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Topics Cover in This Post
- The struggle to get to sleep.
- PTSD and sleep disorders.
- How can ACT help with insomnia due to PTSD?
- Can ACT reduce hyperarousal.
- Can ACT help with nightmares.
- Is ACT the best approach to insomnia due to PTSD?
- Ending the struggle to sleep.
The Struggle to Get to Sleep
The knowledge that going to sleep can be so effortless is what makes insomnia feel so cruel. It is not a skill that we needed to master, but an ability we were born with. It is something we usually take for granted. This means that when sleep does become a struggle, it can trigger worry and a sense of helplessness almost immediately.
Those of us who have been diagnosed with post-traumatic stress disorder (PTSD) can provide reasons for why we are experiencing insomnia. This doesn’t make things any easier though. We are still left with the struggle to get to sleep. It is the exact same struggle that unites everyone with insomnia.
In this post, we are going to be looking at what acceptance and commitment therapy (ACT) can offer those of us dealing with sleep problems. One of the suggestions from this approach is that it may not be so much the reasons we struggle (e.g. PTSD) that is the issue, but the fact that we are struggling.
PTSD and Sleep Disorders
It is believed that up to 91% of those with PTSD experience insomnia (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4967368/ ). This disorder means that people have a problem getting to sleep or that they wake-up in the middle of the night (or too early in the morning) and are unable to get back to sleep. Acute insomnia is where this occurs occasionally and doesn’t last more than a few nights. Chronic insomnia is where this happens for at least three nights a week over a period of at least three months. It is common for people who have developed PTSD to also experience chronic insomnia.
One of the reasons for why people with PTSD struggle with sleep is that they may be experiencing a state of hyperarousal. This is where the body is on high alert for a potential threat. The chemicals that are flooding the body in this state promote alertness and wakefulness. Hyperarousal often occurs when something has triggered a memory of the trauma. Nightmares are another symptom of PTSD that can disrupt sleep. It has also been suggested that sleep disordered breathing and sleep movement disorders are more common for people with PTSD (https://pubmed.ncbi.nlm.nih.gov/16800716/ ).
How ACT Can Help with Insomnia Due to PTSD
ACT is a type of therapy that was developed in the 1980s. It is based on the understand that the problems we experience as human are usually due to struggling against reality instead of working with it. There is a crossover between ACT and mindfulness even though the former originated in behavioral psychology (particularly relational frame theory) rather than spirituality. The approach also makes use of behavior change strategies with the goal of increasing psychological flexibility (https://en.wikipedia.org/wiki/Acceptance_and_commitment_therapy )
“The more we try to avoid the basic reality that all human life involves pain, the more we are likely to struggle with that pain when it arises, thereby creating even more suffering.”
Russ Harris – The Happiness Trap
ACT offers is a approach to insomnia (aka ACT-I) that has been shown to have ‘ a significant effect on primary and comorbid insomnia and sleep quality…’ (https://bmcneurol.biomedcentral.com/articles/10.1186/s12883-020-01883-1). It involves accepting whatever thoughts and feelings arise while at the same time gently attending to those parts of your experience that naturally move you toward sleep. For example, a suggestion by Steven Hayes (the creator of ACT) is to view thoughts as like words written on leaves that are gently moving along in a river (https://stevenchayes.com/having-a-hard-time-sleeping-do-nothing/ ) – this image is automatically relaxing.
Can ACT Reduce Hyperarousal?
As we have already mentioned above, it is hyperarousal that is believed to be the main cause of insomnia in people with PTSD. This state of mental agitation is only made worse by the struggle to get to sleep. Anything we do to try and stop the mind from being restless will tend to only make things worse. ACT does the complete opposite. By relating to this agitation in a mindful and accepting way, it allows everything to just naturally start to settle down. This is because the perception of acceptance is naturally restful.
What Does ACT Have to Say About Nightmares?
People with PTSD can often be woken up in the middle of the night due to disturbing nightmares. If these dreams are disturbing enough, they can leave the person in a state of hyperarousal that makes getting back to sleep difficult. The ACT approach is for clients to develop the capacity to be able to accept these nightmares. This can be done by initially working with imagery in a safe environment with the help of an ACT trained therapist.
The goal with ACT then is not so much to get rid of the nightmares but to learn to work with them. This may ultimately be a far more beneficial approach because life is full of disturbing things, and we will never be able to get rid of them all. By learning how to deal effectively with these disturbing things, we are in a far better position to live life to the fullest.
Is ACT the Best Approach to Insomnia Due to PTSD?
The best approach to most problems is going to be the one that works for you. Like most things, there isn’t yet one solution to insomnia due to PTSD that works for everyone. ACT can certainly be effective, but it does require looking at things in, what for most of us will be, a radically new way. It also requires a willingness and ability to get outside of our comfort zone.
Ending the Struggle to Sleep
“You’ve probably been told that if you can block out your thoughts, get rid of anxious feelings and control your pounding heart, you will be more relaxed and therefore more likely to sleep. While these things do make it more difficult to sleep, they’re not the problem. Struggling to sleep is.”
Guy Meadows - The Sleep Book: How to Sleep Well Every Night
The important message coming from ACT is that it is our struggle with insomnia that is causing the problem. There are now so many books, programs, and tools to help us get to sleep that it can feel like a major undertaking similar to climbing a mountain. We forget that natural sleep is effortless sleep. So, is it really so outrageous to suggest that instead of doing more to fight insomnia we need to be doing less? Isn’t it at least worth a try? What happens when we lie in bed at night and just accept the state of wakefulness? At the very least, the fact that we are no longer struggling should mean that we get more rest even if we don’t fall asleep.
ACT is one of the approaches that we use at 180 Sanctuary to treat a number of conditions including insomnia. Please contact us now to find out more.