Getting Some Rest as a Complex Trauma Survivor
It’s no secret that survivors of trauma often have an incredibly difficult time with sleep. Whether that's due to experiencing terrible nightmares, night terrors or sleep paralysis; having a racing mind that won’t turn off; only feeling safe to sleep during the daytime; or wrestling with any of the countless complications surrounding bedtime — we know that the time of day most really look forward to can be one that fills many survivors with dread. We have accumulated, used and witnessed the success of many different tools and strategies over the years - tools that are designed to help trauma survivors not only get to sleep, but do so safely and stay asleep peacefully. In sharing some of them with you here, we hope it may even shift your overall approach to sleep, while ultimately leading to a much more secure and restorative rest. As an added bonus, you can also take away that you are not alone, crazy, or making too big a fuss out of “something so simple”. It’s not simple or you wouldn’t be struggling with it! Hopefully we can help with that and get you some long overdue rest.
We will tackle four main areas - Nighttime Routine, Journaling (both before bed and as a tool for nightmares), Internal Parts (for those with DID, but also still applicable to most), and Medication. Feel free to take what you need and just leave the rest. And please feel free to add your own experiences, struggles, and suggestions below. You may find that someone else has the perfect solution for your biggest challenge, or that by sharing your own experience you spark a light bulb in another that brings some clarity to their lifelong battle with sleep. So, don’t be shy. Your voice is valuable.
One staple skill for just about anyone to keep in their toolbox if they're fighting with sleep, is to create a nighttime routine. Whenever you take a series of deliberate, personalized steps about 30-60 minutes before bed - and do so night after night - you send an early signal to your mind and body that you plan to sleep soon. It learns that once you've begun step one, it’s time to start slowing down, settling your heart rate, and preparing to turn off and recharge shortly. And, as you are likely very familiar, most (C)PTSD minds are extremely hyperaware and vigilant for any sign of distress. So any early indicators you can give your mind that you plan to disengage (while also letting it know you’re taking intentional steps to ensure it will be safe to do so) can make a dramatic difference in it following through. ...and doing so by the time you're settled and would like to relax.
For many, this routine may start with taking nightly medications — which is a great place to start if you have any that are for sleep — that way they have time to take effect before your eyes are closing. Perhaps there are sitcoms or online videos you like to watch that help you unwind and get into a lighter place. If this kind of entertainment is an important part of your evening, it’s good to add those early in your routine so that you’ve had a solid 15-30 minutes without electronics before shuteye. This isn’t only a good idea because of the way digital devices keep our minds active and can affect sleep rhythm, but they are notoooorious for sucking us in and getting us to watch one more episode, scroll a little longer, or play just one more game. ...sometimes hours longer than we intended. ;) And if you're dissociative orrrr just really really avoiding sleep? I don’t think you need me to tell you that you can fall down a hole that's not easy to get out of. ;) So, enjoy these early on and continue with the rest of your bedtime routine. Get a snack, drink some tea or something calming. Feed your pets if you have them. Wash your face. Brush your teeth. Take out your contacts. Put on your PJs. Set your clothes out or gather other items that you need for the next day. Do all the things that you need to be ready for bed while adding in any self-care items you aren’t currently doing that you think could be helpful to you and your sleep.
Once you’ve climbed into bed, we know that this can be the hardest part. Ease into it. Go ahead and plug in your phone, set your alarms for the next day, turn on any light music or white noise apps that you enjoy. Then instead of just closing your eyes, you’ll want to take some extra steps that are just for your mind. Whether that’s through journaling (discussed more below!) or mental imagery, do what you can to consciously put the day - and alllll its stressors and triggers - away. Then take some time to acknowledge to yourself where you are, the year, that you are an adult and that you are safe. Look around and do some self-talk reminding yourself of all the ways you are secure in your home and in your room, that no one can interrupt your rest in any unsafe way. If you have parts inside, go ahead and take time for them - making sure their needs are met and they are ready for bed as well. (More on this below!) Then spend a bit more time on pleasing imagery for yourself, whatever that may look like. Safe place imagery, progressive muscle relaxation, color breathing, or just envisioning a special place you’d like to be resting your head. Hopefully, it shouldn’t be too long before you drift.
