Living with Insomnia: Building a Foundation for Restorative Sleep

Nov 28

By Renee Brush Ph.D.

I’m writing this to you the Monday after Thanksgiving weekend during a break at work and I’m exhausted. I spent my whole life as a “night owl,” staying up late and sleeping in late. Not just as a teenager, but even as an adult. It wasn’t until my late 40s that this became a big problem and I had to do something about it.

When I was married, I would try to go to bed at the same time as my then-husband. But, when I did, I would lay in bed wide awake, my mind racing, thinking of all the things I needed to get done. Or all the things I wanted to do in the future. Or all the things I regretted not doing in my past. My brain would not shut down.

I went back to graduate school during my second marriage and I found myself staying up late - like 3 or 4 am - trying to get all of my schoolwork done. I was also teaching as an adjunct professor at three local colleges and so I had a lot of work to do for my classes as well, either preparing for lectures or grading homework. There was always work to do. Despite that, I often didn’t get to work on these things until the evening.

Why? Honestly, part of it was to avoid the husband. PTSD is a severely isolating disorder, although I didn’t realize that I was dealing with that. But also, the performance anxiety I felt kept me paralyzed most of the day until I HAD to get something done. Plus, I probably perform better at night - at least at the time I was, since I stayed up so late at night. I wouldn’t go to bed until my work was done, even if it meant staying up until 4am. Most days, I didn’t have to get up early, so I could sleep in until 9 or 10. It became a habit.

Just like with a lot of other things I have shared with you, a lot of my understanding of how my abuse as a child affected my sleep habits began to make sense during my Somatic Experiencing training. Then I began to understand that I did not feel safe at night in bed. I was intentionally staying up so late so that I would be exhausted so I would literally crash into bed. Most nights I was asleep by the time my head hit the pillow.

Then one night - this was after I was divorced and realized how much harm my mom had done - I was lying in bed with my eyes closed and the lights on. I was waiting for my dog to join me in bed. My whole body tensed and the thought ran through my head: “Don’t open your eyes. She’s here.”

I have shared this story before, I’m sure. When I did open my eyes, I saw a vision of my mother when she was younger standing over my bed, looking very angry. I wasn’t scared in that moment, but I knew I had been scared as a child. I don’t know what she did back then and I don’t know how often. But I knew without a doubt I had been scared. And I instantly understood why I avoided going to bed my whole life.

The Importance of Sleep

Many of us don’t realize how important sleep is to the functioning of our bodies. I certainly didn’t. I remember in 2012 I was part of a medically supervised weight loss program and the doctor kept getting after me for my poor sleep. He talked about how my poor sleep was causing my body to be more inflamed and it was making it more difficult to lose weight. Not only were the tissues inflamed, but they were also retaining water.

Sleep is when our bodies work at healing itself (NINDS, 2023; Pace-Schott, Germain, & Milan, 2015). While we are asleep, the body works at repairing any damage done, such as removing toxins and water from the body. It is when our memories are stored by forming and maintaining the neural pathways in our brain. Without the proper amount of sleep, we will have more difficulty with paying attention, handling stress, and responding quickly. I’m not going to go into a lot of details about sleep, but you can refer to the article from NINDS (the link is in the references). Research says that we adults need about 7-9 hours of sleep to be healthy, but we will need to figure out individually how much we need. You can do this by seeing how much you sleep when you have not set an alarm (thus, waking up naturally) over the course of several days.

Understanding the Effects of Abuse on Sleep

Now that we understand how important sleep is, we can consider how trauma affects it. Knowing this can help us decide how we want to improve the way we sleep. Interesting enough, trauma has effects directly on the sleep, but also through its effects on the physiology of our bodies. Even more interesting - Pace-Schott et al. (2015) argued that disruptions in sleep are part of the cause for developing Posttraumatic Stress Disorder (PTSD).

People who have experienced trauma and abuse - diagnosed or not - have physiological changes to their bodies that ultimately affects how they sleep (Newsom & Dimitriu, 2023). Trauma and abuse leaves us feeling anxious and constantly on alert (we call this hypervigilance). As a result, our brain doesn’t shut off. Our central nervous systems (CNS) are then in a state of fight or flight. For people who experienced abuse as children, they may be constantly in this heightened state. In Somatic Experiencing, we called this “ constant global high activation” (or something like this). It just means the CNS never relaxes. It’s like our fire alarms are constantly on. And, if your CNS is constantly on, how are you going to go to sleep?

