The Trouble With Sleep

Late Night Carnage

"Life is really simple, but we insist on making it complicated." ~ Confucius

     When I woke this morning, my feet hit the floor with the rest of my body feeling just a touch of inner rage.  My brain is still processing all the information of the past eight years of study I've now completed in recovery.  My dreams last night were fragmented.  Coming in fits and starts.

This leaves me often uneasy in the morning still, with flashing images in my mind without any real rhyme nor reason to go along with the film my dreams create. 

I've lived through far too many restless nights like this.  To many mornings, rising with a start.  Pager Stress, I call it.  I'd never attempt to sleep with an alarm clock anymore.  The reminders of my past work-life, when my sleep is disturbed, take a little bit of time still to get out of my head with any early morning demand to jump out of bed with a fright.  The fight response (anger for me) is usually how my mornings still play out after a night like this.  All this as a rocky start this morning, because HIS HIGHNESS, Marty- My Bernese Mountain Dog, decided for himself that 5:30 am was his desperate time to pee.

For too many years in my life, serving my rural home community as a Primary Care Paramedic, needing naturally to make a dollar or two, myself and many of my cohorts lived together melded lives without any real consistent structure to them.  Sleep was often compromised in favour of manning cars to continue supporting our local citizenry in their times of dire, human need.

We were still considered slightly-paid volunteers when I was still working.  We'd receive payment for call-outs, of course.  Carrying a pager, we could still try to live a normal family life.  Impossible pursuit really.  The pager and radio on my hip seemed constantly obtrusive to family life.  Especially near the end of my service and ultimate psychological demise to trauma and PTSD.

I don't know how many times my family life was interrupted by the work.  I've lost total record of the number of times in my paramedic life, I'd risk taking a shot to perhaps take in one of my two son's various school performances or other normal family-time experiences in human life.  Ultimately, I would find myself startled out of attempting to relax into the enjoyment of watching my children show-off for Mom and Dad, needing to escape to attend to the needs of others.

It seemed I was always running away from my number one priority in life.  My family accepted this as part of the job.  My son's today, don't state any real losses related to those times when I would up and leave them, attending to the needs of someone living some sort of darkness in my home town.  PTSD however left behind so much family pain.  Thank God my son's and I survived at least with our relationships still intact.

We all as rural paramedics accepted this lifestyle.  Some of us, had no choice.  Once we'd left other employment or found ourselves laid off from our primary sources of income, with my own goal at one point graduating to full-time work in the city, financial obligations kept us often tied to a pager for far too many hours at a time.  Our symbolic ball-and-chain.  The hallmark of living a very unhealthy work-life-balance.  In a word, it often felt as though I'd unwittingly chosen a life of slavery. 

I'm ashamed of myself, actually.  Thinking the needs of others were of greater importance than the needs of myself and my family.  If I only knew then.  I don't recall how many times I've heard myself say this too.  Hindsight isn't 20-20.  For me, hindsight remains a bit of a nasty bitch. 

We were all dedicated servants, in my view.  Including our families.  We all worked with the same unspoken common tenant.  At the core of our being, our honourable sense of duty kept us willing to remain deeply engaged in the provision of care to others in their time of need.  

We viewed our community as family, ironically.  We'd often agree to keep working beyond personal limits.  The key motivation to do so was income of course.  Most of us lived in denial to the health consequences of our chosen lifestyle, including our husbands, wives and kids.  

Many of us lived the stress of believing the world simply wouldn't turn around the sun if we weren't available to answer at our communities beckon call.  All this biologically unnatural living robs us of so much in life.  One of the most troublesome of biological losses being the regular receipt, of quality, uninterrupted sleep.

When we sleep, our body uses the down-time to rest and restore energy levels. A good night's sleep is often the best way to help cope with stress.  Sleeping well improves our ability to solve problems, or recover from illness.  Sleep restores.  It is naturally an active state that affects both our physical and mental well-being.  Both for the better, and with lack, for the worse.

During sleep, the body cycles between NON-REM and REM SLEEP. Typically, we begin the sleep cycle with a period of non-REM sleep.  Followed by a minimally short period of REM.  Dreams generally occur in the REM stage of sleep.

My own REM cycle was doing it's job well last night.  Waking this morning, I can easily recall the movie-dream was of the stigma imposed upon me when I was first diagnosed.  Prior to October 2013 (I left the work in 2005) I hadn't yet found my way to definitive treatment.  The current treatment of choice in recovery, EMDR, finally released the stuck trauma in my nervous system.  The release from my own suffering leading ultimately to the construction of this blog and support site.  

