Assessment Of Sleep Disturbances In Ptsd
Sleep disturbances can be screened and assessed with a clinical interview and objectified with other measures such as actigraphy and PSG. An actigraph and/or smartwatch can be helpful in detecting nightly arousals and limb movements, as well as daily rhythms in sleep and activity, and estimating sleep onset latency, total sleep time and sleep efficiency . PSG provides an accurate picture of multiple physiological parameters related to sleep and wakefulness. PSG is less suitable as a screening tool, because it is an elaborate measurement which might not be readily accessible and financially feasible.
For an accurate diagnosis of PTSD according to DSM-5 criteria , the Clinician Administered PTSD Scale can be used. It is a structured interview to diagnose current and life-time PTSD. However, the CAPS-5 is not sufficient for assessing the presence of sleep disorders, as it contains only two questions regarding sleep problems, considering nightmares and sleep disturbance in general. Diagnoses of sleep disorders are easily missed if specific diagnostic criteria are not inquired about. Therefore an accurate clinical assessment according to the International Classification of Sleep Disorders 3 of sleep history, present sleep quality, sleep-wake behavior and screening for sleep disorders is essential.
Tip : Support Treatment
Despite the importance of your love and support, it isnt always enough. Many people who have been traumatized need professional PTSD therapy. But bringing it up can be touchy. Think about how youd feel if someone suggested that you needed therapy.
Wait for the right time to raise your concerns. Dont bring it up when youre arguing or in the middle of a crisis. Also, be careful with your language. Avoid anything that implies that your loved one is crazy. Frame it in a positive, practical light: treatment is a way to learn new skills that can be used to handle a wide variety of PTSD-related challenges.
Emphasize the benefits. For example, therapy can help them become more independent and in control. Or it can help reduce the anxiety and avoidance that is keeping them from doing the things they want to do.
Focus on specific problems. If your loved one shuts down when you talk about PTSD or counseling, focus instead on how treatment can help with specific issues like anger management, anxiety, or concentration and memory problems.
Acknowledge the hassles and limitations of therapy. For example, you could say, I know that therapy isnt a quick or magical cure, and it may take a while to find the right therapist. But even if it helps a little, it will be worth it.
Encourage your loved one to join a support group. Getting involved with others who have gone through similar traumatic experiences can help some people with PTSD feel less damaged and alone.
Try To Relax If You Cant Sleep
If you cant sleep, focus on relaxing instead. You might get out of bed and engage in quiet reading on the sofa until you feel ready for sleep. Avoid watching television or using electronics in this situation because this could make it even more difficult to sleep. Try focused relaxation to get your body ready to sleep. Imagine yourself in a peaceful setting, thinking about specific details that make you feel relaxed.
Childhood Trauma And Sleep
Childhood trauma can continue to impact a persons health long after childhood has ended. The CDC-Kaiser ACE Study investigated the impact of childhood traumas, called adverse childhood experiences , on the lives of 17,000 adult participants. This landmark study found that ACEs increase the risk of mental and physical health problems later in life, including depression, anxiety, heart disease, and even early death.
One way in which childhood trauma increases the risk of diseases later in life may be through the development and adverse effects of sleep problems. Up to one half of children show some of the symptoms of PTSD after trauma, including hyperarousal and trouble sleeping. Trauma can have a significant impact on childhood brain development, so sleep problems may persist or get worse as the child progresses through adolescence and into adulthood.
Compared to adults with few or no ACEs, adults with a significant amount of childhood trauma are more than twice as likely to have trouble falling asleep and are also twice as likely to feel tired after a full nights sleep. The effects of ACEs on sleep can last for up to 50 years, with each ACE experienced in childhood increasing the risk of not getting enough sleep as an adult by 20%.
Educate Yourself On Ptsd
This condition tends to be misunderstood, and theres often a stigma attached to it. If you have a friend who is struggling with PTSD, start by learning about it. Learn not only the symptoms but also learn about how it can make people feel and the emotional experience that can come with PTSD.
Learning about PTSD and gaining PTSD education can help you be more understanding and empathetic, and can also clear up misconceptions you might have.
When you learn more about PTSD, youll see that most peoples experiences arent like what you see in popular culture. The symptoms and the effects of PTSD can be more subtle and less overt, but no less difficult for the person experiencing them.
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Tips For Helping Someone With Ptsd
When it comes to helping someone with PTSD, it can feel overwhelming. It is a serious disorder that can have a significant impact on a persons life. Its not up to you as a friend or loved one to try and cure someone with PTSD or force them to get help.
What you can do is take positive steps to show them you care and that you support them. You can also encourage them to seek treatment or find online support through teletherapy, although its ultimately up to that person whether or not they do. Here are nine different ways you can help a loved one with PTSD.
