CPTSD And Sleep – What you need to know

What if the silent battlegrounds of the mind reveal tales of endurance and resilience? There lies a path to healing: Complex Post-Traumatic Stress Disorder (CPTSD) can blossom into resilience that can act as your supportive companion even in the aftermath of prolonged trauma.

Complex post-traumatic stress disorder (CPTSD) often occurs in individuals who have experienced long-duration and repeated trauma, such as childhood abuse, domestic violence, being a prisoner of war, or war and combat experiences.

In this article, we will be understanding the relation between “CPTSD and Sleep” and a few management techniques to handle such situations better next time.

What Is CPTSD?

Causes and Types of Complex PTSD:

> Childhood Abuse and Neglect:

Childhood abuse and neglect significantly contribute to the development of Complex PTSD. When a child experiences physical, emotional, or sexual abuse, or if they endure constant neglect, the foundational trust and sense of security necessary at an early age is disrupted and breached.

Example: Imagine a caregiver not fulfilling their responsibility nor providing the necessary emotional support or a safe environment for their children. They might grow up struggling with forming connections in one way or the other. However, those troubles in relationships are on the end and not like everyday day-to-day issues.

> Repetitive Trauma:

Exposure to repetitive traumas, such as ongoing domestic violence in households or long periods of war in a residing country or homeland, can lead to the development of complex symptoms. The cumulative impact of these traumas overwhelms the individual’s coping mechanisms, making it challenging to process and cope with the thoughts about these experiences.

Example: Consider an individual who has been in a war country before. The constant exposure to life-threatening situations and loss can create a cumulative traumatic effect. This person might develop symptoms of Complex PTSD, struggling with the emotional toll of their experiences.

> Victimization:

Ongoing victimization can have a severe impact on mental health, especially in adults. The sustained stress and threat to one’s safety may contribute to the development of Complex PTSD.

Example: Someone trapped in an emotionally abusive relationship is exposed to constant manipulation, gas-lighting, and psychological harm by their partner. Such toxic environments may lead to symptoms like hyper-vigilance, self-deprecating anxiety, and finding it difficult to trust others.

> Re-Experiencing Trauma:

Re-experiencing trauma is a hallmark of Complex PTSD and involves intrusive memories, flashbacks, and nightmares. These symptoms vividly bring back certain aspects of the traumatic event, making it feel as if the trauma is happening again.

Example: Imagine a survivor of a car accident. When they undergo near-like experiences of their trauma, they may experience intrusive memories of the crash, where the sights and sounds of the accident involuntarily flood their mind, causing intense distress.

> Avoidance:

Individuals with Complex PTSD often adopt avoidance strategies to cope with reminders of the trauma. It can manifest as actively avoiding people, places, or activities associated with the traumatic event.

Example: Consider someone who experienced a violent assault in a park. To cope, they might completely avoid going to any park or public spaces, attempting to run away from the anxiety and fear associated with the traumatic event.

> Changes in Beliefs and Relationships:

Complex PTSD can lead to significant changes in beliefs about oneself and others, affecting the formation and maintenance of relationships. Negative self-perception, difficulty trusting others, and distorted perceptions derived from toxic relationships are common in this category.

Example: Think of an individual who endured an abusive relationship. They may develop a negative self-perception, feeling unworthy of love or respect. Trusting others becomes challenging, as the betrayal from the abusive relationship distorts their view of people’s intentions.

Individuals must seek professional help for a comprehensive assessment and appropriate guidance before self-diagnosing themselves.

CPTSD and Sleep:

Causes and Risk Factors:

The causes of CPTSD and sleep disturbances are rooted in exposure to chronic trauma, which can dysregulate the body’s stress response system. Individuals with CPTSD may have heightened arousal levels, making it challenging for them to relax and achieve restful sleep. The risk factors include a history of prolonged abuse, neglect, or other traumatic experiences, particularly during developmental stages.

Distinction from General PTSD:

While both PTSD and CPTSD involve sleep disturbances, CPTSD is often associated with more pervasive and chronic issues. The prolonged nature of the trauma in CPTSD distinguishes it from the potentially isolated traumatic events that lead to PTSD, difficulty falling asleep, staying asleep, waking up at a specific and exact time of the day, or experiencing restful sleep.

• Insomnia: Prevalence and Symptoms:

Insomnia, characterized by difficulty falling or staying asleep, is a common disturbance in individuals with CPTSD and sleep. Symptoms may include persistent difficulty initiating or maintaining sleep, waking up too early, and experiencing recurring thoughts while trying to fall asleep.

Example: Someone who experienced long-term severe emotional abuse during childhood. They often lie awake with racing thoughts, finding it hard to quiet their mind, relax, and forget about those events.