One of the most common ways sleep is disrupted is by not being able to fall asleep or to fall back to sleep if you wake up in the middle of the night. This is known as insomnia. Obviously, since this is what I titled this post, this is what I deal with the most. More severe trauma can lead to more severe sleep problems, especially for those of us who have childhood trauma. And, as I said before, if the trauma happened at night, it might make us more likely to avoid sleep. Many clients were awake at night as children because that is the only time they had any peace and now they can’t sleep at night.

Trauma and abuse can also affect the sleep cycles. As we sleep, there are several stages we go through, including light sleep, dream sleep (known as rapid eye movement or REM sleep), and deep sleep. Experts are not entirely sure how trauma affects the sleep cycles, but it seems REM sleep is affected the most. For example, one sleep disorder, known as REM sleep behavior disorder, causes people to move or cry out in their sleep (Pacheco & Rehman, 2023). This is unusual because our bodies are designed to be immobilized during REM so we don’t hurt ourselves. A similar disorder is night terrors, which is more common in kids but can occur at any age, which is when the person screams or cries out while sleeping. They are often very difficult to waken when this is going on and they usually don’t have any memory.

Of course, the other common problem with trauma is nightmares or distressing dreams. I don’t always have nightmares. I have what I call “shame dreams” - I dream that I’m doing something that is not good enough. Or I’m at my job but can’t remember what I’m supposed to be doing or how I do my job. My version of waking up naked at high school. The topic of the dream is thought to reflect the nature of the trauma (Newsom & Dimitriu, 2023), though not necessarily if you ask me. It is believed that this is the brain’s way of working through the trauma. Of course, it is not pleasant.

The Benefits of Prioritizing Sleep for Trauma Survivors

Obviously, in order for us to get healthy, we need to have better sleep. In their review of the literature, Pace-Schott et al. (2015) emphasize that healthy sleep is related to more stable emotion regulation. And we have discussed how getting enough sleep allows our body to repair itself, which also allows us to handle stress better. The same appears to be true for exercise. Thus, sleep, exercise, and emotional regulation all seem to affect each other bidirectionally. Plus, with enough sleep, we are able to think, learn, and remember better.

The fact that sleep helps to consolidate memory is key to Pace-Schott et al.’s (2015) argument that disrupted sleep causes and maintains PTSD. The analogy I used is that PTSD and complex trauma is like having your fire alarm constantly on. At our last house, the fire alarm went off anytime you opened the oven or cooked bacon. Nothing had to be burning. The alarm just went off. We were safe, but the alarm thought we were in danger. This is similar to when our brains are chronically hypervigilant - the brain thinks we are not safe, even when we are. It’s truly a FALSE alarm.

Pace-Schott and his co-authors (2015) argued that our brains cannot learn that we are safe after a traumatic event because of the disrupted sleep. We need sound sleep to consolidate the memory that we are now safe. Instead, we are focused more on the unsafety. For example, I am no longer around any one who hurts me - so I am safe - but I remain dissociated and/or anxious most of the time. And I have distressing dreams more often than not. My brain would need sound sleep to begin to consolidate the memory that “I am safe” and extinguish my fear response (meaning I need to unlearn this response).

This last research is new to me - and it solidifies for me why helping people with trauma get some good sleep is vital.

Steps to Establish Healthy Sleep Hygiene

Now that we have discussed why it is important to have good sleep, let’s look at the steps to take to make it happen. Many of my clients, including myself, have trouble figuring out how to make this happen. So, I have been building this list for some time.

Create a Relaxing Sleep Environment

First, you have to make your room into a “sleep sanctuary.” It has to be your safe place - more than any other place in your house. If you are like me and tend to have clutter in the house, make this the ONE place where there is no clutter. Keep it as neat as possible. Put up photos that you find relaxing and soothing. I chose the pictures for this page today based on their soothing nature. On my bedroom walls, I have pictures of landscapes that bring me joy and peace. My walls are a calm sage green color.

Consider the impact of light, temperature, and noise

Research shows that a quiet, dark, and cool room will help you sleep better at night. So, I have a fan that runs at night for the white noise, which also helps muffle the sound from outside. I have blackening curtains on the window so it is very dark in my room. I have a pink salt lamp which I can have on when I am feeling nervous or I can turn it on late at night when my dogs get up and I need to check on them. Also, I keep the temperature down at night.