While we know there can be other pitfalls to sleep that we’ll discuss in a moment, establishing a routine like this that you try really hard to follow in the same order each night can do wonders for your rest. Setting that rhythm and getting your mind, neurology, and whole body in sync can be a key in helping you get the sleep you aren’t currently getting. The more you can stick with it, the better the efficacy. But, hey, we know that life happens, it’s okay if it gets interrupted or you forget a step or two. It’s less about absolute perfection and more about the intentionality of taking gradual steps to walk away from high-alert and into a more settled and calm you.
Journaling to Help with Sleep
One of the best ways to ensure a good night’s sleep is to practice a coping skill called containment — and one of the most universal mediums for that is journaling. Containment allows you to temporarily “put away” upsetting or difficult thoughts and feelings by mindfully and consciously giving them a place to go. This way you can continue on with your day, or your rest, without those things intrusively revisiting you.
Everyone has experienced sleep made more difficult by even mild stress throughout the day, but triggers you've encountered, worries and fears you have about the upcoming day, memories you’ve been wrestling with, and all sorts of similarly challenging material can make it a million times harder. Taking a moment to write about some of these things gives your mind a chance to acknowledge and validate how much they are affecting you. (And this is important because it keeps you from stuffing them, or pretending they don’t exist or faze you, which nearly always leads to them thrusting themselves back into your awareness whenever they feel like it. ...any way to not be ignored or forgotten. That includes in your dreams.) But, more importantly than just validating the tough stuff, journaling also gives it a place to go. The journal gets to hold on to it, and when you shut the book, it's contained within its pages -- allowing your mind the freedom to concentrate on more pleasant, calming thoughts so you can drift to sleep faster. Thinking of it in this way, and making the conscious effort to believe the difficult items are contained tight within your journal until you want to revisit them (whether that means the next day, in therapy, or weeks from now), you're far less likely to have your dreams disturbed by their content. This skill is especially important if you’ve been triggered that day, are dealing with really difficult memories or therapy material, or have been having an excess of nightmares or unsettling dreams.
“How long should I journal?” “What should I write about?” “Won’t thinking about all the hard stuff right before I lay down just make me feel WORSE?” “I’m so tired before bed, I don’t have time for that, I just wanna sleep!” “I have never journaled before and I’m not a writer.”
Fear not, we’ve got some answers! Firstly, you don’t need to have ever journaled before to be able to benefit from or be “good” at this skill. Because the cool thing is, you don’t even need to write full sentences. In fact, many avid journalers can even get swept away in their storytelling and get themselves worked up and fully “in it” again. And we don’t want that before bed! So, some useful tips include not only setting a time limit for yourself, but consider keeping it a short one. If you want to do longer journaling (which we highly support and recommend!), you can do so any other time of the day! We just don’t want you to do that right before bed. Keeping it simple is just as effective and doesn’t get your neurological system all revved up and firing again when we just settled it down through your routine. Take only a short moment to write a bit about your day, some of the things that are recycling through your mind or upsetting you, and a bit on how it made you feel. For some, this may literally just be in a bulleted list, no sentences at all. If the material is particularly triggering, writing a full sentence about it may even take you right back there - so an effective tool around that is to just give it a headline. What would a newspaper title the full story? You’ll know what it means without needing to write any more detail. For anything else, it's possible just listing what you did or what happened that day through timestamps is appealing to you, while others care less about the events of the day so much as the emotional experiences in it. There are so many different journaling techniques (we will likely even make another post about them at some point!) but there are many ways to do this, so personalize it. Some may work better for you than others. Don’t give up if it the first tries haven’t gone perfectly!
(As an aside, another common objection to journaling is being afraid that someone will read it. While we love the thought of you getting a journal that feels like a really personal, inviting place to hold all of your experiences for you — there is nothing wrong with or ‘lesser' in just writing via the Notes section of your phone. Then it is always on your person, you can lock entries so no one can find them, and you still help your mind displace some of its recursive thoughts by putting them somewhere outside of your pretty little head.)
