PTSD - Part 2 - edited and up-dated.

One of the symptoms of PTSD is nightmares, also called night terrors. These aren't your average run of the mill bad dream. They can leave the sufferer in an intense mental and emotional state that takes a while to recover from, even after the sufferer has learned how to best

Another symptom is sensory over-load. This occurs as the result of an extremely heightened state of mental alertness that kicks in most commonly when the sufferer is put into a dangerous situation, or just any situation the mind believes to be dangerous, such as waking up from a nightmare. It's usually worse when associated with nightmares and flashbacks as any real-life trigger can allow the suffer to have a better chance of finding something to ground themselves into reality with. Sensory overload is different for each sufferer. Some may find they can't focus on one sense, because they become over-stimulated by another. Others may just get an over-sensitivity to everything. My experiences with PTSD are more extreme than most, but are not the worst it can get. This is what it is like for me:

I wake up with a shudder and an overwhelming feeling of intense fear. My heart is pounding hard and fast, I'm breaking out in a sweat, I'm holding my breath, listening to every sound. My eyes are quickly focusing on what little I can see. My body is aware of everything it is in contact with. I can smell everything that can be smelled. With all this intense and hyper-vigilant sensory input I instantly and excessively become aware of my surroundings.

I'm in my bed, my room, my house. It's dark, but there's a little bit of pale distant light creeping in from a street light on the other side of the street. The moon isn't up yet and it's a clear night. There is no breeze outside. I'm laying on my side facing the window. My son is in his room in his bed - I can hear him gently snoring. My bedroom door is open but his is closed. My dog is asleep by the foot of my bed - I can hear his breathing as well. A neighbour has their air conditioner turned on. There are half a dozen cars driving through the neighbourhood, only one of which is within a block from here. There's someone walking casually across the road out the front. There's a small moth fluttering around at the window...

I feel no abnormal pain, though all my muscles are very tense and some are starting to push the boundaries of cramping. My stomach is in a knot and my throat is constricted tight. My arm isn't totally comfortable where it is and the bed could be softer. I've not been sexually active for a while. I forgot to brush my teeth before going to bed. I didn't brush my hair either. My scalp is dry. I've got a pimple coming up that's creating a tiny itch on my lower back. I need to shave my legs. There's a single grain of sand at the bottom of the bed under my foot...

There is a warm adult male body lying on the bed behind me. I realise who it is as soon as I'm aware he is there - instant recognition. I can hear his gentle sleepful breathing. Although he's behind me, I know he's laying on his back with his head turned towards me. I can feel his breath on the back of my head... just... and I can feel the skin and hair of the side of his right leg against the back of my legs and his right forearm is nestled against my back, his fingers are gently tangled in my hair. I can just smell his breath - and he had a cigarette and a drink of coke before coming to bed. I can smell his natural body odour, clean and fresh, showered only a couple of hours ago and he used my conditioner...

No one else is in the house. I slowly release my breath and try to relax. I'm safe. I became aware of all this within seconds. If I awake normally, it takes me a minute or two at best to figure out which way is up. But right now, I'm hyper-alert to an extreme and it takes me a minute or two to settle down and start switching off my awareness of the things around me. I force myself to numb out my senses and eventually the only things I'm aware of is the darkness, the body beside me, and my bed.

I get up. My hair pulls a little as I had forgotten it was tangled in his fingers. I stumble across the room in the darkness and fumble around to open a door that is already open. My senses have mostly returned to normal and my heart rate is gradually coming down. I'm breathing more normally now. The nightmare is over. My fear ever so slowly starts to fade, but it will take a little bit longer yet. If I lay in bed and try to relax back to sleep I will end up just waking up again in the same way. I need to totally shake myself free of all the fear, all the over-sensitivity, and get myself feeling tired again. This is why I'm getting up for a little bit. I am far too awake.

Things would have been so much worse if, in those first seconds I noticed an unfamiliar sound, sight, or smell I didn't instantly recognise. I would have remained terribly fearful, became paranoid, and the hyper-sensitivity would have overwhelmed me and I could have ended up having a flashback, taking me into a twisted blend of now reality and history. Even without a flashback, I would have been useless as with so much sensory overload, I can become disorientated, confused, and able to react no better than if I was aware of nothing at all. But it didn't happen. It was a normal quiet night.

The nightmare wasn't of some boogie man or a fear of something that might happen. It did happen. It was 20 years ago, but it was a total re-living of an event, second by second, every emotion, every physical sensation, every smell, sight, sound... it was all real and I was re-living it all over again... only this time I was asleep and it was my brain that was making it happen. As I awoke and realized the reality of now, the nightmare rapidly vanished and as I stumble out of bed I can't even remember exactly what it was about... though the fact that I can't seem to shake the sense of over-sensitivity in my feet is a good indication. I can feel every speck of sand, every bit of dust, every grain of wood in the bare floorboards under my feet.

