The Rub

“To sleep: perchance to dream: ay, there’s the rub;” (Hamlet soliloquy, Act 3 Scene 1)

While I was discussing combat PTSD with friends, a WWII Veteran asked if someone could get that from bombs. Then he shared that he hardly has a night without a nightmare.

Reminder: For the past few months, this blog has been dedicated to my reflections on a book by Ashley B. Hart II, PhD, called An Operators Manual for Combat PTSD: Essays for Coping.

“One of the most common complaints of combat veterans with combat post traumatic stress disorders is the problem of sleep.” (Hart, 2000, p. 144)

For years, until a few weeks ago, I maintained that I did not have sleep problems—that I did not have nightmares. I was wrong. While it is true that I do not have recurring dreams of combat experiences, I do have frequent dreams, and even night terrors, with recurring themes of helplessness, frustration, and/or danger. I have concluded that my trauma is as much situational and conceptual as related to one specific incident or engagement.

I also have concluded that dreaming is not just what I thought it was. Dr. Hart describes a physiological reaction to decreased respiration as an endocrine response of hormone secretion. This triggers our brain’s reticular activating system pulsing electricity through neural pathways, and we dream. He says, “Our dreams are the result of electrical stimulation of specific areas of our cortex.” (p. 145)

He then goes on to describe the production of RNA and amino acid rearrangement as learning. I find that really cool. Okay, I’m an old geneticist, and the DNA–>RNA–>protein thing fascinates me, partly because I find it plausible as explanation.

Deep in the subcortical regions of our limbic system or primitive brain lie the hypothalamus, amygdala, and hippocampus, the latter associated with long term memory management. Trauma survivors have reduced hypothalamus (short-term or working memory) capacity and enlarged amygdala structure and function (fight/flight response). We also seem to have impaired hippocampus function. It is less effective and the amygdala takes over. The result is an increase in feelings of terror and panic (I would add, rage) in response to stimuli including these electrical impulses called dreams. This is my conclusion or inference from Dr. Hart’s discussion. I invite you to read the original.

“Combat veterans are frequently diagnosed with sleep apnea.” (Hart, 2000, p. 146) He goes on to explain why: We have a tendency to not breathe when we are stressed, a natural reaction to threat that prods the body to produce adrenaline for the fight or flight. We can awake in full arousal reaction even into a wild ride of dysregulation (Dinosaur Dump).

This is not conducive to marriage.

There are many avenues of help, and my friends in group report successes. Medicines improve sleep time and quality (with side effects, of course, including male impotence). Machines support breathing while we may be holding our breath. Some life habits improve our sleep significantly as can certain practices.

Dream inoculation is one that fascinates me although I have not tried it. (Note to self: Try this.)  Just before dozing off, I tell myself that if I dream I will recognize that I am in a dream and I will be able to change the outcome. It is a metacognitive process of seeing myself from outside or above.

Deliberate relaxation with deep breathing and beautiful visualization before bedtime really helps. It is a matter of making it a habit. Watching news or disturbing TV does not.

Because of serotonin production is conducive to quality night sleep, periods of peaceful relaxation during the day helps. Again, it becomes a matter of discipline. A few minutes listening to the birds (real or recorded), babbling brook, seashore, or Native American flute music not only improves my efficiency during the work day, it improves it the next day as well because I sleep better at night.

It is hard to be a good guy on a bad night’s sleep. There is help. Rest easy.