Sleep 2.0 – On Fatigue, Depression and How It Relates to (C-) PTSD

Watched a documentary on sleep research tonight. The link points to a show in German, but I’m sure it’s syndicated from something on Discovery Channel or something. So I have to ask you to dig deep(er) for yourself for an English version of the show. Anyway, here’s the gist of things: The entire show confirmed everything I’ve empirically experienced and analyzed over the past years. Bottomline: Sleep is an essential basic need. As such, it’s non-negotiable, as in: You’ve got to have enough restorative sleep. Period. Even a healthy person does. As soon as sleep deprivation occurs – the reasons are manifold, sleep apnea due to e.g. being overweighed is one -, health and normal functioning deteriorate – and very quickly so!

In the past years, I’ve done a lot of reading and experimenting in regards to improving my overall health situation. That is, after – and even before – I got my diagnosis of (C-) PTSD. I sank my teeth into getting better, into healing, into recovering as much as possible. (Luckily I now know that it can absolutely be done, as amongst others, like. e.g. Amber Lyon, Michele Rosenthal says on her blog and in her upcoming book). That’s the good news.

The other news and aspect I’ve only recently identified as an absolute must-have is healthy sleep. The documentary made this crystal-clear – not only to me. You see, with PTSD and the nightmares and flashbacks and hypervigilance as some of the most pressing symptoms, sleep is a “scarce commodity” as Michele Rosenthal says in her blog entry. And according to above mentioned and linked documentary, sleep deprivation alone brings on a lot of dysfunction like microsleep in your waking hours – which is among the highest ranking reasons for fatal car accidents, b.t.w. and which is also mentioned in the international handbook of war, torture and terrorism as a basic method of torturing detainees….  -, mood swings and – depression. You heard that right: Only a few nights of insufficient sleep increase the risk for developing depression in its aftermath by a factor of 5 to one! (It’s even higher for children and another overlooked side effect is for them to be falsely diagnosed with ADHD – because children become hyperactive from lack of sleep).

Why would I go at lengths of writing a blog about this? You see, in trying to sort out the symptoms that made my life a living hell at times and in making an attempt of tracking them back to their potential cause one by one and then eliminating that cause if possible, I often arrived at the seemingly insurmountable conundrum of fatigue and depression. In simple words: Which came first? Fatigue or depression? Was I feeling tired because the physical aspects of depression had their grip on me? Or was I being depressed because I never found good sleep? Which was it? Which was I supposed to target first?

Above mentioned show seems to have given a very clear answer: (Good) Sleep can’t be rated highly enough! And since the documentary also made a strong point about the correlation of sleep and eating habits, lack of sleep sets off a cascade of other symptoms often manifesting so-called co-morbidities like e.g. eating disorders. To be more specific: If you’re feeling fatigued, chances are you develop food cravings for not exactly healthy foods (like fatty, sugary ones, often resulting in diabetes type II ). There’s also a tendency to binge-eat (overeat) on those foods as you’re dying to replenish your personal energy level. I can personally attest to this vicious cycle totally kicking in if I haven’t gotten enough sleep: The brain’s signals for being hungry are all out of bounds and have you hungry almost all day. When you do eat, the perceived prior craving often results in totally overeating (binge eating) as the consumption of fatty and sugary foods sets of a surge of dopamine in the brain (the “reward” neurotransmitter), which then counters the feeling of being depressed from perceived low energy. And sure enough, eating too much at inappropriate times – ruins your sleep, of course! I had almost arrived at this insight from simply observing myself. And now there’s total affirmation on all these interdependencies from researchers!

So, in closing, my personal conclusing for starting the healing process from (C-) PTSD is this: Make it your top priority to find enough restorative, healthy sleep! (ideally 8 hours, 7 at the very least according to the documentary). You are going to feel totally self-empowered per se after waking up from a good night’s sleep! How do you do that? Move to a quieter place, if you have to. Find CDs, radio channels or recordings with relaxing, meditative music (spoken words or mantras are counterproductive from my experience – make sure, it’s instrumental music only, such as ambient, meditative, sleep inducing music. For some, binaureal beats may work – but maybe only until some time further into the process. And use with caution! If you have e.g. ever suffered from epilepsy or suffered a stroke, binaureal beats may trigger those – ask your doctor first in this case!). Make time for being outdoors as much and as often as you can! (Depending on your personal shape and considering other conditions, I’d suggest a medium- to fast-paced walk for some 30 mins. during your lunch-break and after having had a small, healthy meal; add another 30-60 mins. of moderate workout after work – not in a gym, but outdoors in a park or something! Get appropriate clothing if you have to. Nothing beats working out in a natural environment and a walk does wonders to your body and your psyche!).