Healing for me came fairly rapidly since finding EMDR.  We're now hearing of similar results from those with even long-standing trauma issues, left behind in soldiers who fought forty years ago in Vietnam.  In my own body, I only recently returned to any sense of a normal, physiologically- balanced inner-state.  After twenty-two years of struggle, with the last eight years committed to rectifying the safety issues existing within EMS Systems here at home.  My own self-care has up until now taken a very unhealthy back-seat.  

Frankly, EMDR was never offered to me by anyone until I met a buddy last fall.  Safety issues relative to sleep, as far as I know have never appropriately been discussed in our service system.  Today, I know how important it is for the human body to make it through all the necessary cycles of sleep to keep us healthy enough to maintain resiliency in the work.  A lesson in life, that for me came far too late.

Non-REM Sleep (NREM) is viewed by those who study such things as progressing in stages in the human body.  Sleep study specialists label these stages simply with the numbers one through four.  Each stage in the cycle can last from five to fifteen minutes. A completed cycle of normal healthy sleep consists of a progression through all four stages before REM Sleep is attained.  Then, the cycle starts over again and is repeated.

In stage one, Polysomnography (sleep study readings) shows a reduction in activity between wakefulness and stage one sleep.  The eyes are fully closed, however we can easily be aroused without too much difficulty.  If we are awakened from this stage of sleep, as might happen in paramedic, fire, or police service during the night, a person may feel as if he or she has not really slept at all.

We all sometimes notice entering this stage with the feeling of falling during the start of sleep.  We all likely can relate to the sudden muscle contractions that sometimes happen at this stage (hypnic-myoclonia).  Shortly after our heads hit the pillow, we often suddenly feel a false-sense of a fall, startling us back to our alert and conscious awake state.
    
Stage two, is a period of light sleep during which polysomnographic readings in sleep studies show intermittent peaks and valleys, or positive and negative wave patterns in the brain.  These waves indicate spontaneous periods of muscle toning mixed with periods of muscle relaxation.  During stage two, the heart rate slows and the body temperature decreases.  At this point, the body prepares to enter deep sleep, stages three and four.
    
Stages three and four are deep sleep stages, with stage four the more intensely deep of the two.  These stages show in sleep study slow-wave, or delta-wave patterns of activity in the brain.  If we're aroused from sleep during these stages, we may feel disoriented for a few minutes before we're able to fully function consciously.  

In my own experience, recalling in the work being startled to arousal by a pager in the middle of the night, I can attest to this truth.  I wonder some days how I survived at all with so much family and sleep disruption in my life, let alone survived my own experience with PTSD.  In retrospect, I wouldn't allow myself to go there now.  The lifestyle of rural paramedic service in British Columbia today, continues to create these perfect storms for human, psychological demise.

During the deep stages of NREM Sleep, the body repairs and regenerates tissues, builds bone and muscle, and appears to strengthen the immune system. As we get older, we sleep more lightly and get less deep sleep.

Aging is also associated with shorter time spans of sleep.  Studies show the amount of sleep needed doesn't appear to diminish with age and there really isn't any magic number in terms of an average amount of sleep we require.  If memory serves correctly, the numbers I recall as a guide is that six to eight hours of uninterrupted sleep significantly improves generalized physical and emotional health.

In a study released in 2013 by the American Psychiatric Association, Dr. Anne Germain, PhD. researched sleep disturbance as a hallmark for PTSD, continuing the work of previous researchers, namely Ross et al in 1989.

Germain proposed in this study, the hypothesis that rapid eye movement (REM) sleep disturbances are the hallmark indicator of post-traumatic stress disorder (PTSD).  She revisits the influential hypothesis of Ross and his colleagues, in light of clinical and experimental findings that have since accumulated over time.  

Other polysomnographic studies conducted in adults with PTSD, yielded mixed findings regarding REM sleep disturbances.  This generally suggested to researchers modest and nonspecific sleep disruptions.  In her work, Germain identified that: 'prospective and treatment studies have provided more robust evidence for the relationship between sleep disturbances and psychiatric outcomes and symptoms.' (Germain, 2013)

She goes on to say that experimental animal and human studies probing the relationship between REM sleep and fear responses, along-side studies that focused more broadly on sleep-dependent affective and memory processes, all provide strong support for the hypothesis that sleep plays an important role in PTSD relevant processes.

