Question: What have you been taught about the importance of treating the sleep disturbances of your trauma patients?
Answer: If truly little, Putting Trauma to Sleep will provide you with what you need to know.
What is the link between trauma and sleep disturbances?This diagram provides you with an overview of the way that trauma impacts sleep. The autonomic arousal triggered by trauma activates the brainstem. These tightly packed centres collectively create the neuromodulatory networks that activate hyperarousal, supress sleep, and generate a complex array of trauma symptoms. The interactions between these brainstem centres are elaborated in full in Putting Trauma to Sleep
Where are threats of danger first detected? The brain’s alarm response to danger is only possible at the lowest brain level that can integrate all incoming sensory signals (visual, auditory, somatic) sufficiently to identify an external threat. In addition to identifying the threat, this centre must also be able to relate the location of that threat to one’s current location. The proximity of the predator, relative to self, is required to initiate an optimal survival response. This integration occurs first in the brainstem’s Superior Colliculus (SC). The SC integrates visual, auditory, and somatic stimuli to determine how critical, and how close, the impending threat is.
How does the Orienting Response activate a defensive response sequence? The SC effectively initiates a response to that threat with an orienting response. The SC orienting response activates the adjacent Locus Coeruleus LC and Periaqueductal Gray (PAG). The LC initiates both downward bodily shock responses as well as upward cognitive hyperarousal. The PAG initiates appropriate behavioral, defensive response sequences.
Where is the hub of the Hyperarousal response? The LC alarm reaction, with its dense web of norepinephrine (NE) activated neurons, spreads upward to all brain regions, and downward into the body. This integrated alarm response produces intense activation of all nearby brainstem centres including the Reticular Activating System, Dorsal Raphe, and the Orexin-Thyroid system in the Lateral Hypothalamus (LH). These brainstem centres both activate shock reactions, preparing the body for response to danger, as well as shutting down the organism’s sleep drive. Effective trauma treatment needs to be Sleep-Informed and target quieting the brainstem’s LC arousal hub.
How can this understanding of brain responses be applied clinically to my patients? All of these complex interactions have a direct impact on your patient’s sleep. In Putting Trauma to Sleep the reader is provided step by step interventions within the context of clinical cases. You will learn how to assess and treat patients with sleep apnea (Chapter 6), desynchronized circadian rhythms (Chapter 7), nightmares & intrusive thoughts (Chapter 8), severe chronic insomnia (Chapters 9 & 12), somatic distress (Chapter 10), and depression & brain fog (Chapter 11). The book provides a manual to clarify how and why the clinical interventions are necessary to reset these brainstem neuromodulatory centres effectively.