Also, see Michele’s blog on nutrition and what works (better) for individuals recovering from (C-)PTSD and what are the “no-no’s” in regards to that. (I’m still working on that… 😉 )

However, the most important thing to keep in mind is this – and I owe it to Michele’s work and the many kind supporters and co-travellers along the way: You can eliminate PTSD-symptoms 100% and you can have a rewarding, meaningful, successful life! (In my darkest hours, I never thought I’d stand a chance to get there. I’m glad I didn’t fold then, because now I know there are people who managed to totally overcome and heal their PTSD).

Another thing: You are strong! If you weren’t – you wouldn’t be here anymore…

P.S. I should mention that I have managed to sleep quite a bit as of late. Eversince I do, I have not experienced depression. Sadness sometimes, maybe, mostly from feeling isolated, but not depression, which I can safely tell apart from other states of mind and heart by now.

P.P.S. This comes with a strong prior trigger warning! However, if you’re a sceptic (like me), you may find it beneficial to read about Amber Lyon’s complete recovery from severe PTSD!

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Self-Empowerment and … Common Sense?

Now that I’ve recovered from the worst outcomes of all that medication (antibiotics) they gave me at the hospital, I seem to find that I’m different from before. I feel stronger. Restored. A little proud. I have overcome one of the worst fears I ever had. This experience restored my self confidence, at least in part. I can do it. I can rise above whatever fear there is. I have done it before, when I had a life, a career, a wife, friends and the freedom to go whereever I wanted to go and do whatever I wanted to do – within the boundaries of our societies, of course. I had empowered myself beyond that ingrained role of the victim and I had been standing on my own feet, providing for myself and later for our small household. I can’t think of anything more powerful along the lines of recovery from trauma and abuse than finding the strength to overcome all these debilitating fears. So I can in part relax and depend on my ability to do this, to rise above. As far as keeping my demons in check, I feel sufficiently equipped to deal with them again. And from all the many failed experiences with therapists and psychotherapy at large, I a) am not comfortable to open up and trust again, to put it mildly, and b) don’t think that there is all that much new information that I haven’t heard, read or otherwise learnt and hadn’t applied all along. In fact – I must have found ways of coping all along, or else I wouldn’t have been able to work or go about life like I did. I may not have had the highest degree of self esteem then, true, and this is what stabbed me in the back in the long run. But I’m different now. I am not ready to take shit from anyone any more! Which is another reason why psychotherapy might not work out for me all that well. I get the feeling I have become “therapy intolerant” of sorts. After all, why would I listen to someone who has – likely – never been to any of the experiences I went through? Who are they to dole out advice? Exactly what quality puts them in a position of telling me anything – in particular, when their knowledge is second-hand? And abstract? Also, I need to feel in control of things – and I am fully aware that having become this OCDed control-freak is a result of the abuse that went on in my later childhood years. I rather see shit coming my way, even if it’s the worst kind of shit – than be “surprised” by it. That hadn’t worked out too well earlier, so chances are it might not end well again. So, I much rather do things on my own again.

However…. (you saw it coming, right? ;-)) – there is still the physical side of things – the body, which never forgets – and mercilessly so. Like for example tonight: On most nights, I stay upstairs and sleep on the couch (only about 30 inches wide), because it’s a tiny bit further removed from where my landlady moves and walks around, like in the mornings, when she is probably using the bathroom one floor above me and the kitchen, both not directly above my modest living room, which softens some of the noises and vibrations – that’s the only reason I mention it, I’m not intentionally “spying” on her or anything). This way, I wake up, but not as hard as in the bedroom, which is in her part of the building and closer to the stairwell. When I’m in the basement, the tiniest of noises wakes me up – and brutally so, as my body goes into a minor shock. I’ve talked about the manifold triggers I respond to and this is one of them. It’s agonizing. It’s torture. It’s brutal. Because once my body has gone into this mode of being alarmed, there is no thinking of going back to sleep any time soon (don’t ask what it was like in the other place, where I lived before, when Mr. Neighbour came home late or got up for bathroom breaks – I’d wake up several times per night and it often took me no less than an hour to snooze off again). Last night I decided to sleep downstairs, where there is a real bed, which I sleep more comfortably in. Also, the mosquitos have been very aggressive here since the major flooding in my country a couple of weeks ago. It’s basically impossible to keep them out, although there are mosquito nets in the windows. So I chose for more comfortable sleep downstairs (took me months to use that room at all given my residual vulnerability to the tiniest of triggers). As I enjoy the quietude of the late evenings, when she has gone to sleep – usually around 9.30 p.m. or 10.00-ish on her part – and as these are the only times I feel all by myself and having some privacy, I returned to a cycle of staying up late(r) and sleeping in. So I went to bed at 1.30 a.m. hoping to get to sleep until 9.30. At 5.50 am I woke up for the first time, went to the bathroom and returned to bed. At around 7 a.m. I wake up again and decide to go upstairs, hoping to snooze for another hour or two. She must have left shortly afterwards as I managed to fall asleep even without meditiation music, which I usually use to be more comfortable and in order to feel safe. I then speak my mantra and usually fall asleep quickly. So now at 7 a.m. I come back upstairs, place myself on the couch and snooze off for a bit. I must have fallen asleep pretty deeply, as I almost overheard the alarm set for 10.00 a.m. There were some dreams, but they were not as vivid and easy to recall as usual. The entire point being: I woke up being toast. Technically and telling from the sum total of hours, I had had more than enough sleep. But it was poor sleep that wasn’t refreshing at all. It’s a little better, when I sleep on the couch, but not really refreshing, either. When I think of it, I can’t think of any time in my adult life that I’ve slept well – except for those times, when I was a touring musician and fell right into a “coma” from being overworked and overexhausted on some nights.

