by Dr Sarah Hattam MBCHB, MRCGP, DFSRH

Earlier this year, I spent a short time volunteering in a refugee camp.  It was an immense privilege to meet some of the women and their children in this camp, where living conditions can at best be described as squalid.  

Families there spend many hours of their day in lines queueing for basic food rations and water.  Listening to their accounts, I realised that each one involved some level of trauma and this sadly does not end with their arrival in the camp.  Every face looks weary. The children yawn throughout the day. Worry lines are etched on the faces of their parents and each one tells a story.

It made me think again about the impact of trauma on sleep and vice versa. 

For survivors of trauma, whatever the specifics of their individual experience, the body’s stress switch frequently gets stuck in the on position.  The net result of this is that the body and brain become flooded with the stress hormones adrenaline and noradrenaline.  This unusually high stress hormone environment can make it difficult to relax and drop off to sleep.  We also know that high levels of noradrenaline can prevent the brain maintaining good rapid eye movement or REM sleep.  This phase of sleep is associated with dreaming and but also seems to help to detox painful memories.  A kind of balm for the emotions.  If we think about the analogy of running the previous day’s emotions through a “sieve” then it is REM sleep that helps to strain out the negative ones.  In his book, Why We Sleep, Professor Matthew Walker describes a good night’s sleep as “overnight emotional therapy.”

The good news is that there are several practical strategies which help us to flick our stress switch off. To lower the level of stress hormones coursing through our body.  These involve activating the opposite side of our nervous system which is sometimes called the “rest and digest”  system.

Why Not Try These Tips For a Better Night’s Sleep?

• Put a hand on your belly and try breathing in for a count of three, holding the breath for four and taking a long slow outbreath for five counts. Whenever our out breath is longer than the in breath we activate this “rest and digest” system and interrupt the cascade of stress hormones.  
• Take a warm bath just before bed. This lowers the core temperature of our body and this helps us to feel sleepy.
• Before you go to sleep, try alternately squeezing and then relaxing different muscles groups around your body, starting with your feet and working up to your hands and shoulders. This practice of progressive muscle relaxation can help to identify and reduce muscle tension that has built up during the day.
• Avoid watching thrillers, crime dramas or even the news near to bedtime which, although entertaining, may leave you feeling unsettled.
• Think about putting tech away 1-2 hours before your usual bedtime and saying goodnight to social media at the same time. All back-lit smartphones and devices emit short wavelength blue light which blocks the brain’s production of our “go to sleep” hormone, melatonin. 
• Try to ensure the bedroom is cool and dark. Many people who have experienced trauma do not like to sleep in complete darkness.  If this is you, then consider using a plug- in light with a red or orange glow which will not interfere with melatonin release.  If you need to sleep with more light on, then try a sleep mask as this is easy to remove quickly if you wake in the night.  A few drops of calming essential oil such as lavender on your pillow may aid relaxation.
• Dial down alcohol. Although some people are adamant that alcohol helps them to relax and get off to sleep, it actually reduces the amount and quality of REM sleep which is so crucial for emotional processing.
• Don’t fret. If you wake during the night, playing some white noise or downloading binaural beats from You Tube may help you to get back to sleep.  If sleep is not happening after twenty minutes, it’s advisable to get up, keep the lights low and do something non-stimulating like reading a book.  Then try going back to bed once you feel really tired.  Lying awake in bed for hours feeling frustrated at the elusiveness of sleep is likely to be counterproductive.

So … which of these tips will you try tonight?

Goodnight and sleep tight!

Dr Sarah Hattam is a GP and founder of organisational health consultancy www.conciliohealth.com.