Three Common Sleep Issues for Trauma Survivors (and an effective treatment for nightmares!)

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Trauma survivors with and without DID often have sleep-related problems.  They are so common, in fact, that it leaves many providers wondering if disordered sleep should be a component of the next DSM diagnostic criteria.

I will leave that to the psychiatrists.  Today’s post is about sleep behaviors that scare adults with DID, and why they are really guideposts to a solution for better mental and physical health.

That’s right.

Scary sleep behaviors could be your brain’s way of getting your attention and pointing out how you can heal from trauma.

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  1.  Hypnic Jerks.  These are the sudden large-muscle movements that happen just before you fall asleep.  Good news:  they aren’t a sign of anything bad.  They are usually an indication that your brain is struggling to wind down.  Lower your caffeine, alcohol, nicotine, late-night exercise marathons, and work on getting more sleep.  To repeat:  they aren’t dangerous.
  2. Sleep Inertia:  This is the grogginess you can feel on awakening.  You might find it hard to move, speak, think, or pay attention.  It can last for a few minutes or over an hour.  This is also….normal!  In fact, the degree of sleep inertia you experience is mostly based on genetics.  It isn’t an indication of trauma or even sleep deprivation.  People with DID are so used to thinking of themselves as abnormal, and used to other people thinking that too, that it might come as a shock that this is 100% normal.  Recalculate how you see yourself.
  3. Sleep Paralysis:  OK, this one can be really scary for people with DID.  This can happen when falling asleep OR when waking, even in the middle of the night.  You can’t move, can’t talk, you may have what seem to be hallucinations, and you may experience a lot of fear from any of those things.  Good news!  This isn’t an indication of anything that you aren’t already aware of!  It is more common with people with trauma histories, people with insomnia, anxiety, panic attacks, and narcolepsy.  Building better sleep routines should decrease these episodes, even if you aren’t in therapy.

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What can you do?

Work on improving your sleep hygiene in ways that also support your system and make your waking life better.  Healing from DID means that you must communicate internally and be engaged with your system as much as you are capable of doing at this moment.  Don’t have any way to build connections inside but still want to sleep better?  You can still work on sleep skills, but you might hit a lot of resistance and make very slow progress compared to the effort you are putting in.

When you sleep better, you are more capable of dealing with everyday stress and with working in therapy.  You will be a better friend, partner, parent, and worker.  Life gets better, even if therapy isn’t going great or if you are still trying to find a good therapist.  Don’t take my word for it.  There is a bunch of research on the many types of mental issues that get better when sleep problems decrease.  Really.  The good kinds of studies:  peer-reviewed, double-blind; all that stuff.  Not on DID.  Sadly, DID ends up being exclusion criteria for a lot of studies.  But these have been done across a large number of diagnostic categories of mental illnesses, and for people who are really struggling in everyday life.

Do you have an issue with nightmares?

This is a very common problem for people with all forms of trauma, and there is a treatment for it!

No, not a drug.  There is no drug that will sedate you enough to get rid of nightmares.  None.

Imagery Rehearsal could work for you.  It is something you can learn and use.  If your nightmare is of being abused, you may have to try lucid dreaming techniques too.  The reason that many therapists have been told to avoid using Imagery Rehearsal with trauma survivors that dream about their abuse is (you already knew the answer)  they don’t know how to deal with dissociative responses.  And they don’t know how to teach stabilization techniques to people with DID so that they actually can use them at home.

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If you have brushed off practicing these techniques because you wanted to get into talking about the past or talking about your boss, you may want to rethink that decision.  When your sleep improves, you will have the energy to deal with jerks at work and the brain reserve to work on painful things too.  There is at least one research study that suggests that working on nightmares BEFORE you work on other sleep issues could give you the biggest boost in sleep quality.  But you have to be able to talk about and visualize your nightmares without severely dissociating and being unable to recover during your practice.

Your therapist can help you figure out if you are stable enough to work with Imagery Rehearsal techniques.  If not, there is good news (I know, you weren’t expecting that)!  Better sleep hygiene strategies improve the quality of your sleep.  Your brain will thank you by being calmer during sleep, reducing the nightmare frequency and intensity.  If you combine great sleep hygiene strategies with internal communication and daily stabilization techniques…you will get even better results from your sleep AND in therapy.  This is a win-win-win!!!

I will be getting certified as a sleep coach this spring.  My hope is that I can support the DID community to build this essential physical and mental health skill!

Need more information on managing life with DID?

I wrote a book on how to handle healthcare appointments and improve your ability to care for yourself!

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“Staying In The Room:  Managing Medical and Dental Care When You Have DID” is filled with practical strategies to get good care…and not need so much of it!  It is available as an affordable e-book or as a paperback on Amazon  .

Published by Cathy Collyer

I am a licensed occupational therapist and a licensed massage therapist, in private practice in the NYC area. I have over 25 years of professional experience in adult and pediatric treatment, with a focus on sensory processing issues and treating the consequences of complex trauma. I am the author of four books, including "Staying In The Room: Managing Medical And Dental Care When You Have DID" and "The Practical Guide To Toilet Training Your Child With Low Muscle Tone". Over the years I have lectured about trauma treatment and pediatric development.

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