Insomnia is a hallmark of PTSD.
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Episode 002: Previously, we discussed the negative impact of stress on the brain. Specifically, we looked at how chronic increases in adrenaline and cortisol shrink the hippocampus and prefrontal cortex areas of the brain. This negatively affects stress tolerance and the formation of new memories.

In today’s episode, we’ll examine the components of success or failure in any endeavor: capacity, opportunity and motivation. We’ll use this construct to dive in to the effects of adrenaline and cortisol on quality of life, very often from the perspective of the PTSD sufferer as well so it’s more interesting to listen to. This intuitive approach will allow you to be better able to assess the strengths and weaknesses of a PTSD Recovery Plan – of your own design.

There is a dose-dependent effect that adrenaline has on nightmare experiences. The more adrenaline you have pumping through your veins, the more nightmares you will have. Therefore, the primary medical approach is to use the old blood pressure meds that block adrenaline receptors. It’s that simple.

Once in a while the prazosin, propranolol or clonidine used to treat nightmares lower the blood pressure too much – before we can get the dose high enough to knock out the nightmares. Prazosin is by far the number one choice in multiple studies. The average dose of prazosin throughout the VA health care system, for example is 15mg po total daily. Because it is used to treat nightmares, the dose is quite high. But that makes me consider that adrenaline may be responsible for lots of uncontrolled hypertension, but we’re not adequately considering trauma and PTSD in healthcare.    

I tell all of my primary care colleagues that will listen that they need to do good trauma assessments in all of their patient because, just like dementia and delirium, we’re terrible at knowing who has PTSD on our patient census.  I use the term “Adrenaline-Associated Sleep Disturbance” to better describe the neurobiological relationship between stress, PTSD and trauma-related nightmares.  I believe we are keeping our head in the sand when we continually separate the diagnoses of insomnia, REM behavior disorder, sleep paralysis, restless leg syndrome, PTSD, nightmare disorder and night terror disorder – without asking how they can all be linked together quite simply. Adrenaline appears to overwhelm the Globus pallidus enough to allow coordinated breakthrough contractions of skeletal muscle. You move when you sleep – when you’re biologically not supposed to. Therefore, therapies can’t call themselves holistic if they aren’t addressing ways to calm down the adrenal glands in order to improve sleep quality. No, we still seem to ask all the wrong questions.

PTSD symptoms occur in syndromes commonly

  • Cognitive Problems – decreased memory, short attention span,  forgetfulness, decrease problem solving ability
  • Mood Problems – poor impulse control, increased impulsivity, prone to instability, quicker to rage, then feels remorse or depressed after outburst
  • Social Problems – Increased sweats, panic, decreased socialization, increased isolation, loneliness, then hopelessness sets in

Therefore, when anger is incorrectly attributed a “my PTSD is acting up”, they’re referring to the end result of the medical changes that have occurred in the body. The pitfall to this way of thinking is that the victim stays a victim and lazily scoffs at the dozens of things they can do to help themselves.

Sadly, this also means that the cycle of Adrenaline-Associated Sleep Disturbance can be re-triggered from life events such as visiting a hospital, physical pain, anniversaries of trauma, near misses while driving, and even eustress.

News Flash: When someone refuses help, that’s not PTSD.

Now that you understand how adrenaline affects the brain and sleep, this is a good time to introduce the Success Factors for Any Endeavor: Capacity, Opportunity, and Motivation (COM). At any point in time, a person is in a different state of flux with these three areas – and using COM as a tool can quickly help you come up with solutions to problems. Because we’re always changing our state of being with reference to capacity, opportunity and motivation, any amount of investigation into how we’re doing with these three areas is referred to as assessing the “state” of affairs. States change, traits are more long-lasting modes. We’ll discuss traits in Episode 3.


Assessing states of being: capacity, opportunity and motivation

CAPACITY. The ability of the brain and body to rest is hurt by too much adrenaline and cortisol. The more the hippocampus and prefrontal cortex shrink in the presence of elevated adrenaline and cortisol, the more memory problems, mood dysregulation, and decreased stress tolerance occur. At this point, the capacity of the individual to achieve an adequate quality of life are compromised. Regaining a health quality of life involved attacking and reclaiming all of the different factors possible that go into improving one’s capacity to overcome trauma. This means that we’ll be talking about quality sleep, memory, cognitive function, nutrition, inflammation, and real physical exercise.

OPPORTUNITY. The opportunity available to a trauma survivor to get good treatment is limited, often by a lot of different factors. Barriers to care include transportation, money, bad therapists, geographic isolation, toxic relationships, and scheduling difficulties. The most common take-away from assessing the state of one’s Opportunities is to realize that we must all individually BE the opportunity to succeed in their healing journey. But Opportunity can also involve the relief that comes when you realize that you’ve never had the opportunity to hear the accurate information, get a good diagnosis, or even conceive that a holistic, health program for PTSD could actually exist – or at least be created with relative ease.

MOTIVATION. This is the most powerful determinant of success among the three. Extraordinary motivation, persistence, and a winning attitude can overcome dire circumstances in capacity and opportunity. Underdog stories like this are exceedingly common in PTSD lore and teach us the most about human limitations and the ingredients necessary for success. The PTSD Academy is an opportunity that reaches through the internet so that the geographical isolation faced by many is rendered obsolete. Taking a class and getting a certificate at PTSD Academy creates a PTSD-trained individual to go forth and combat stigma in your community. You will be able to better motivate individuals when you’ve gone on the journey yourself. Of course, this topic is much more complicated than bumper sticker psychology would suggest. Motivation involves all of personality development and, even under the best of circumstances, all of the life experiences that led you to your current beliefs and attitudes. You’ll definitely be hearing about Motivation hacks in the future.

By Doctor Dan

[veteran, physician, psychiatrist]

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