sleeping without it. Foods high in magnesium include halibut, almonds, cashews, and spinach. While the best way to up magnesium is to eat a balanced diet, taking supplements can greatly help. Calcium is directly related to our cycles of sleep. In one study, published in the European Neurology Journal, researchers found that calcium levels in the body are higher during some of the deepest levels of sleep, such as the rapid eye movement (REM) phase. Magnesium and calcium are both sleep boosters, and when taken together, they become even more effective. Plus, by taking magnesium, you cancel out any potential heart problems that might arise from taking calcium alone. Take 200 milligrams of magnesium—lower the dose if it causes diarrhea—and 600 milligrams of calcium each night.
  • Hot Teas and Juices: Making up a nightly drink to help you fall asleep has the double benefits of the drink itself lulling you off to dreamland, and the ritual of drinking it which tells your brain and body “ok, it’s time to relax.”
  • Valerian is one of the most common sleep remedies for insomnia. Numerous studies have found that valerian improves deep sleep, speed of falling asleep, and overall quality of sleep. However, it's most effective when used over a longer period of time.  *About 10% of the people who use it actually feel energized, which may keep them awake. If that happens to you, take valerian during the day. Otherwise, take 200 to 800 milligrams before bed or prepare tea at bedtime by boiling valerian root in fresh water (1 tsp of dried valerian root per 8oz water).
  • Chamomile relaxes your muscles, and has a substance called apigenin which causes sleepiness. You can, of course, buy chamomile tea from the store, but it can be made fresh as well.
  • Catnip, a plant that is a member of the mint family, isn’t just for cats-it works as a stimulant for cats, but it has a sedating effect on humans. The compound responsible for catnip’s effects across both species is called nepetalactone. While it can make cats frisky and wild, it can make people relaxed, drowsy, and ready for bed. Enjoy it in the form of a warm tea before bed with a little bit of honey. (1-2 teaspoons of dried catnip per 8 ounces of boiling water)
  • Lemon balm is used primarily to lift mood and promote calmness and relaxation. Since depression is often related to insomnia, probably because of a lack of serotonin, lemon balm can help you achieve sleep by promoting mental and physical health. Several studies have confirmed its sedative effects, however it should be noted that too high of a dosage (1800 milligrams) actually increased anxiety. For a mild, uplifting, and relaxing tea use 2 tablespoons of dried lemon balm, or 8-10 tablespoons of fresh lemon balm with 2 teaspoons dried chamomile and 8 oz of fresh water.
  • Saint John’s Wort is used frequently to help with depression, and in turn helps with disrupted sleep by raising the overall level of serotonin in the brain. More serotonin = more melatonin= better sleep. You can take it in capsule form, or prepare a strong tea to use as a sleep aid. (2 teaspoons of dried Saint John’s Wort (herb top/flowers) per 8 ounces of freshly boiled water)
  • Hops… yes, as in hops that are found in beer, but this quick growing vine is also an excellent remedy for calming nerves and promoting relaxation (not in the form of beer, sorry!) Rather, it can be made into a strong tea and drank right before bed, or made into a sleep sachet and placed under your pillow at night (just replace or add it to the lavender). (2 tablespoons of dried hops per 4 C. boiling water, allowed to steep for at least 5 hrs or overnight, and then strain. Reheat or chill and drink a cup 30-45 minutes before bedtime for an easy and restful slumber. This will keep in the refrigerator for 2 days.) Thirty to 120 milligrams in capsule form is also effective.
  • Tart cherry juice (1/2 to 1 C.) is a tasty way to drift off to sleep, and is a natural because it’s full of tryptophan. (Tryptophan is an essential amino acid that coverts to serotonin, which then coverts to melatonin.)
  • Melatonin:  This chemical is oh-so-important to sleep, but our body needs outside sources to get it. Although some experts recommend taking higher doses, studies show that lower doses of 0.3 to 0.5 milligrams are more effective. Plus, there's concern that too-high doses could cause toxicity as well as raise the risk of depression or infertility. While it can be taken as a natural supplement in pill form, here are some foods that will help boost production:
  • Cherries contain melatonin and also contain tryptophan which is metabolized into serotonin and finally melatonin
  • Bananas   contain tryptophan, and potassium and magnesium as well, which are muscle relaxants. Have one a half-an-hour before bed every night and up your magnesium levels while simultaneously relaxing your muscles.
  • Kava kava: This supplement works very well for insomnia that is caused by stress or anxiety. It is a good relaxant that also helps promote better sleep patterns.
  • L-theanine: This amino acid comes from green tea and not only helps maintain a calm alertness during the day but also a deeper sleep at night. However, green tea doesn't contain enough L-theanine to significantly boost your REM cycles. Look for pure L-theanine capsules of 50 to 200 milligrams to be taken at bedtime.
  • Wild Lettuce:  If you've suffered anxiety, headaches, or muscle or joint pain, you might already be familiar with wild lettuce. It's also effective at calming restlessness and reducing anxiety—and may even quell restless legs syndrome. When using a wild-lettuce supplement, take 30 to 120 milligrams before bed.