Establish a Consistent Bedtime Routine

I recently purchased an Apple Watch to get better data on my sleep, since I have been actively working on having better sleep at night. I’ve tried out several sleep tracking apps and ALL of them talk about going to bed and waking at a consistent time. The science says that it helps with your circadian rhythm, which is the way your body regulates the sleep-wake cycle. Back when I first started trying to get to bed earlier, I set an alarm on my phone that said “Go to bed” when it went off. I didn’t always listen to it, but it was a start and eventually I did get into the habit of going to bed at a decent time.

One way to help you get ready for bed at a consistent time is to develop a calming routine before bed. This can be whatever you want it to be - reading or taking a bath. I like to have a hot cup of tea. I’m trying to build reading into my routine. I recently decided this could be the time when I read my Bible, especially since reading does help me feel sleepy. Once I’m in bed, I am in the habit of doing a meditation and listening to calming music.

Another thing sleep experts suggest is to make the bed for only two things: sleep and sex. Yes, I said it! The idea is very behavioral - you are training your brain to do either one of those things. But, if you are watching TV in bed, then you are training your brain to be awake, which is counterproductive.

Also, if you are lying in bed and can’t fall asleep, using that same behavioral thought just mentioned, you should NOT stay in bed. Lying in bed awake for hours again trains your brain to do just that - lie in bed awake. So, if you are still awake after 20 minutes, get up, sit somewhere else, and do something quiet, like read. Do this quiet thing until you are sleepy again and then you can go back to bed.

Avoid Stimulants and Unhealthy Habits

I hate to say it, but research also says that there are things we have to avoid in order to fall asleep easily. My doctor frequently reminds me to not drink caffeine after about 2pm and no alcohol three hours before bedtime. I’m not going to lie - the alcohol restriction sometimes gets in the way of keeping a consistent bedtime, but I’m working on that! Also, research suggests that using the phone before bed is not great, since the blue light it emits is like sunlight. So, it will tell your body it is time to wake up. When I had an android phone, it had a blue light filter, which was good. I used that, because pretty much everything - even my Bible and meditation apps - are on my phone. They do have the glasses with the blue light filters, so that is also an option.

Engage in Physical Activity

I know! I know! I hate it when my therapist or my doctor suggest this to me too. But hear me out…

Research consistently shows the link between exercise improving mood. A recent meta-analysis (which is an examination of a bunch of studies) found several good studies that suggested that exercise reduces PTSD symptoms, anxiety, and depression and leads to better sleep (McGranahan & O’Connor, 2021). Exercise can help you sleep better, fall asleep quicker, and wake up fewer times during the night (Pacheco & Singh, 2023).

But what exercise is the best? Interestingly, the answer seems to be based on what time you are working out. Pacheco and Singh (2023) suggest that aerobic or resistance exercise is best in the morning, high intensity exercise is best in the afternoon, and light resistance or aerobic exercise is best in the evening. According to the authors, there is a debate about when you should avoid intense exercise - with three hours being the key. But, this is apparently up for debate. And I think that some bedtime yoga or stretching may not be so bad. There have been times when I have tried to make that part of my routine - and I probably need to consider it again!

Managing Stress and Anxiety before Bedtime

I have talked several times about ways to reduce stress and anxiety, such as grounding, deep breathing, etc. Please refer to those posts to help for more tips on those. But, there are some particular techniques I wanted to mention related to sleep.

First, it is important to have self-compassion and self-acceptance. If good sleep at night is an issue and you have trauma in your history, you will have more luck at incorporating any techniques if you realize that this will be a work in progress. And, keep in mind that even rest is something, even if you don’t get good sleep. Being upset at yourself or your body because you didn’t sleep will not help anything.

The biggest help I have found is with meditation. I realize that many people have trouble with meditation. But I actually got my start with meditation doing guided sleep meditations. And I think this a great way to get started, since it offers a distraction to our thoughts. Two types of meditations that you might want to consider include sleep hypnosis or yoga nidra. Sleep hypnosis is exactly what it sounds like, but it’s different than what you. Might expect. The teacher is literally just making suggestions about sleep while guiding you through a relaxation strategy. This helped me create a sense of safety for myself when I was having the worst trouble with sleeping right around the same time I had that image of my mom. Yoga nidra is actually NOT yoga with the poses. It is a form of progressive muscle relaxation where the teacher is directing your attention to various parts of your body. Again, it distracts the mind and helps relax your mind and your body.