So poor sleep is only because of my body responding brutally to the most delicate of noises or vibrations. This surely is the physically ingrained pattern that must have gotten triggered in my earliest stages of infancy at the hospital. I can imagine that they often woke me up and probably made me subject to painful or otherwise disturbing examinations or otherwise unpleasant, disconcerting physical contact. And my body kept the score of those experiences – to this day. This is a residual huge problem. It is so taxing on my body that I just don’t see how I can ever get to a healthy cycle of eating and sleeping. On most days, I’m too fatigued to go about much physical activity, like riding my bike or even simple household chores. When I force myself to do something, I often overeat in order to feel “energized”. Depending on the amount of overeating, I sometimes then feel too bad to do something at all, which sends me down a tailspin of self-loathing followed by a bout of depression. To break free from this vicious cycle, I need to sleep better! And the latter never happened. Nor is it likely to happen given the current state of things. I don’t have too much confidence in hypno therapy working at this deep a level that my body “forgets” the early ingrained pattern. According to Schore’s article it never does, but there seems to be other scientific findings that roll her conclusion back to an extent. Or modulate it. But I’m not too optimistic, frankly speaking.

Other than that, I’d rather return to a place of “sucking it up” and just trying to blend in as well as possible and becoming rather aggressive with some of my deficiencies I have no way of further squaring away. The physical situation is brutal though. There is no better word for that. Also, I have decided to look for a different place to live in. I simply don’t get the privacy here that I seem to need. The physical proximity with my landlady living this close is anything between annoying to plain petrifying me. It’s not her fault, either. I know it’s me. This was an experiment of sorts: To see, whether I might adapt to such a situation. The experiment failed. I haven’t adapted to it to a degree, where I feel comfortable in my skin. So … trying to find something else – and better suited given my vulnerabilities – has become a top priority again. Feels like I’ve been running for my entire – effin’ – life. “Ugh” don’t even cut it…

P.S. LMDAO! Just found this. That pretty much puts everything in a nutshell 😉

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How Comorbidities Manifest – Tentative Findings

A Warning: This article may retrigger some of you in substantial ways. Read at your own risk and discretion. It deals with tracking down my personal set of symptoms of C-PTSD and comorbidities coming from that. You may find it helpful, but at the expense of getting triggered.

update: I’ve attached my own tentative approach to findings about initially experienced trauma and its fairly complex set of outcomes as a kind of “trauma map” along with primary and secondary outcomes (comorbidities). A picture is said to say more than 1,000 words… well, hopefully it does.

Last night I went for another musical night out downtown. There is a monthly open stage night, which I try to set money aside for from the very meager monthly budget I have been depending on since around 2009-ish. For those of you not familiar with the music scene: An open stage or open mic night is usually commenced by some kind of “house band” regularly performing in the venue, while visiting musicians get to sit in upon the second set of music. If there is enough variety in terms of instruments, sometimes complete new ad hoc bands form for a set or two. I like that particular venue, where this happens for the musicians there, the nice staff, the convenient location, which is not exactly at the heart of the city, so I can find parking easily (or take the train, when feeling up to it). More than anything, I like the kind of music being performed along with the appreciative audience. Although I’m still feeling pretty weak from the after effects of all that medication that they flushed me with undergoing surgery about two weeks ago, I kind of dragged myself there as it is my one-stop-chance to socialize once a month – and I’m sorely missing the socializing aspect and having become this isolated recluse has brought about new problems I previously didn’t know I could have. But I’m digressing again. Comorbidities then…