Overall, the literature suggests that disturbed REM or non-REM sleep can contribute to maladaptive stress and trauma responses and may constitute a modifiable risk factor for poor psychiatric outcomes.  Another perfect storm, I suggest, adding to an already complicated work-life for all Emergency Services Workers in Canada.

I share this ti-bit of quality information with hope of stimulating change from the hearts of the people responsible now for the protection of emergency services workers in British Columbia.  It's all I can comfortably do now, short of traveling personally to Victoria and kicking down the Legislature door.  It is my hope that this identifies, the already vulnerable position paramedics and others are in as they continue their dedicated service to my fellow citizens in our times of darkest need.  I continue to find myself disappointed with the lack of compassion demonstrated on the part of power across the nation.

I want to remind, all of Canada, that in just ten weeks, The Tema Conter Memorial Trust: Heroes are Human PTSD Awareness tour, uncovered thirteen confirmed suicides among our public-safety personnel across Canada.  If these stories aren't enough to invoke compassion in our power-base, frankly I can't imagine any longer what actually could.

We remain in a dead-lock in every province in the nation in terms of developing sincere provision of care for psychologically injured workers in this industry.  Only recently did the Province of Ontario accept presumption of illness language into it's own laws governing worker safety and compensation.  I'm not aware of any suicides happening as yet in BC.  I hope the day never comes.  For all my friends and fellow survivors visiting here, please ensure you always remind yourselves that suicidal thought is simply the demon of depression talking.  Your life is waiting for the experience of Post-Traumatic Growth as you continue to heal.

To the citizens of British Columbia, all I can suggest is beware.  Try to remember the issues facing emergency workers, who without doubt will do their best to sacrifice themselves in terms of self-care to ensure the protection you will continue to dutifully receive.  We put ourselves last in this equation.  My brethren still live as I did, with the small improvement to an almost minimum wage to stand-by for you.  They live at the station, often for days at a time.  Covering sometimes both day and night, in order to attend to you through the darkness and fear of your need.

We've tried to ensure our workers in this industry are safe.  Without you, maybe busting down the legislature door on our behalf, power might continue to block any movement towards the adoption of Alberta's Legislation, which has already comfortably paved the way to improvements protecting more appropriately emergency workers and their families from psychological harm across Canada.  I hug my buddy every time I think of him, for accomplishing this on behalf of his own, fellow man.

I doubt our power-base wants a suicide landing as a burden on her already over-weighted shoulders.  I know the citizenry certainly doesn't want to have to live with anyone's suicide as blood on their hands.  Stay alive in BC.  All of you, for the worlds sake.  We deserve to walk with you proudly for the remainder of your long and eventually happy lives. 

I speak out here today, because I'm one of the lucky ones.  One of the many  with PTSD in public safety professions who've survived.  Compassion could lead both power and citizenry to avoid any unnecessary pain.  I can certainly tell all responsible for emergency worker safety in BC, such blood will no longer splash it's pain upon me.  Be Well.  Blessings.
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Further Reading

EMDR Canada: Information and Links to Find A Therapist In Your Area.

Announcement: Presumption of Illness for First Responders: Premier Allison Reford: May 4, 2012

PTSD and Emergency Services Workers: Alberta leads the way in creating presumptive legislation for workers’ compensation claims.

Fear: A Distressing Emotion.

Meet Your Brain Waves: Introducing Alpha, Beta, Theta, Delta, And Gamma: Finer Minds

What Is Rapid Rye Movement Sleep: REM?

Sleep: What It Is: How It Works: Why We Do It: What Can Go Wrong.

How Fear Works: The Fight-Or-Flight Response.

Stress Management for Emergency Responders - What Responders Can Do: Centres For Disease Control and Prevention: Podcast.

PTSD Research Quarterly: PTSD SLEEP RESEARCH: AN UPDATE Steve Woodward, Ph.D. National Center for PTSD: 2004.

National Sleep Foundation: How Much Sleep Do We Really Need?

Sleep Disturbances as the Hallmark of PTSD: Where Are We Now: American Psychiatric Association: 2013: Anne Germain, Ph.D.

Mayo Clinic: Tests and Procedures: Polysomnography: Sleep Study.

Stages of Sleep: Sleep Disorders Help Centre.
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Darren Michael Gregory.  August, 9th, 2014.  Darren Is A Community and Workplace Traumatologist, currently living in Creston, British Columbia, Canada.

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Understanding Trauma: How Stress and Trauma Cause Chronic Pain, Anxiety, Depression, & PTSD Video Courtesy of Musgrave Wellness & Performance