Another thing to consider is journaling at night. Either to write down your thoughts and feelings. You can write down what you are grateful about or what you did well that day. I like these ideas the best because it forces you to focus on what was good that day. The other way you can use journaling is to write down anything you didn’t get done for the day that you want to be sure you don’t forget for the next day. Like a mind dump. One of the scientific sleep apps I have used creates a mind dump journal and then reminds you about it in the morning so that you won’t lie in bed worrying about what you have forgotten!

Tips for Better Sleep During Triggers or Flashbacks

Some common problems people experience at night include being triggered or having nightmares. That sense of unsafety that I generally felt throughout my life is an example of the triggered. Now, when my clients have trouble sleeping, I have them explore what traumas happened at night. Also, the nightmares, even though they may be the way our brain processes events, can keep people from going to bed but then also keep them awake. Having grounding exercises that will help you feel safe will be important here. Also, you may consider weighted blankets or something else in the room to help you feel safe. Again, refer to my grounding post to help you with this.

It will be important to find a way to deal with the nightmares, if possible. Creating a sense of safety afterwards is important. But, another technique I love is to change the ending of a nightmare. This is something I learned when I was helping to edit a peer’s paper when we were in graduate school. If you can remember the dream when you wake up, you get to become the author of the ending of that dream. If someone is attacking you in the dream, who can come to your rescue? Maybe the police come. Or maybe someone calls the police for you. Or maybe you are able to fight back with Hulk-like strength and stop the person. It doesn’t matter what ending you choose - just choose an ending that helps you feel secure. Whatever you come up with will help your brain feel like the event has been resolved.

Seeking Professional Help

As usual, if you are having trouble resolving this on your own, it may be time to consult a healthcare professional or therapist for sleep-related issues. They can help you develop a personalized coping plan and even hold you accountable so they can help you tweak it. It might also be important to also talk to your medical doctor about sleep issues to make sure there is nothing physical going on.

Your primary care physical and/or your psychiatrist/medication provider can also help you decide if medication is appropriate. There are several types of medications that are available, both prescription and over-the-counter. Of course, the easiest might be something like melatonin or a Sleepy Time tea at night that has valerian or chamomile in it. With these though, you will want to check with your doctor or pharmacist to make sure it is not counteracting with any other prescription medications you might be taking.

For many of us with a history of trauma, sleep is incredibly difficult. I can attest that creating the required sense of safety takes time. Even when I was getting to sleep at a decent time, I was dealing with nightmares. That’s not to say don’t try - that is saying that it will take time and be patient!

I have given you a bunch of options to try. Please, don’t go crazy with making changes. Pick one or two things at a time that you feel like you can address and work on those for a month or two. Then, pick something else. Slow and steady wins the race is definitely the rule here!

I would love to hear what is working for you! Feel free to leave a comment below.

References

McGranahan, M. J., & O’Connor, P. J. (2021). Exercise training effects of sleep quality and symptoms of anxiety and depression in post-traumatic stress disorder: A systematic review and meta-analysis of randomized control studies. Mental Health and Physical Activity, 20. DOI:10.1016/j.mhpa.2021.100385

National Institute of Neurological Disorders and Stroke (2023). Brain Basics: Understanding Sleep. Retrieved from: https://www.ninds.nih.gov/health-information/public-education/brain-basics/brain-basics-understanding-sleep

Newsom, R., & Dimitriu, A. (2023). Trauma and sleep. Sleep Foundation. Retrieved from https://www.sleepfoundation.org/mental-health/trauma-and-sleep

Pace-Schott, E. F., Germain, A., & Milad, M. R., (2015). Sleep and REM sleep disturbance in the pathophysiology of PTSD: The role of extinction memory. Biology of Mood & Anxiety Disorders, 5:3. DOI: 10.1186/s13587-015-0018-9

Pacheco, D., & Rehman, A. (2023). Parasomnias: What they are, who they affect, their distinct types, and which treatments can help. Sleep Foundation. Retrieved from https://www.sleepfoundation.org/parasomnias

Pacheco, D., & Singh, A. (2023). Exercise and sleep. Sleep Foundation. Retrieved from https://www.sleepfoundation.org/physical-activity/exercise-and-sleep

Renee Brush