• Nightmares and Night Terrors:

Night terrors, characterized by sudden awakenings with intense fear and physical symptoms such as rapid heart rate and sweating, may also occur. These sleep disturbances, such as nightmares, and vivid and distressing dreams are often related to the content of traumatic memories.

Example: Mark, who survived a traumatic event in his adolescence, frequently experiences nightmares where he relives the traumatic incident. These nightmares contribute to his sleep disturbances and daytime distress.

• Sleep-Related Anxiety and Hyper-Vigilance:

Sleep-related anxiety and hyper-vigilance involve heightened alertness and an increased state of arousal during sleep. Individuals with CPTSD may have difficulty feeling safe, even in their sleep, leading to a constant state of readiness for potential threats.

Example: Someone who experienced domestic violence over an extended period often wakes up in the middle of the night in a state of heightened anxiety. They may check their surroundings and listen for any signs of danger before being able to attempt to go back to sleep.

Coping Strategies and Therapeutic Approaches:

1. Self-CBT

CBT, or Cognitive Behavioral Therapy, is a powerful tool that can help improve CPTSD and sleep. By reshaping negative thoughts and behaviors, CBT addresses the underlying causes of sleep disturbances. The process involves identifying and challenging negative thoughts contributing to insomnia or poor sleep quality. Here’s how CBT helps improve sleep:

Identifying and Challenging Dysfunctional Beliefs:

• Process: CBT begins by identifying and challenging dysfunctional beliefs and attitudes that may worsen sleep quality. Individuals may hold negative thoughts about their ability to sleep or have unrealistic expectations about the consequences of poor sleep.
• Example: Challenging the belief that “I must get 8 hours of sleep every night, or the next day will be a disaster.” to “I would appreciate whatever amount of sleep I get to have.” would help tremendously.

Sleep Restriction Therapy:

• Process: Sleep restriction involves limiting the time spent in bed to the actual amount of time an individual typically sleeps. It helps consolidate sleep and improve sleep efficiency.
• Example: If someone typically sleeps for 6 hours a night but spends 8 hours in bed, they might initially restrict their time in bed to 6 hours and gradually adjust based on sleep improvements.

Stimulus Control:

• Process: Stimulus control helps break the association between the bed and activities that are not sleep-related. It encourages using the bed only for sleep and avoiding activities like using a phone or watching TV in bed.
• Example: Restricting activities in bed to sleep and intimate relations, avoiding stimulating activities.

Relaxation Techniques:

• Process: Incorporating relaxation techniques, such as progressive muscle relaxation or deep breathing exercises, to reduce anxiety and promote a calm state conducive to sleep.
• Example: Diaphragmatic breathing promotes relaxation before bedtime.

Establishing a Consistent Sleep Schedule:

• Process: Individuals should go to bed and wake up at the same time every day, even on weekends, to regulate the body’s internal clock.
• Example: Setting a regular bedtime and wake-up time, avoiding significant variations.

Monitoring and Journaling:

• Process: Keeping a sleep diary to track patterns, identify potential triggers, and monitor progress or calm your state of mind through journaling can help tremendously
• Example: Recording bedtime, wake-up time, sleep quality, and any relevant factors like caffeine intake or stressors.

Addressing Underlying Psychological Factors:

• Process: CBT may address underlying psychological factors contributing to sleep difficulties, such as stress, anxiety, or depression.
• Example: Integrating components of traditional CBT to address broader psychological issues affecting sleep.

Tips: Improving CPTSD AND SLEEP

1. Screen Time:

• Digital Limitation:: Set a specific time, ideally at least an hour before bedtime, to stop using electronic devices to improve CPTSD and sleep. The blue light emitted by screens can interfere with the production of the sleep hormone melatonin.

• Limit Stimulating Content: Avoid engaging in activities on screens that are mentally or emotionally stimulating close to bedtime. Look for calming activities such as reading a physical book or practicing relaxation techniques.

2. Establishing a Bedtime Routine:

• Consistent Bedtime: Set a consistent bedtime and wake-up time, even on weekends. It helps regulate your body’s internal clock, making it easier to fall asleep and wake up naturally.

• Wind-Down Activities: Engage in relaxing activities before bedtime, such as reading a book, taking a warm bath, or practicing gentle stretching. It signals to your body that it’s time to prepare for sleep.

• Limit Stimulants: Avoid consuming stimulants like caffeine or nicotine close to bedtime. Look for non-caffeinated herbal tea or warm milk if you enjoy a bedtime beverage.

• Create a Relaxing Atmosphere: Dim the lights in the hour leading up to bedtime. Create a calming environment in your bedroom with comfortable bedding and a cool, quiet, and dark room.

3. Creating a Safe and Calming Sleep Environment:

• Comfortable Mattress and Pillows: Invest in a comfortable mattress and pillows that provide proper support. Proper sleep surfaces can significantly impact sleep quality.

• Minimize Noise and Light: Use blackout curtains to block out external light, and consider closing your door to minimize disruptions from ambient noise from outside.

