I woke this morning thinking I really ought to post a memo for people with post-traumatic stress disorder telling you how to sleep.
PTSD is a specific medical condition following a life-threatening event, or at least something your brain registers as life-threatening. It consists of recurrent brief traumatic nightmares that reprise the death threat event, trance like flashbacks triggered by other events evoking the original trauma, panic, depression, and of course the usual biological markers of psychiatric upheaval -- difficulty falling asleep, difficulty staying asleep, despair in the morning, weight loss, fears of death while also wishing to be dead, and loss of one's usual ability to concentrate, have pleasure, or connect emotionally with other people.
My own crash course in PTSD occurred in December of 1991 when I was trapped in the back of a runaway Checker Cab and smashed into oncoming traffic. I could see it coming; I knew I was going to die. The bullet proof shield between driver and passenger closed around me, decelerating me over six inches and preventing my being thrown out, but it also trapped me in a vehicle surrounded by chaos, listening to the last moments of the dying driver, one "Buddy" Barry, a veteran driver for Checker. It broke several bones in my body, but fortunately there were no serious internal injuries. The worst thing was the PTSD that followed, the visual and auditory replay of the accident.
I'll write more later in another post about PTSD and its natural course and symptomatolgy, and perhaps a little about the kinked accelerator cables that occurred in the Chevy Capri of the early 'nineties -- although that may violate some gag order I signed with GM. But today I do want to tell you how to "sleep."
Suffice it to say that I had difficulty falling asleep after the crash -- after just a few moments asleep I was back in the cab, hurling through space to my death, falling into oblivion. And the dream happened every night, ten times a night, and it kept me from "falling" asleep because I dreaded the falling through space.
So you have PTSD, you long for sleep but dread the "falling," and especially the impact of the re-experienced trauma. Here's what you do:
- Day or night, lie comfortably on your back, your whole body loose, head on a small pillow, fingers interlaced, thumbs together, hands on your navel, eyes gently closed. Breathe normally.
- Assess your breathing, notice your lungs filling at the top and then gently pushing your belly up against your loosely clasped hands. This is the key step -- your belly pushes your hands an inch or two upward (gravitationally upward, away from the floor or mattress). Allow the breath to leave your chest, throat, nose, passively pushed up and out by the weight of your belly and hands.
- Keep your eyes gently closed, but roll your eyeballs upward toward a point between your eyebrows. They won't stay there, but keep at it, rolling them back while you're pushing your belly up against your hands. Back and forth, it won't be perfect, but keep at it. Try to focus on your eyes and your belly, and gently push out of your mind all the other things that want to intrude.
- Eventually you'll drift off, not into actual sleep but into "nidra sleep," a relaxed meditative state. In it you don't lose the sense of thoughts occurring and emotions present, but they are more distant. Time seems to stop.
- The mistake I think most people make about meditation for sleep is to try to use meditation to "get to" sleep. My experience was that nidra sleep doesn't get you to sleep, it substitutes for sleep. You come out of it refreshed. After some practice I found that I could go a whole four or five hours at night in nidra sleep and get up refreshed and functioning well for the following day.
I would love to hear from some of you out there who do try these exercises. They worked for me. I hope other PTSD sufferers can find a way to escape the terrors of the darkness, just by these breathing adjustments.
This is background to my upcoming book The Harvard Medical School Guide to Yoga with Marlynn Wei, MD