On Insomnia and Irregular Sleep Patterns or: Dissecting and Analyzing the Vicious Cycle of Sleep Deprivation and Chronic Fatigue

I’m writing this after another one of those nights that have become standard for me in decades. Repeat after me: In D.E.C.A.D.E.S.! First of all, I have to say that I’ve sobered myself from self-medicating via alcohol. There is no more drinking alcohol at home, let alone in the evenings. Second, I don’t have coffee later in the day. Third: I moderately work out, ideally outside and breathing fresh air (I live in a rural setting with nearby lakes, so breathing fresh air is in the picture). At the very least I’m going for a fast walk of about 90 mins. every day, no matter, what the weather. Fourth: When not succumbing to binge eating attacks – and I can’t even begin to go into the plethora of reasons for that -, I see to it my food intake is roughly along the lines of balanced and healthy. Well, in this last regard I haven’t been doing too well in the past months, but I haven’t given in to as many binges as before. I’m saying this in reference to known requirements for good sleep and I’m trying to make a point that I do my best to be disciplined enough to respect those requirements. Oh and last, I try not to eat meals or foods that are known for high energy output to the system, like high sugar or high carb foods or beverages. However, again I need to relativize in this last regard: Depending on whether or not I feel the need to have more energy available, e.g. when writing my blog, researching sources for it or otherwise “brainy” stuff, I may or may not fare well with regard to food and drinks. Alright, enough ado about the prerequisites, let’s cut to it:

Last night, when I had returned from my 90 mins. walk – in pouring rain this time and with temperatures barely above freezing – I noticed sleepiness setting in fairly quickly. As I hadn’t had more than 3 hours of sleep the night before, I gave myself permission to go to bed right away – at 9 pm, mind you. I really can’t remember the last time I went to bed at that time. Must have been in my childhood days. Anyway, I go to bed and fall asleep fairly quickly. In this context: I’ve managed to learn – to some extent – how to release fear of fear in a relatively short amount of time, so I get to fall asleep fast instead of tossing and turning for hours, like I did in recent years. To accomplish this, I use a combination of meditational/ambient music, which is known to have beneficial, healing effects on brainwaves along with a practice of autosuggestion that evokes a mild trance, thus reassuring myself of perfect safety. So anyways, I go to bed and manage to fall asleep – until about 11.30 pm, when the most subtle “noise” of softly creaking stairways must have woken me up as they usually do. Bang! A trigger went off in me and I’m wide awake! There is not even the most remote thought of going back to sleep from that situation! For non-affected readers, here’s another analogy to give you an idea: Think of travelling a foreign city with a group of fellow tourists. You’re on a tour through the old city, listening to the guide’s deliberations, enchanted by the sights and sounds, lost in thought for a minute and – the group have moved on without you noticing! And now you’re in the middle of somewhere, possibly not speaking the language, your group is out of sight, you don’t have a map and don’t know how to catch up with your group. Panic, right? That’s how it felt last night, that’s how it regularly feels when a trigger is set off in me or anyone suffering from the same or similar condition. Except, in the described situation you might manage to retrieve directions as to getting back to your group and get your heartrate back to normal. Not so with this condition as the triggering situation is something like an emotional replay of something in the past, where this thing in the past may or may not be a distinct memory. It gets worse, if the latter, that is: It’s not a distinct memory. Which is the case for me. Anyway. As I know the pattern and as I know I won’t be able to go back to sleep for another few hours, I get up and decide to hang out on the computer for a while. A while turns into four hours. In the past, getting up from being hypervigilant could have easily turned into a full blown middle of the night binge, but I’ve recently ordered myself to muster willpower in order to regain control over this. So I am happy to say that I did not give in to the mad craving of stuffing something down my throat, enjoying the sedating effect afterwards. Instead, I had a few cups of tea while surfing, reading and leaving random comments on Facebook and elsewhere. Finally, at around 3.30 am I give sleep another try and go back to bed. As I’m dead beat by now and as I can almost be certain that there won’t be any more disturbances, I fall asleep right away – usually until about 7.30 am, when my neighbour/landlady gets up. She is a very quiet, nice elderly lady with some sympathy for my needs, but I’m heartbroken to say that this doesn’t help. Any nearby utterance and I’m wide awake, sometimes waking from dreamless deep sleep states… I must admit that those moments are the hardest to bear. Can you imagine yourself getting repeatedly woken up from someone or something when your body is in the middle of being totally relaxed? Like, e.g. a snorting spouse? Well, sleep inertia explains how one feels then and I’ve come across sources – both online as well as personal testimonials – that state that sleep deprivation is one of many methods of torture. Aye – I can relate to the latter. It’s been like this for as long as I can think. In more than 30 years, I can think of ONE NIGHT that I’ve had really restful sleep: The afternoon and night following our arrival in San Francisco when joining my (ex-) wife for a business trip of hers and when we gave in to acute jetlag. Both of us meant to take a nap at around 4 pm local time – and we never woke up until about 8 am the next day! That’s sixteen straight hours of sleep and next to spending time with a loved one, this was one of the sweetest moments in my life ever!