I mentioned last night as it made me aware of another set of interrelated symptoms coming about from an underlying, only recently identified condition of complex post-traumatic stress disorder (C-PTSD). But before I go into that, I need to fill in another blank: I had been pondering hard as to my relationship with music in general and why it seemed so hard for me all of a sudden to rekindle the passion I had been feeling for it for almost all my life. I now don’t have too much doubt about that any longer: The degree of primary and secondary symptoms had aggravated to the point, where it completely overrode any potential for becoming passionate about anything. In other words: Where acute anxiety and fear culminating in panic attacks rule your days, there simply isn’t any room for the heart to beat calmly enough that you get to the place, where the Muse resides: In the quiet, still moments of the heart and mind, in the recesses of the soul seldomly visited – unless in those moments of inspiration. But you can’t feel inspired when standing on a battlefield in full riot gear all of the time, figuratively speaking. To stay in that analogy: How can you have a quiet moment when grenades, mortar fire and machine gun shots whizz by left and right? Right?! It’s been like that for me for the larger part of 2009, all of 2010 and again the larger part of 2011. Adversity had risen to unprecedented levels, which simply didn’t leave any room for even the remotest moment of relaxation or coming into myself. And simply practicing the physical movements by forcing myself to play the instruments (guitar and piano) felt weird, pointless and didn’t help to rekindle said passion. In that context: I don’t consider myself a musician as much as I’d like to think of myself as a songwriter/composer, who happens to play some instruments and sings. When I think of it and during times I afforded myself the most dedicated training, it was the song that was almost paramount to me – and certain instrumental parts that added to the overall song structure and arrangement. Whatever training on the instrument I afforded myself or received in a formal setting, I always regarded as mere “skill” to come before songwriting and arrangement. But naturally – I’m digressing again.

So last night I went to this open stage night downtown, which I had been looking forward to for some time – and more than anything for reasons of getting to socialize! (I really feel like a dying plant left in the shade about that forced on isolation, I need to feel part of some kind of group or social context of some kind. Playing in bands has always and often conveniently provided that. About the convenience – that may have become a different story. I guess, I’ll find out about that soon enough). I had not slept all that well or much the night before and gone about my regular routine, which consists of lunges and push ups after getting up, fixing myself a small breakfast, then getting on the computer for a couple of hours, usually to be followed by some going outdoors and moderately working out, like e.g. riding the bicycle or taking a walk of an hour at the very least. Since I’m still feeling the after effects of the medication from having undergone surgery in the hospital about two weeks ago, I couldn’t bring myself to doing the latter and had to rest after a late lunch. I took a shower and got myself ready for going out, went there, took a slow walk at where I arrived, then attended the event. I felt weak and a little dizzy the entire time. It wasn’t until short after midnight that I realized that my feeling weak and dizzy had been due to major fatigue along with the physical effects of the antibiotics and cortisone, which my body is still busy getting decomposed and flushed out. Despite all that, I enjoyed myself and the company there and was my old self, whom I’d describe as open minded, approaching people, being mildly talkative and generally sociable. The latter, however, I only mildly resumed after this major boost in confidence and courage that overcoming my fear of hospital has provided me with! I had literally holed myself up for the past six years on account of feeling inadequate and damaged to the point of it showing in pronounced ways, the latter of which I didn’t want to risk getting punished and bullied for one single more time! Since I had been feeling fatigued, depressed, exhausted, hopeless, utterly defeated and often times angry to the point of being raving mad with the world – and from disappointment so… – I saw no point in going out there and getting beaten up some more on account of all the aforementioned. After all, how many times can you run into a wall at full throttle and pick up the debris from the impact? I felt I had done that enough times to afford myself a break from that brutal experience. Yet, the latter had me isolated for good – or so it seemed.