Final thoughts on this! Ultimately, the purpose of journaling right before bed is to put away the day’s worries and stressors - but, some really like to use it as more than that. While we highly recommend following up your journaling with pleasant imagery and “good vibes” once you lay down, many incorporate that into their journaling. They use their 'good thoughts' as a bookend to their writing so it doesn’t feel as if all the “yuck” is just left open-ended on the page. If this appeals to you, you can do so in various ways:
Some choose to end by further describing a container they’d like to place these specific things in - such as a chest under the sea, flown away on a private airplane, a flood of emotions filling up an entire canyon that you can walk away from, images projected on to a movie screen that you can leave in the theater, a filing cabinet with an elaborate system of locks..so many possibilities. Those struggling with the emotional side of things may like to end their journaling with 5 to 10 statements that challenge any upsetting beliefs or distorted thoughts. Statements like, “I have worth.” “I am safe and can protect myself.” “Their beliefs about me do not MAKE me those things. I know who I am.” “I am not to blame; they made that decision when I wasn’t even there.” “My needs are important. I am not too much.”. Many like closing up with 3 positive things they like about themselves, several grounding statements, 5 wonderful things about the day, or a handful of things they are grateful for. There are many positive, uplifting, affirmative, or calming things you could use. Choose whatever feels right to you and what best meets your needs so that your mind is in a more peaceful and light place before you even close the book. Then, that satisfying close of the cover, locking up all the hard stuff, will feel that much more satisfying because you’re already in a much better place before you shut the book.
Journaling to Help with Nightmares
Journaling isn’t only a great tool to use before you go to sleep, it can also be incredibly useful after you’ve had a nightmare. Some nightmares are just too stubborn and intrusive that all the coping skills in the world before sleep can’t keep them from finding you. And, returning to sleep after one can be positively dreadful, if possible even at all. Keeping your journal nearby may be all that lends a hand when little else does.
Similarly to above, this can work as a kind of containment that your mind really needs after all that distressing content was pulled to the forefront of your mind. Though you may be exhausted, and your handwriting illegible, scribbling down a bit of your nightmare can help you ‘get it out’ so you’re less likely to just keep thinking about it as you try to fall back to sleep. It also allows your journal to “hold it” for you and keep it away from you and your sleep. You don’t have to write much detail or elaborate heavily, just hitting the key components that are most distressing to you is what matters most. Just list them, give them a headline, name a few feelings or objects or people, draw something if the words are too hard....anything to get the bulk of the nightmare out on paper and out of your poor head. For good measure, a lot of people like to fold that page of their journal over so they can’t even see it anymore. It gets extra-contained in that folded page. Then you can close the book up tight, set something heavy on top of it if you please, shut it tight in a drawer, and even move to the other side of the bed if you feel you need to. …nothing is too silly if it helps you feel it can no longer reach you. Now you're free to think about whatever pleasing scenery or place you wish to be instead, knowing it is tight and secure in its square on the page, and you’re in your safe place heading toward more pleasant sleep.
As a bonus, jotting these nightmares down can be incredibly useful to bring to therapy. If you have a particularly recurring dream, there are strong themes in your nightmares that may be trauma-related, or you’re having actual flashbacks in your nightmares, these notes can be extremely valuable when you’re in sessions. Having them written down the moment you woke from them, as authentically and raw as they get, can help you tackle things in much more nuanced way. This can get you through them more quickly and more accurately, which inevitably leads to better solutions for them all-around. Nothing could be more relieving than that.
Internal Parts (DID)
Not all survivors with Complex PTSD have internal parts, as this is more DID-specific, but that doesn’t mean some of these ideas won’t still be helpful for all to at least consider. There are many different aspects of the whole self that can struggle with sleep, aspects of yourself that you may be unaware of or had never considered before. For those who have DID, we know it can seem so simple or obvious that alters may be the reason your sleep is so disrupted. But it’s also completely understandable that you might be inclined to look just about everywhere else for what may be to blame before you ever think to look inside. "Did I have too much caffeine?" "Is this work project getting to be too much?" "Did I stay online too long?" "Maybe I shouldn’t eat that before bed anymore..?" When there are sooo many things that can keep a person from sleeping, it never hurts to be reminded to stop and consider…hm, maybe someone inside is keeping me up. While individual alters may be physically responsible for keeping you awake, for trauma survivors without DID, the younger aspects of yourself and traumatized parts of your mind may still need just as much attention and care. They could very much be the source of your restlessness, too.