Night Terrors Or Arousals
If the patient has night terror-induced arousals, the bedpartner can sooth the patient with a soft and low voice, directing him/her back to bed and to sleep. Do not force awakening, ensure safety and trust that the patient will have no recollection of the event. If the arousals occur often and generally at the same time of the night it can be helpful to awaken the patient 1530 mins before the expected arousal to prevent its occurrence .
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How Sleep Problems Relate To Ptsd
Sleep is tied to memory. It helps pull together and make sense of memoriesspecifically emotional memoriesand fits new memories into existing ones. So among other things, a person needs sleep in order to sort out and process a traumatic event.
Sleep is also important for learning. And one important step in recovering from a trauma is to learn reminders of a traumatic event are not dangerous and you can feel safe again. So it makes sense that reduced quality of sleep is a risk factor for PTSD.
However, research results regarding the relationship between PTSD and sleep problems are inconsistent: While some studies have shown improvement in PTSD symptoms after insomnia treatment, other studies have found the opposite: Treatment for insomnia doesnt necessarily result in PTSD improvement. Its unclear at this point whether effective treatment for sleep problems also can address PTSD symptoms.
Create A Sense Of Safety
Stability is deeply important for veteransstruggling with PTSD. While you cannot always drop everything at a momentsnotice, you should take care to be a consistent, steady presence in your lovedones life.
Respect the veterans privacy and understand that everyone has their own timing for recovery. Treat everything your loved one tells you as entirely confidential.
Encourage Specialized PTSD Treatment
If your loved one has not already sought andenrolled in specialized treatment for PTSD in veterans, encourage them to doso. This can help minimize the symptoms of PTSD but also reduce the long-termrisk of developing additional mental-health conditions and symptoms.
Do some research into the different treatment options for PTSD in veterans. This will not only help you understand what your loved one is experiencing, but also help you understand how to communicate with them.
Some of the different PTSD treatments forveterans and military members include:
- Medication, such as anti-anxiety medication or antidepressants
- Counseling and talk therapy, either one-on-one or in the form of group therapy, which take many forms:
Self Care for Family & Loved Ones
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Disorders Stemming From Trauma
In addition to experiencing short-term side effects of traumatic experiences like those described above, there are also psychological disorders that can affect victims long after the initial traumatic event. While many trauma victims will experience initial anxiety and fearfulness post-trauma, many will recover from those feelings and go back to their daily routines with a sense of normalcy. However, there are some people who will continue to have those feelings and flashbacks to the traumatic event, and develop disorders stemming from those feelings.
Another common disorder that trauma victims may experience is acute stress disorder . In acute stress disorder, people who have experienced a trauma recently may have flashbacks to the event, avoid situations that remind them of the trauma, and have heightened fears or awareness of their surroundings. While this may sound strikingly similar to PTSD, the symptoms for ASD begin within 4 weeks after the traumatic event and resolve after no more than a month. If symptoms last longer than a month, ASD may evolve into PTSD.
The Role Of Dissociation In Surviving Childhood Abuse
Both cognitive behavioral therapy and EMDR have been established as being effective and are recommended as first-line treatment for PTSD .
Medications are often used to treat symptoms of posttraumatic stress disorder, including problems with sleep such as insomnia and nightmares. The FDA has approved both sertraline and paroxetine treatment of PTSD. These medications are used to treat depression, anxiety, concentration problems, and insomnia. Anti-anxiety medications can be used to help patients manage anxiety symptoms but have significant dependency liability and should only be used briefly. Prazosin is a medication that is sometimes used to help control PTSD related nightmares.
I will briefly mention two additional treatment approaches that are under active investigation and have often been used illicitly by people suffering from PTSD to manage their symptoms. In both Vietnam and in our wars in the Middle East soldiers have utilized cannabis both in the field and when returning to home to manage symptoms of PTSD. In fact, veterans groups have been very active in advocating for research into the potential benefit of cannabis for treatment of PTSD. The Multidisciplinary Association for Psychedelic Studies has been a leader in this effort and information about their proposed study is available online. After years of effort the DEA has recently agreed to allow this research to move forward.
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Causes Symptoms And Risks
PTSD is caused by experiencing or witnessing single, repeated or multiple events. For example:
- serious accidents
- physical and sexual assault abuse. This could include childhood or domestic abuse
- work-related exposure to trauma. Such as being in the army
- trauma related to serious health problems or childbirth
- war and conflict torture
Not everyone who experiences trauma will develop PTSD.
The risk of getting PTSD depends on how the experience affects you. PTSD is more likely to develop if the traumatic event:
- is unexpected,
- Self help
How can the NHS help me?