Well, apart from my personal rant and the frustration of undergoing the ever-same recurring torture, both mentally, emotionally as well as physically, it doesn’t come as too big a surprise to me that the medical field lists some effects of sleep deprivation on the body and mind, most of them even beneficial in particular regard to treating depression and other so-called “mental” illnesses (I reject the term as non-accurate and derogatory). However, I remain very skeptical of their findings. In fact, contrary to what sleep research findings suggest, I challenge those by saying that chronic fatigue in individuals suffering from ptsd or c-ptsd is the outcome of a vicious cycle. And here’s how I arrive at this conclusion:

The wikipedia article on Slow-wave sleep says: “The highest arousal thresholds (i.e. difficulty of awakening, such as by a sound of a particular volume) are observed in deep sleep.” What’s important to me in this statement is the phrase in brackets: “… such as by a sound of a particular volume.” From my own experience that comprises above mentioned decades of very poor sleep, I’ve observed that the arousal threshold is typically significantly lowered. In other words: The slightest of sounds at even the most modest volume will wake me up. What is more, I don’t even suspect sound to be the reason for waking up, but the associated vibrations, even most subtle ones. The latter preliminary conclusion comes from connecting two known dots: In my previous living situation, I’d regularly suffer a full blown trigger to be followed by a more or less pronounced panic attack from the subtle vibrations of neighbours walking around in their flat above me. (And before you say, “move upstairs”: I’ve tried it all, i.e. top floor, middle floor, downstairs. I find downstairs to be the best bearable one, but ultimately, I will have to find a detached house for myself in order to remove the worst of triggers. The latter will prove to be difficult seeing as I depend on a very modest disability pension, where certain restrictions with regard to accommodation apply.) Every time I’d find myself waking up from non-REM (NREM) sleep states – which I infer from realizing that I didn’t awake from a dream and as dreaming typically happens during REM states -, I’d notice follow-up noises or utterances, like e.g. more steps across the wooden floors or the bathroom flush being operated a.s.o. a.s.f. I can’t know for certain, but I find it highly probable that the sequence is of this nature: I wake up from steps in neighbouring appartments, when they’re on their way to the bathroom and it is after that when I notice other noises. I’d also notice the grogginess associated with waking up from NREM sleep states called sleep inertia. The above mentioned wikipedia entry then states that “After sleep deprivation there is a sharp rebound of SWS, that is, the following bout of sleep will include more and deeper SWS than normal.” In theory, I’d have to add. Or rather: In individuals not suffering from PTSD spectrum disorders. Because, here’s where “we” branch off: As I’ve been woken up by noises and utterances that are known as triggers during wakefulness, I tentatively conclude that the body switches to hypervigilance by default after being awakened! The latter then acts as an inhibitor to the “sharp rebound” as the article says. The result: Going back to sleep is interrupted for hours, restful sleep has become more or less impossible on a regular basis and a profound exhaustion will establish over time that expresses itsself as chronic fatigue including all the associated symptoms, which have a striking overlap with symptoms associated with PTSD. Voilà, the vicious cycle has manifested! (And yes, I’m aware that a distinction needs to be made between PTSD and C-PTSD. However, I have come to experience and realize that both conditions share a set of symptoms on the physical level, which is my focus in this blog).

So, how can I or fellow sufferers break this pathological pattern? As for me, I’ve arrived at the firm insight that for starters relief can only come by removing even more of the worst of triggers, which means I have no other choice but to keep looking for a living situation that will allow for such relief, i.e. a detached small house with no direct neighbours inside the same building. This will sound outrageous and “demanding” to some, as I have to depend on social welfare and disability – to be factored in against each other, not on top – and as fairly rigid limitations apply. I prepare myself for legal battle with the authorities as a climate of social chilliness has spread fast within the past five to seven years in my country, largely dominated by an “air” of social darwinism. In other words: I not only perceive stigma typically associated with this disorder, I have to experience it. I guess, I should give myself a bit of credit for having thoroughly internalized the ongoing practice of resilience then, shouldn’t I…?

P.S. Sudden, random insight in the context of writing and researching this blog entry: I think I have just identified that I’ve been a survivor of both, PTSD and C-PTSD.

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