For DID systems…. Parts inside might not be intentionally trying to keep your body awake, but that is actually also a possibility, too. Checking inside to see if someone is afraid to go to bed, has a belief that you need to be more productive or don’t deserve to sleep, or actively wants to punish you for something they feel you did wrong, are all things that could be going on beneath the surface. Looking to see if any of these types of feelings are what’s at play may lead you to some very surprising answers. Other possibilities may be much more innocent. Like parts making a bit of a ruckus inside, but not because they wanted to keep the body awake; it was just an accidental byproduct of their distress. Maybe a small kiddo part really wanted a you to sleep with their favorite stuffed animal or wear your fuzzy socks. Or they needed someone inside to come tuck them in or read them a story before they could rest, which left you wide awake up front. Other parts may be having an incredibly difficult with nightmares or triggers around bedtime that you weren’t even aware of - and their nervous energy or insomnia even on the inside may be keeping you up. Some insiders may just be ungrounded or unaware that it’s 2017, and extra grounding help before bed may be all they needed to quell their terror and lead them to sleep. Other struggles may be more challenging to overcome, though, like a part not liking that you have to share the bed with your partner if you have one. Issues like this may require a lot of talking and compromise before you can all get some shut-eye. A simple nighttime snack may have been the answer for someone one night, while making sure to double-check the locks on the doors may be a absolute non-negotiable every single night for someone else. There are countless things different parts could be having a hard time with - some that may relate to sleep and others that might not at all. But until their needs are heard and met, you will likely be left awake.
The good news is that there are often solutions to many of these issues. Some are quick fixes while others take a lot of work, time, therapy, and/or compromise. But there are usually answers somewhere, if given the proper time and attention. If you don’t yet have good internal communication, learning what the issue even is may be the harder part for you. But if you remain open to hearing from your mind, and let everyone know it's safe for them to express their needs or worries, you’ll likely hear (or at least pick up on) something you can work with. Perhaps making sure all parts have gone to independent safe places before bed is what you will need to do nightly. If they each have their own room, maybe child parts will need bedtime stories and snugs from maternal, comforting parts inside. And, sometimes things on the outside are your answer to making parts happy - like special PJs, blankets, a fan being turned on, a favorite movie, or even something more serious like not sleeping in just undies. The solutions may not always be comfortable to you, and this is where compromise and explaining your needs alongside theirs will be necessary. But it’s a start. And a start is often better than nothing if it’s been months since you’ve slept and you’ve tried EVERYTHING. If this is the first time you’ve gotten any insight to what’s keeping you up, it’s worth giving it your best effort.
It’s just too easy as we go about our lives to forget about parts inside or even those younger, traumatized parts of ourselves if we don’t have individual alters. Tending to their needs, fears and worries - or just taking extra time on self-care and grounding for all of you before bed - can do wonders for your mind. You’ve been through so very very much and your mind is going to wrestle with the idea of turning off for awhile, especially when it's the most vulnerable position you can be in all day. It’s only natural that you may need to take some extra time, thought and attention toward your health, safety and comfort. Yes, when you’re absolutely exhausted and just want to rest, this can feel like such a pain. But I can promise you that it’s well worth it if it actually results in good, restorative sleep in contrast to the restless, angst-ridden wrestling and warring you’re currently doing. Be kind to yourself, to your body, to young you and teenage you and adult you. You each have your unique challenges, but you are all one, and that whole person in this singular body needs and deserves a great night’s rest each day of the year. So, whenever you find yourself just having zero luck catching even a moment of decent sleep, or you're routinely waking up at the same time each night, we urge you to check inside. See what might be going on for the rest of you that you’re often less aware of during the day. Whether that is to each individual alter, or the traumatized and still-healing aspects of the singular you, give some thought to what you may need and ways you could tend to those worries or fears. The worst that happens if you try and it’s not where the problem was? Well, you just get a little extra self-care and comfort. Shucks! ;)
Oh, medication — it seems it’s either the most vital necessity or the greatest enemy to complex trauma survivors. And heck, both can even be true within the same person at different points in their life, orrr even at the same exact time! When it comes to sleep, there are no ifs, ands, or buts about it — you absolutely must get it and you just cannot keep going if you aren’t getting a good amount. For many of you, this will require medication at some point in your life, and that is one-hundred percent okay. Whether the decision to try medication comes after you’ve tried everything else, or is something you jumped for at the first sign of trouble, there is never any shame in asking for, or needing, medication to help you sleep. We fully support and recommend its assistance to you under the direction of a mental health professional (most preferably one who is familiar with complex trauma, but we know those are hard to find. We’re working on that!). That said, we know just as well as many of you know, that sometimes medication can just stop working one day, never really did in the first place, gave you awful side effects, left you with terrible nightmares, or is something parts inside (or even you alone) have intense misgivings about and can’t reliably take each night. We want you to know that no matter where you fall on this spectrum of the medication journey, we empathize with you completely and are sorry that it has to be so difficult. Sleep is so important and absolutely vital; we ache for anyone who, even after all their best efforts on their own terms, can't even rely on medication to be a sustainable resource.