The Don’ts:

  • Don’t smoke. Need another reason to quit? Smokers commonly exhibit symptoms of insomnia — possibly because their bodies go into nicotine withdrawal during the night
  • Don’t drink alcohol right before bed. Booze might seem like an obvious choice for calming down pre-bedtime, but it can actually disrupt sleep cycles later in the night. You don’t have to give up the good stuff completely; just drink it with dinner (around 6 o’clock) and skip the nightcap.
  • Don’t use your brain before bed. Don’t work, watch stimulating TV shows, read complex material, or think too hard — about anything — before bedtime; working out the brain keeps the body awake.
  • Don’t try to sleep unless you’re sleepy. Yes, it sucks when it’s 2:00am and you still don’t feel tired, despite knowing you need rest. But climbing into bed when you don’t feel ready for sleep is setting yourself up for failure. Instead, engage in relaxing activities (like gentle yoga and meditation or listening to soothing music) until you get the strong urge to snooze. If sleep hasn’t come within 20 minutes, get back out of bed and try relaxing activities again until you’re sleepy enough to give it another go.
  • Don’t let yourself give in to bad thoughts. Judgments (“I should be asleep”), comparisons (“my BF/GF/roommate is sleeping; why can’t I?”), and catastrophic thinking (“If I don’t get eight hours’ sleep tonight, I’ll mess up that presentation tomorrow, lose my job, and die tired and alone”) don’t do us any good.
  • Don't go to bed at different hours every night. Go to bed at roughly the same time and get up at the same time every morning. This helps your body establish a regular sleep cycle.
  • Don't eat late in the evenings at all. Digestion is slowed when we sleep and often triggers indigestion etc. If you do have a snack, try foods with tryptophan in them like a bit of turkey and whole grain crackers, or a bit of nut butter or a banana.


Finding your personal sleep-time ritual
     A sleep ritual is a great way to develop a habit that cues your body and brain that it's time for sleep. About an hour before you want to turn in, engage in a routine or series of habits that promote sleep. A candlelit bath to relax the body and to reduce exposure to light is a good choice. Add a few drops of relaxing essential oils. Alternatively, sip a cup of chamomile or sleepy-time tea. Light a candle, read a bit or write in a journal. You could also focus on meditation or unwinding. If you have discomfort in the body that wakes you, some light stretches and yoga poses that induce relaxation can help you enjoy a more restful sleep. Never do any kind of strenuous exercise in the evenings though or it will keep you up.
     Sleep rituals induce relaxation in the body and mind, making it easier to sleep. It may take a bit of trial and error to find the right combination of strategies to obtain improved quality and increased quantity of sleep. Adapt your ritual to meet your needs, and rest well, friends.


References/Links for Further Information

http://hubpages.com/hub/How-to-Fall-Asleep-Fast-Remedies-for-Insomnia

http://www.health.com/health/gallery/0,,20306715_6,00.html


http://divinehealthfromtheinsideout.com/2012/07/adrenal-fatigue-trouble-falling-asleep-7-tips-to-better-sleep/

http://www.theurbanecolife.com/the-best-natural-sleep-remedies/

http://bembu.com/foods-high-in-magnesium

http://greatist.com/health/cant-sleep-advice-and-tips

http://sleepfoundation.org/sleep-disorders-problems/trauma-and-sleep

http://www.adaa.org/understanding-anxiety/posttraumatic-stress-disorder-ptsd/symptoms/sleep-problems

http://www.sleephealthfoundation.org.au/files/pdfs/Post-Traumatic-Stress-Disorder.pdf

http://www.medicalnewstoday.com/releases/163169.php