• De-clutter Your Bedroom: Create a clutter-free and organized sleep environment. A tidy space can contribute to a sense of calm and relaxation.

4. The Role of Social Support and Its Impact on Sleep Quality

• Communication and Connection: Maintain open communication with loved ones. Discussing concerns or sharing positive aspects of your day with someone you trust can help alleviate stress and promote emotional well-being.

• Bedtime with a Partner: Establish bedtime activities with a partner, such as reading together or talking about your day in-depth. Positive interactions before sleep can enhance feelings of security and connection.

• Emotional Support: If stress or anxiety is affecting your sleep, look forward to spending time with friends, family, or loved ones for emotional support. Having a support system can provide comfort and coping strategies.

Remember that individual preferences and needs vary, so it may take some experimentation to find the strategies that work best. Consistency is key, so aim to incorporate these tips into your routine gradually and make adjustments as needed. If sleep difficulties persist, it’s advisable to consult with a healthcare professional for personalized guidance and support.

Conclusion:

The constant state of hyperarousal and hypervigilance in CPTSD and sleep can significantly impede the ability to relax and attain restorative sleep. Insomnia, nightmares, and sleep-related anxiety become formidable challenges, perpetuating a cycle of exhaustion and heightened vulnerability to triggers. 

Approaches, such as Self-Cognitive-Behavioral Therapy (CBT), provide targeted interventions to improve sleep quality by addressing underlying psychological factors.

Open communication, establishing consistent bedtime routines, and creating safe sleep environments are crucial. Additionally, the role of social support cannot be overstated, as connecting with loved ones and seeking emotional support contribute to a sense of security and well-being.

FAQ: 

1. Is CPTSD hard to live with?
   Yes, living with Complex Post-Traumatic Stress Disorder (CPTSD) can be challenging. Individuals with CPTSD often face enduring symptoms resulting from prolonged trauma, including difficulties with emotional regulation, forming and maintaining relationships, and coping with day-to-day stressors. Although, with consistent efforts, it is very much possible to heal.
2. What are the signs of CPTSD?
   The signs of CPTSD can vary but often include re-experiencing trauma through intrusive memories or flashbacks, avoiding reminders of the trauma, negative changes in beliefs and feelings about oneself or others, challenges with emotional regulation, and difficulties with interpersonal relationships. Physical symptoms such as sleep disturbances, hyper-vigilance, and heightened startle response may also be present.
3. Is it possible to heal from C-PTSD?
   Yes, it is possible to heal from CPTSD, although the process varies for each individual. Seeking professional help, such as therapy (including approaches like Cognitive-Behavioral Therapy), and developing coping mechanisms can significantly contribute to the healing journey. While the impact of trauma may persist, many individuals with CPTSD experience substantial improvement and enhanced well-being with appropriate support.
4. How to improve sleep quality affected by C-PTSD?
   Improve CPTSD and sleep by establishing a consistent bedtime routine, creating a calming sleep environment, and addressing specific sleep disturbances through therapeutic interventions like Self-Cognitive-Behavioral Therapy. Managing screen time, practicing relaxation techniques, and seeking professional guidance are essential to enhancing sleep quality.
5. How do I calm down with CPTSD?
   Calming down with CPTSD involves employing various coping strategies. Techniques may include deep breathing exercises, staying mindful in the present, and engaging in soothing activities. Develop a toolkit of personalized coping mechanisms and seek support from loved ones.

Mental Health Help:

National Helplines:

• National Suicide Prevention Lifeline: 1-800-273-TALK (8255)
• Crisis Text Line: Text HOME to 741741
• SAMHSA’s National Helpline: 1-800-662-HELP (4357)

Online Resources:

• NAMI (National Alliance on Mental Illness): https://www.nami.org
• MentalHealth.gov: https://www.mentalhealth.gov

Local Resources

When looking for mental health support, it’s often best to start locally. Many communities have mental health clinics, hospitals, and community centres that offer counselling and therapy services. You can find these services by searching online directories, like Psychology Today’s Therapist Finder, which allows you to filter results by location, specialty, and insurance coverage. Additionally, your primary care doctor can be a valuable resource, as they can refer you to local mental health professionals or services that meet your needs.

How to Find Help

Finding the right mental health help can be overwhelming, but there are several ways to simplify the process:

1. Online Directories: Websites like Psychology Today, GoodTherapy, and Therapist Finder offer comprehensive directories of mental health professionals. These platforms let you search by location, issues treated, and insurance acceptance.
2. Health Insurance Providers: Your health insurance provider can give you a list of covered mental health services and providers, ensuring you receive care within your network.
3. Healthcare Providers: Don’t hesitate to speak with your primary care physician or a general practitioner. They can provide referrals to trusted mental health professionals or guide you on how to access the services you need.