You can speak to your GP about your concerns. They will be able to talk to you about treatment options and coping strategies. You dont have to do what your GP thinks that you should do. But you should listen to them.
Make sure that you understand the pros and cons of your treatment options before you make a decision.
Your treatment with be managed by your GP or the community mental health team . In some cases, your treatment maybe shared between both primary and secondary care. Healthcare professionals will agree who will monitor you.
Some people will get care under the Care Programme Approach . This means that you will have a care plan and care coordinator to make sure that you get the support that you need.
Look at the following section for more information on NHS treatment.
Adult social services
What other help is available?
There may be a different service available, such as employment or isolation support.
Take Control Of Your Night
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. Its 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 doesnt 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 nights sleep.
Help For Veterans With Ptsd
If youre helping a veteran with PTSD, the above tips are all important, but there may be additional considerations. For example, if your loved one got PTSD due to being in a combat zone, you may wish to learn more about the effect that being in a combat zone has on a person. The effects of war on a person is the focus of this section at the National Center for PTSD: War.
You should also know that the VA offers a lot of help for veterans with PTSD. Veterans should see their local Vet Center for help or call the Veterans Crisis Line by calling 1-800-273-8255, and pressing 1.
APA ReferenceTracy, N. . How to Help Someone with PTSD, HealthyPlace. Retrieved on 2022, August 15 from https://www.healthyplace.com/ptsd-and-stress-disorders/ptsd/how-to-help-someone-with-ptsd
Exposure Rescripting And Relaxation Therapy
Variants of imagery rescripting interventions have been developed since the late 1970s for the treatment of idiopathic nightmares. The exposure, relaxation, and rescripting therapy involves psychoeducation about sleep and nightmares, relaxation, sleep hygiene, exposure, and nightmare rescripting.40 While IRT focuses on changing the nightmares by building imagery skills, the exposure element of the ERRT protocol requires individuals to write down their target nightmare and read it aloud so that the event evokes an affect similar to that experienced in the presence of the actual stimulus. The exposure element offers the opportunity for the subject to face the fear in a safe place and habituate to the anxiety.
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Other Resources For Ptsd
- REM Sleep Disturbances and PTSD: Patients with a PTSD diagnosis may also experience disturbed or reduced amounts of REM sleep, which may make symptoms worse.
- Post-Traumatic Stress Disorder: Persistent thoughts and memories are hallmarks of PTSD, and these thoughts often bother people during both the daytime and nighttime hours.
- Post-Traumatic Stress Disorder Treatment: Treatment of PTSD usually involves psychotherapy and prescription medication to relieve depression and anxiety.
Dr Elissa Mccarthy Explains Why Sleep Is Important
Poor sleep may lead to:
- Slow reaction time
- Trouble with learning and memory
- Feeling irritable and mood problems
- Trouble with thinking and concentration
- Thinking about suicide or acting in ways that self-harm
Also, sleep problems that last a long time are related to medical problems such as heart disease, depression, kidney disease, high blood pressure, diabetes, obesity and stroke.
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Ptsd And Sleep Problems: A Double Whammy
Sleep problems and post-traumatic stress disorder are two common difficulties experienced by Service Members. They can share a complicated relationship, so for those experiencing or at risk for this double whammy, as well as for those treating patients, its important to understand how they can influence each other in a cycle. In a series of 4 articles, beginning with this one, guest experts explore the connection between PTSD and sleep, examine the different ways to approach treatment, introduce evidence-based therapies available for both PTSD and insomnia, and explore the connection between trauma and nightmares.
Ptsd Is A Very Real Illness
PTSD is a debilitating anxiety disorder that occurs after a traumatic event, like war combat. Experts estimate 8 million adults have PTSD to varying degrees each year in the United States. Like depression or other mental and behavioral issues, its not something that a person can snap out of.
Symptoms arise anywhere from three months to years after the triggering event. In order to be characterized as PTSD, the person must exhibit these traits:
- At least one re-experiencing symptom . D. installed security cameras in his home to monitor threats and had terrible nightmares.
- At least one avoidance symptom. D. didnt like crowds and would avoid activities that included a lot of people.
- At least two arousal and reactivity symptoms. D. had a very short fuse and would get frustrated easily when he wasnt understood.
- At least two cognition and mood symptoms, which includes negative self-esteem, guilt, or blame. D. would often say to me, Why do you love me? I dont see what you see.
D. once described his PTSD to me like a constant waiting game for ghosts to jump from around the corner. It was a reminder that bad things happened, and that that feeling might never stop. Loud noises made it worse, like thunder, fireworks, or truck backfire.
There was a time we sat outside watching fireworks, and he held my hand until my knuckles turned white, telling me the only way he could sit through them was to have me next to him.
He also had explosive outbursts of rage, which left me in tears.
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