In analyzing my personal outcomes in a more structured, commonly viable way, I tentatively identify more or less chronic fatigue coming from a somewhat excessive need for good sleep, the latter in turn being the result of constant hyperarousal from getting triggered on a more or less permanent basis. I now seem to better grasp the full impact of trauma, in particular since Jean’s sharing of this article, which pinpoints the facilitating neurological processes predominantly located in the limbic system, with some involvement of the amygdala and other “fear-based”, ancient/archaic systems in the brain circuitry. So, depending on the type of trauma incurred – by the way, in looking through this list, I have identified repeated and ongoing exposure to eight seven of all twelve types of traumatizing experiences… talk about a full plate in that regard…. – the number of triggers will vary and thus create a more or less densified, intense situation of being triggered with varying degrees of retraumatization, which in turn and again make for depletion of physical resources more rapidly than in non-affected individuals. I would mention those days as proof, when I had the opportunity to find sleep for no less than eight hours – individual needs may very and generally decrease as one gets older, the latter in affected as well as non-affected individuals alike: On those days, I felt satisfyingly energized, settled and resilient, which in turn generated enough confidence in myself to take on the challenges of the day. On days that followed a night of sufficient and fairly healthy sleep with alternating healthy patterns of NREM and REM sleep, I would feel productive and self-sufficient and go about my routines in an organized and sufficiently efficient manner. Days following poor sleep typically feel like a hangover, even when no previous alcohol consumption is involved. (I have quit drinking alcohol altogether to eliminate yet another source of maladpative self-medication).

Feelings of exhaustion, lonliness and despair seem to have gradually brought about my eating disorder of occasional binge eating – in order to drive away that feeling of thorough exhaustion and from not giving myself permission to simply be exhausted or endure otherwise negative feelings! (The latter, I’d tentatively identify as yet another outcome of perpetuated abuse in the form of self-abusive, self-deteriorating behavior in so far as I don’t seem to have been given the opportunity of expressing negative feelings without ensuing reprimand or emotional and occasional physical abuse in earlier life). What is more and from my experience, an eating binge not only caters to dissipating exhaustion, it temporarily – though with taxing side effects – takes care of other basic needs largely unmet during my early development and leaving behind major emotional deficiencies: Depending on the type of food, there typically is a burst of endorphines that gets rapidly released into the system and binding to the opioid receptors in the brain, resulting in feelings of rapid relaxation and feelings of being safe and nurtured beyond physical needs. From the mechanism of action brought about, it is no surprise any longer how hard it becomes to break that vicious cycle of dependency. In other words: With the bulk of basic emotional need having remained unmet throughout my earlier personal development – or rather lack thereof -, binge eating seems to deliver in regards to all residual deficiencies.

And there is another aspect to it, which had crossed my mind a few years ago and which I had meant to monitor more closely and keep in better check: Eating binges and often so at unusual times, like e.g. late in the evening or even at night, seem to mess up the messages of physical needs in general – or their correct interpretation thereof, to be more accurate. In other words: I seem to have been mixing up feelings of fatigue and hunger and vice versa, typically resulting in an eating binge, when I should have tried to find sleep instead. One could go as far saying that I haven’t eaten or slept in a normal, healthy manner throughout my entire adult life! Last night strongly reminded me of that tentative finding. I had felt weak from the medication along with some recurring fatigue, but dragged myself to that venue in – successfully met – hopes of having a good time out with other people. Given my still fragile condition following surgery and heavy medication, I noticed this strange dizziness throughout the night, while displaying behavior of natural, authentic exhiliration. Around midnight, I notice a critical point of my body giving way to the physical exhaustion. I had some water and had to sit down, then quickly excused myself and rode back home for about 45 mins and went to bed immediately. This time, I had managed to correctly interpret the signals sent by my body. At other times… I seem to resort to some self-abuse in the form of a late eating binge, which then naturally results in insomnia and/or poor sleep.

It’s going to become crucial to be more observing of my physical needs, particularly so after having recovered from the outcomes of that heavy medication (antibiotics and a messed up bowel tract from it being the most resilient, longest lasting outcome, resulting in said feelings of physical weakness beyond previous compare…). In this context, having been at the hospital seems to have “reset” my system in unexpected ways, thus shedding some light on the interdependencies of physical triggers of one or the other kind. Finding good sleep seems to be the pinnacle in thwarting and deactivating this vicious cycle of (physical) dependencies and co-dependencies. And sadly, sleep deprivation has been a given throughout my entire adult life and remains to be the core problem, as the routines of my landlady’s along with the proximity here run counter to my own. I have pinpointed the set of problems to the initial one. But with so many other issues that arise from it – I don’t see a solution there, not short term and not in the long run, either. I’m going to push for a higher degree of disability coming from my recent formal diagnosis of C-PTSD along with an attempt of pushing for extended, special needs in regards to social welfare. The latter… equals the beginning of yet another battle with the system, quite expectably spanning several years and with no clearly anticipated outcome yet. That’s my life for you…

P.S. I’ve tried to organize the interdependencies of trauma and behavioral outcomes the way I seem them or have experienced them so far. This is my personal “trauma & outcomes map”.

trauma map

My own tentative approach to experienced emotional trauma and its outcomes, W. Nieke 2013

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.