Normally, after a long night on guard duty at Fort Drum in upstate New York, Melanie Pote would have been first on line for breakfast at 07:00. But that morning in March 2002 was anything but normal. Pote, 18 months into her U.S. Army service, had lingered at her post a bit before heading for the mess tent, where several others had already assembled for chow.<\/p>\n\n\n\n
That’s when it happened: During military exercises, two artillery shells\u2014each one capable of destroying a tank\u2014fell short of their target and came hurtling toward the tent. They hit, sending a storm of searing shrapnel everywhere.<\/p>\n\n\n\n
The soldier at the front of the line\u2014Pote’s usual spot\u2014was killed instantly, while she was thrown through the air. Still conscious, she spied a sergeant contorting in pain and came his way, trying to help. She hadn’t realized that she, too, had been hit, with two pieces of shrapnel in her left leg.<\/p>\n\n\n\n
After being treated for her wounds, Pote healed physically. But Post Traumatic Stress Disorder (PTSD) soon set in, interfering with Pote’s daily life\u2014and her nightly life as well, wreaking havoc on her sleep.<\/p>\n\n\n\n
\u201cI had a constant feeling of dread, walking around with tightness in my chest and heart palpitations,” Pote recalls. \u201cI’d go to bed and wake up every hour on the hour, never able to rest soundly. There were horrible nightmares\u2014I’d be having flashbacks in my sleep.” It was as if Pote might never feel normal again.<\/p>\n\n\n\n
Way back when, veterans struggling with symptoms similar to Pote’s would be said to have \u201cshell shock” or \u201ccombat fatigue.” But in 1980, PTSD was officially recognized by the medical establishment as a mental disorder with specific, reliably diagnosable symptoms.<\/p>\n\n\n\n
According to the National Institutes of Health, PTSD is associated with changes in brain function and structure<\/a>. The symptoms may be subtle at first, with more severe symptoms not emerging until months after the traumatic event.<\/p>\n\n\n\n Veterans are by no means the only ones to experience PTSD; the condition has been associated with survivors of sexual abuse and other violent attacks, as well as severe weather events such as hurricanes, for example.<\/p>\n\n\n\n Those in the military, however, may be less likely than others to seek treatment. \u201cThe first thing I heard after the event was ‘drive on,'” Pote says. \u201cSo I stuffed it down. But I wasn’t really able to do that, and that started my trouble.”<\/p>\n\n\n\n Pote was hardly alone in her attempts to ignore her pain.<\/p>\n\n\n\n \u201cVeterans with PTSD have difficulty letting go of the ‘soldier mode,'” says Daniella David, MD, chief, psychiatry service, and PTSD program medical director at the Bruce W. Carter VA Medical Center and professor of clinical psychiatry at the University of Miami Miller School of Medicine.<\/p>\n\n\n\n “Their brains\u2014and specifically the limbic system\u2014are consistently on alert for danger,” she explains, adding that while “most of us are able to decrease alertness in order to fall asleep, veterans with PTSD\u2014many of whom experienced disturbing situations at night\u2014have difficulty doing that as their brain tells them this is not <\/em>a time to relax.”<\/p>\n\n\n\n As a result, veterans with PTSD often experience a host of sleep-disrupting symptoms. \u201cInsomnia<\/a>, delayed sleep onset, and difficulty falling back to sleep upon waking are all related to the hyperarousal symptom cluster\u2014not being able to relax enough to fall asleep,” David says.<\/p>\n\n\n\n And when sleep does come, it can be anything but restful. \u201cTrauma-related nightmares are a form of intrusive re-experiencing of the event and can lead to startled awakenings\u2014suddenly waking up with heart racing and feeling sweaty, shaky, and disoriented\u2014and full-blown nocturnal panic attacks,” says David. \u201cPatients with PTSD may experience sleep paralysis<\/a> [the inability to move upon waking from a nightmare] or REM Behavior Disorder, where they act out on their dreams, possibly attacking a partner as they dream they are fighting the enemy.”<\/p>\n\n\n\n Related: Exploding Head Syndrome and other lesser-known sleep conditions<\/a><\/em><\/strong><\/p>\n\n\n\n Fortunately, there are various treatment options for PTSD\u2014including two specific sleep-focused therapeutic interventions:<\/p>\n\n\n\n Some medications prescribed for PTSD are not without side effects or controversy:<\/p>\n\n\n\n Clearly, there is no single treatment path for a condition as complex as PTSD and its sleep problems, but sufferers are encouraged to try different techniques and therapies. For Pote, who \u201cstuffed it” for more than a dozen years, a combination of approaches\u2014one traditional, one alternative\u2014was the charm.<\/p>\n\n\n\n \u201cI started seeing a counselor who wanted me to talk about the event and how it affected me,” she says. \u201cWhen I finally did, she had to kneel next to me while I spoke about it; I was so shaken up.”<\/p>\n\n\n\n Talk therapy was helpful, she says, because \u201cI could look at it instead of let it simmer, and that took some of the weight off my shoulders.” But her symptoms persisted\u2014until she heard about Transcendental Meditation<\/a> (TM).<\/p>\n\n\n\n Though skeptical initially, Pote began practicing the form of silent mantra meditation daily, and after just two weeks, \u201cit came at me in a flood: The sense of dread and chest tightness were gone, and I was actually able to sleep,” she says. \u201cTM gives you a sense of calm that lasts past the meditation activity into your regular life.”<\/p>\n\n\n\n Now a tattoo artist based in Atlanta, Pote says, \u201csometimes I work crazy hours, but when I sleep, I sleep soundly at last.”<\/p>\n\n\n\n Having come out on the other side of PTSD, her perspective may help those still in its grip. \u201cWhen you’re ready, talk about what happened,” she suggests. \u201cAnd don’t brush off something like meditation<\/a> because it sounds strange.” An open mind can lead to a whole new normal of peaceful days and restful nights.<\/p>\n\n\n\nTreatments for PTSD and sleep issues<\/h2>\n\n\n\n
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PTSD and sleep: finding what works for you<\/h2>\n\n\n\n