Show Notes:

You guys, we are back and talking some more about early indicators for trauma and stress-related injuries that are common to front line workers. We’ve been talking about how important it is to be familiar with what to look for in yourself and those around you, so you can catch things early and ensure your wellness. For your sake, for the sake of the job you love, and for the sake of those who love you. This is crucially important stuff you guys, believe me, I know – because it’s what every client who ends up in my office for stress-related injuries says they wish they had known and done more about sooner to prevent having to get so deeply caught in it, where the impacts are incredibly damaging to them, their families, their potential to continue in jobs they have loved, and so much more. I have these conversations every single day, and I don’t want you to end up in an office like mine having the same regret-filled conversation if you don’t have to. 

We’ve talked about what to watch for around hypervigilance and dissociation and today we are talking about nightmares and flashbacks. 

Now, many people who think about traumatic nightmare and PTSD-related flashbacks likely think of what we see in movies – really intense experiences that make you wake up in a cold sweat or knock the wind out of you while engaged in some totally mundane task. While this can be what nightmares and flashbacks look like when traumatic stress has really taken hold, they aren’t the early indicator presentation, and that’s what we really want to focus on for today.

Before nightmares ramp up to the level of cold sweats and screaming in your sleep, they begin with less intensity but should be an early alert that something is up for us. Let’s talk for a minute about what sleep and dreaming is all about, and that will help us to better understand why and how nightmares play a role as early indicators around our wellbeing. 

When you sleep, your brain begins a really important task called consolidation. I tend to think of this process, kind of like the mail room in a busy law firm on TV shows like the Good Wife. When you go through the day, you have a constant stream of input – data that is coming into your brain. Some of it is important, a lot of it is pretty meaningless, but your brain won’t necessarily know what it what until time has passed. For example, your brain might be aware of tree branches blowing outside your window while you are talking to your spouse or kids – and generally that input of the branches blowing would be pretty meaningless and unimportant…unless one of those branches suddenly broke and blew through your window…suddenly that background noise peripheral input becomes vitally important data that your brain is able to bring to the forefront and use to enact action to duck out of the way. Think of each piece of data – noises, visual input, smells, and so on – as a piece of paper in that busy mail room. By the end of the day it has amassed and there is a ton of material to sort through. 

Your brain doesn’t have time all day to deal with organizing and sorting all of that material, it’s too busy dealing with the next bit of input coming in and working to determine if, in that moment, it is background or foreground information that you need to interact with. So, in the quiet of night when your brain gets to tune out it’s high degree of perceptive awareness of things like sights and sounds, it goes to work dealing with the mass of material you collected that day. Again, think of the mail room and workers sorting through papers – deciding what goes where. Does this need to be kept? Do we need it soon, like a presentation I have to give tomorrow? That might go into our short-term memory stores. Or do we need it for sometime further in the future? That might get put into our long-term memory bank. Is it something that is related to our survival? That needs to be kept locked in an air tight safe in our trauma center. If it doesn’t need to be kept, maybe it can be shredded and forgotten. 

During the night, while you sleep, your brain is busy working on this sorting and filing process, scrutinizing each piece of data. And your brain, wired as it is for imagery and stories, tends to create visual representations and narratives – like shadow puppets of the things it’s working on. 

Imagine that your brain pulls up something about your day that was stressful with your partner, deciding what to do with it, while also pulling another file up of a movie you watched starring some hot actor or actress…suddenly in your dreams you are having an argument with Brad Pitt who is your husband but obviously Brad Pitt isn’t your husband. Your brain smushes the shadow puppets together and concocts stories that often make very little sense when we wake up, but while we’re in it feel like they make perfect sense. 

Psychology has a long history of “interpreting” dreams. I will admit, this isn’t something I do, but the idea is that we process symbolically through our dreams. In some ways we have common symbols that tend to mean common things in what we are trying to make meaning of; but at the heart of it what’s happening is that our brain is combining symbols of various things it is processing and trying to sort through simultaneously and then working to tell a story with it…because that is what our brains love to do. Why do you think we love fiction books and fantasy films and TV shows with intricate plot lines? We are wired for stories. From the beginning of time, people have told stories to translate key information. We have documented stories in pictographs and then written word. It shouldn’t be surprising that our dreams would be marked by story-making.

The thing about early indications of stress, is that we might not be finding ourselves recalling explicit nightmares of detailed events that reflect what we’ve been through. At the early stage, it will likely be less obvious than that. It will show up as more restless sleep – you might get feedback about that from your partner or from your fitbit, or just feeling more fatigued in the mornings. It will show up in dreams that feel more active – not necessarily intense nightmares, but dreams that circle around themes like helplessness, powerlessness, being chased or chasing after something, or other distressing kinds of feelings in the midst of the dream. These might gradually rise to the level of nightmare – again, perhaps not specific nightmares that re-enact the exact details of a traumatic lived experience, but images and stories that reflect fear, helplessness and horror. 

The difficulty of nightmares – whether on the mild end or the intense end, is that they happen when we feel powerless to do anything about them. We can feel the victim of what is happening in our sleep. And this can give rise to a totally new problem, which is that this then builds a relationship to sleep that feels victimizing. It can lead us to stay up later, feel more anxious about going to sleep, use things like leaving a light or TV or music on – intended to bring distraction and comfort but also adding a dimension of ongoing input your brain is having to wrestle with attending to while desperately needing to turn this off to be able to focus on its job of consolidation. It can become a vicious cycle, because as we delay, avoid and degrade the quality of our sleep, we also give our brain less room to work with to do the consolidation job it can ONLY do while you sleep. That means that over time, there will be a backlog. You brain won’t be able to get through a day of material during the night, so it will hold it over for tomorrow night, and so on and so on. Add to that that you are in a job whe...