I wander out the back, tentatively pat the dog who has followed me out, grab a glass of water, and sit out the back and relax myself in the cool darkness outside. I relax a lot better and a lot faster outside. Not many bad things have ever happened to me outside, that's why.

My mind is racing with a million thoughts and emotions. I struggle to get them under control and I deliberately start to concentrate my thoughts onto one subject: what I can post on Minti later has become common. This lets me get my mind onto something logical, something I can plan, no emotional attachment, no complications, just nice calm cold logic that focuses on the now and the near future.

The fear fades away. I'm still a little tense and agitated though. With others asleep in the house, I don't want to disturb them, so I pick something quiet to do that will allow me to better relax and wind-down inside the house. I get on the computer for a little while and do some work on antoher Minti Advice I've been working on. When I have reached the point where I could go back to bed and go back to sleep, I do so.

I could take sleeping tablets, but although they may do well in getting me to sleep, they won't necessarily keep me there... and if I was to take another dose after every time I woke up I could end up taking them 2 hourly, and overdose. They can also become addictive. Lastly, although some sleeping tablets may do better at keeping me asleep, if I do wake up with a nightmare, my senses don't kick in so well because of the chemical-induced drowziness and in being unaware of my surroundings I'm more likely to end up in a flashback... and that is a far worse symptom to suffer. I'd rather just deal with a bit of sleeplessness than the negative effects of taking sleeping tablets. Though, I do keep my supply of prescription medication so that if I do need them in desperation I can use them.

This is one reason why I can be found awake at odd hours. This is one reason why I can be tired, or sound asleep, when I'm supposed to be awake. This is why I can never sleep well - if at all - if I'm not in a familiar place. And it is a contributor to my hyper-activity, as sometimes this hyper-sensitivity and excessive alertness can hit me when I'm awake as well. On the other extreme, when I'm not like this, I can be so totally switched off that I wouldn't notice something if it hit me as I can suffer sensory overload and become disorientated and be unable to focus on any one thing, consequently becoming unaware of just about everything. Sometimes being too aware of things but not totally overloaded, can prevent me from staying still and focusing on anything, and I can end up mentally fluttering around and constantly on the go, trying to do everything at once, like I've got a bad case of ADHD.

These symptoms are a horrible thing to live with, and it's only one small aspect of having PTSD. Though in understanding what happens and why, it does make them easier to deal with - both for the sufferer and those close to them.

We aren't necessarily off with the fairies, we might just be having a bit of an overload at the time... or maybe we're tired cause we didn't sleep properly despite staying in bed for 12 hours or more. We don't just have the boogie man nightmares that most people have.  We can't just tell ourselves it's all not real and can calm down and go straight back to sleep... because it was real... too real... and it might not be happening now, but it once did and for a little bit there it sure felt like it was still happening. It is stressful, it creates a lot of tension, and it is infuriating when someone with good intentions who has no idea what it can be like says, "It's just a nightmare, it's not real, calm down and go back to sleep."

It also makes it hard for some people who don't understand us to tolerate us; never knowing where we are coming from or where we are going, watching us running around in circles all day getting nothing done, being awake and asleep at odd times, and being scatterbrained and tense too often can be hard to live with I imagine... I can only imagine as I've never lived with anyone else with this condition, but I've been told what I can get like. I laugh now and just leave the room for a while when someone tells me, "For crying out loud woman, you're exhausting me just watching you, stop and sit down and rest for a few minutes!"

This is what it is like for me. As I said in part one, it is slightly different for everyone. Some people won't have nightmares at all, others, particularly children, may wake up screaming 5 times a night. What may make a huge difference to a PTSD sufferer with regards to dealing with these nightmares is how they react to them and how other people close to them react. Like I said, it's not a normal nightmare, so the sufferer may need a bit of extra time to calm down and get back into the reality of now rather than the reality of then, as the concept of 'it isn't real' doesn't always gel so well. Relaxation techniques help a lot, as does a a calm, quiet environment that is well known to the person to be safe and familiar.

The hyper-alertness is simply something that the suffer needs to learn how to relax out of. They need to be able to learn that there is no threat, they have nothing to fear, and there is no need to be so on-guard. This can be difficult as it is a problem that can only be solved over time and with a lot of patience. Being told to "calm down and relax" when in this state is like telling someone going through chemotherapy to hurry up and get well again. Sure, they can do it, but it isn't going to happen just because you told them to do it. Learning there is nothing to fear may seem easy, but try learning to never feel afraid of anything... it's an emotion, and emotions don't just go away because we want them to. Getting frustrated at the sufferer will probably only frustrate them, and that creates a nasty spiral effect of stress breeds a greater reaction, which breeds more stress... etc. Again, a safe, familiar, calm and quiet environment is the best starting place.