Wednesday, November 4, 2009
PTSD and Sleep
Sleep is complicated. PTSD can affect sleep habits in several different ways; most often, survivors of a traumatic event have problems falling asleep. A fact sheet by the National Center for PTSD lists several reasons for this, including hyperalertness, physical medical problems (e.g. chronic pain, stomach problems), intrusive worries and thoughts, drug or alcohol abuse, and nightmares.
For the first few months after my trauma, I became nocturnal because I was unable or afraid to sleep. Then I had an abrupt reversal and started to seek sleep to comfort myself, pass the time, and hide from the rest of the world. It has taken me over a year to reach a happy medium without the use of sleep-inducing medication.
(That was the short version of this post. The elaborated version is below.)
I've had a love-hate relationship with sleep since middle school, when I first got internet access at my house. I slept six hours a night in high school and the first two years of college. Then I transferred to my current college, met more people, met more people who stayed up later, and began to stay up much later myself. I had terms where three to four hours a night was normal and five was excellent. Then I had a term with weekly all-nighters, which happened to be when I was first starting to un-repress memories of an abusive relationship, and everything started to spiral downhill. When the incident happened in March of 2009, that was it-- sleep and I were officially at odds with each other.
It happened in the wee hours of the morning, around 5 AM. I stayed up until 8 AM talking about it to a friend, and I was finally so exhausted and worn out that I changed clothes, crawled into bed, and fell asleep for a few hours. It wasn't until the next night that the shock and exhaustion began to wear off and the PTSD symptoms started to set in. I was jumping at the slightest sound, coming to full alertness bordering on wild panic at every little movement or noise. When I tried to sleep that night, the plant on my windowsill rustled and I froze; after that, I couldn't calm down, so I had to leave my room and go downstairs to be in the light with people I knew and felt safe with.
My relationship with sleep became erratic. In the months before the incident, when I was already wading through murky and sometimes severe depression, I had begun to use sleeping as a method of fighting off severe depressive episodes-- my rationale was that if I couldn't be happy, I might as well be comfortable. I would huddle in my bed with my stuffed dog and stare at the wall or cry until I fell asleep. Things were usually better when I woke up two hours later.
However, after I was raped, nighttime terrified me. As my friends began to drift off in search of their beds around midnight or so, I busied myself making sure I had plenty of diversions for the night-- usually novels and movies to pass the time and keep myself entertained or at the very least occupied. Around 1 AM, I would turn on all the lights in my room and settle in for the quiet hours, as I called them. If I was well-prepared for the night, I actually enjoyed it-- there was something about the peacefulness of the seemingly endless night that soothed me. I felt like I could somehow stay this way forever and ward off the coming of the next day. When the sun finally came up around 7 AM, the vague notion of sleep would make its first pass through my mind, and I would finally allow myself to drift off between 7-9 AM. I would then wake up around 4-5 PM and pass the time playing spider solitaire on my laptop until a friend of mine (who was absolutely instrumental in taking care of me and to whom I absolutely owe my sanity) left work and came to find me.
I think my problems with sleep were inextricably linked to my disorientation and lost sense of time. For about three months after my rape, it felt like time had stopped completely for me. I'm not sure how to explain it-- I felt frozen, stuck in the moment, unable to move on with my life. After the first week, it became clear to me that everyone else's lives were still moving forward, and it was extremely disorienting to watch that while I myself was incapable of basic things like eating and sleeping. I honestly don't remember most of those three months. I remember certain specific events, like going to the police station and the hospital and meeting with my dean, and I remember one night when I watched Sense and Sensibility and read Crown Duel/Court Duel by Sherwood Smith, and actually felt completely content. Otherwise, I have no idea how I spent those three months. This would have been my senior spring, my last term as an undergraduate, and I don't remember how I spent most of it. I don't know where those three months of my life went.
My sleep schedule started to fix itself when I became closer to the friend I mentioned previously. We began to sleep together (platonically, just sleep) in the TV room downstairs. Since he had a job with normal hours, he had some semblance of a sleep schedule, and I kind of went along with it. It became a ritual to watch Star Trek then fall asleep. I think not sleeping alone helped a lot, because I could be comforted when I had nightmares or woke up tensed in fear of some unknown thing.
In May we started officially dating. I got a small part-time job for the summer in the afternoons everyday. I would wake up around 9:30 when he left for work, then go back to sleep until 1 PM, wake up, eat lunch, go to work, then meet back up with him at 5 PM. Sleep became less frightening and anxiety-ridden, and I soon grew to see it as comforting.
After a few especially severe depressive/suicidal episodes at the beginning of the summer, my therapist recommended that I see a psychiatrist about medication. She put me on Zoloft, and I suddenly started wanting to sleep 12+ hours a day. I'd come home from work and want to fall asleep right after dinner. Sometimes I would go to sleep at 8 PM or 9PM -- absolutely unheard of since early elementary school. In the fall I got a part-time job with more hours. I became obsessed with sleep, anxious that I wouldn't get enough, afraid that I would be tired the next day. I was convinced that sleep was The Most Important Thing In The World, the be-all-end-all of, well, everything.
Suddenly I started having a hard time falling asleep. Panicked, I got a prescription for Ambien from my psychiatrist. I took one pill religiously every night, my anxiety abated, and I was finally able to sleep. On hindsight, I see now that my trouble falling asleep was probably because I was so anxious about not being able to fall asleep. (Productive cycle, no?) I've always been pretty good about drifting off within a few minutes of my head hitting the pillow, so it wasn't actual biological insomnia; it was the fear of being tired the next day that caused me so much anxiety that I was unable to fall asleep. And so I turned to the idea of the little pill-- importantly, not necessarily the pill itself, just the idea of it-- to soothe myself and allow myself to fall asleep. I couldn't-- or wouldn't?-- sleep without taking the pill.
I took Ambien every night for almost a year. I had some notably terrifying nightmares, but oddly enough, none of the actual rape itself. I had one horrifically violent dream that I could not get out of my head for days, another that played like a movie with an acquaintance-rape scenario starring yours truly, but most of my nightmares were about the aftermath and people's harsh, hurtful reactions. Those I woke up sobbing to, countless times over the course of the year.
Finally, the moment I'd been waiting for came-- I was going to return to classes to finish what was left of my degree. Oddly enough, it was my parents who convinced me to try sleeping without Ambien, and through the most unexpected way: my mom told me about her college years and convinced me that college was more flexible than work, so I could sleep when I needed to. She told me that if I couldn't fall asleep at night, I could wake up and read or play games or amuse myself somehow, and sleep later during the day when I was tired. She finally impressed upon me that sleep was not the be-all-end-all of college, and so one night I tried sleeping without taking Ambien. Lo and behold-- it was exactly the same as sleeping with it. I had absolutely no problem falling asleep once I convinced myself that it was okay if I couldn't.
Since then sleep and I have reached a truce of sorts. I now try to sleep nine hours a night if I can (I usually end up getting six to seven and napping once during the day). I have been off Ambien since the beginning of the summer. I'm actually working on lowering the dosage of my SSRI too, so eventually I will be able to stand on my own two feet again without medication. Despite the complicated relationship I've had with sleep (yes, reference to Facebook silliness fully intended), we seem to be doing okay now.
And we plan to live happily ever after.