We don’t have any hard and fast answers or guidelines here, but we did want to mention its role in this battle against insomnia and nightmares. Because, while it may not be a long-term solution, and may include some unpleasant side effects, it may still be the most welcome rescue to your desperate need for sleep. Now, just going to your personal care physician and telling them you’re having an impossible time with sleep maaay lead to them prescribing some pretty heavy duty sleeping pills. But, we want you to know that not only are these NOT the only options out there, they aren’t always the best option for someone with your specific needs anyway. Talking with a psychiatrist tends to lead to a much more nuanced understanding of what about sleep is so difficult for you. And this can make all the difference in getting either a medication that just physically sedates you, one that takes down your excessive anxiety so you can fall asleep organically, or even antidepressants that can regulate your body’s natural sleep cycle so that you can turn down when you want and wake when you need.
Another lesser-known but available option is a group of medications that target nightmares more specifically. These are usually only prescribed by very knowledgable psychiatrists since they tend to affect blood pressure, and nightmares are not the medication’s primary focus. However, in recent years, they have found that certain medications (such as MiniPress/Prazosin and Catapres/Clonidine), which typically lower blood pressure, have been affective in treating PTSD nightmares. They do not always work and require very close monitoring of the person’s blood pressure since most who are taking it for PTSD reasons do not need their BP lowered. ...but that will still happen anyway. However, it’s always helpful to know that some of these options exist out there and could potentially be viable for you. You will need to talk thoroughly with your physicians to find what is right and safe for you, but just knowing there are various possibilities out there may lead you to the help you deserve. “Sleeping pills” or the hardcore medications you’ve heard tons of awful things about are not your only option. In fact, they’re pretty rarely used for trauma patients (with exceptions of course). Whether it’s through benzodiazepines, antidepressants, other psychiatric drugs with sedating side effects, blood pressure medications, or any other class of meds — there are so many ways to tailor your sleep regimen to your specific needs. There is no one-size-fits-all when it comes to sleep, and that even includes within the same person. What you needed, or did terribly with, as a teen may be the most unhelpful or perfect solution to you now.
Of course, we know there will still be a subsection of you who have tried literally every concoction under the sun and there’s just no way to get relief through medicine. We extend our sincerest sympathies and encourage you to look deep for internal reasons that insist you fight and override every combination of medicines thrown at you. The mind is an incredibly powerful force and if it doesn’t want to sleep, it can beat even the most powerful of substances. This could very much be the case for you, and really taking the time to explore why sleep is so forbidden, frightening, or “bad” could eventually unlock the mystery that’s been - quite literally - keeping you up at night. And, if that doesn’t seem to be a fruitful exploration and you’re still desperate for some Zzz’s, it's never a bad idea to at least consider retrying medications you’ve tried once before. The body, its chemistry, and your personal needs can change dramatically over time. What you need now may be completely different than what you’ve been trying at this stage or in the past. We know just how frustrating this can be and completely understand why you may've thrown your hands in the air already not wanting to try anymore. But you deserve sleep. You NEED sleep. We want to see your body and mind get that wonderfully restorative break.
If you needed a nudge or for someone to tell you that it’s okay to try medication again - or for the first time - this is it. We’re telling you it’s okay. It doesn’t have to be forever, you don’t have to rely on them, and you can stop at any time. But you deserve a chance at peace, comfort and rest.
We truly hope that this has helped some of you in your fight against nightmares or insomnia. If nothing else, we hope that it’s helped you think about this battle you face every night in a different way, and perhaps it will lead to some looooong, peaceful nights. Please don’t forget to share your experiences or own personal tips an tricks with us and others below. We have far too many possibilities to include them all here, so we know that you guys have even more! And, nothing could be more helpful than a collection of survivors’ stories on how they beat what kept them up for so long and finally got some solid sleep!
If you would like to catch other informative or educational posts of ours, give these a try:
• Grounding 101: Featuring 101 Grounding Techniques
• Regarding the Film 'Split': Our Support for Survivors and Public Statement on the Film
• Surviving the Holidays with C-PTSD or Coping with Toxic/Abusive Families During the Holidays