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HD Dreams and Stranger Things: PTSD and Sleep

Those that have followed me on this site for any length of time know that I have been dealing with PTSD since my return from Iraq in 2008. I have written extensively about it including times when I was not doing well at all. Just take a look at some of my articles from 2009 and 2010 and you can see how bad I was doing. I have occasionally likened my dreams to the character of Binkley in Bloom County with his “Closet of Anxieties.”

I am like thousands of other active duty, reserve, retired military personnel or veterans  that suffer from PTSD related to my time at war. When I started treatment in 2008 one of the things that my therapist asked was if I thought that I could talk about my condition. It was a scary thought because there is where we like to admit it there is a stigma attached to PTSD and other psychological conditions. At some point I decided to say “what the hell, I’m going to talk about it.” That was really a big part of why I started writing on this blog. Since then I have been able to share my story in a number of venues and have had a lot of people contact me, many to share their stories and simply to offer either thanks or support. There have been a few knuckleheads but what amazes me is how many people contact me and how many military personnel or family members deal with the same things that I have faced.

I am hyper-vigilant as hell and there are a lot of places that I don’t feel safe. I still have bad days and there are plenty of times that I get in situations, like doing through airports, malls, Wal-Mart and sluggish traffic where I really have to fight anxiety and panic. The sight and smell of smoke and brush fires and sewage send me back to Iraq. The smell of death, which I still occasionally deal with has its own dread quality. Certain types of vehicles, aggressive drivers and debris on the road can send me back to Iraq. I can attribute a number of speeding tickets and an HOV violation to flight or fight responses in traffic.

Loud noises, screams, explosions and numerous other external and unexpected stimuli can trigger one hell of a startle reflex and anxiety. Tonight I was walking Molly down to the beach, a normally peaceful experience when an unexpected loud scream and crashing noise from a beach house startled and scared the hell out of me. That is not normal for my neighborhood. Thankfully Molly was there to protect me and her unflappable reaction was reassuring.

I am also unsettled by the political vitriol in our country, especially that stirred up by preachers because I have seen the results of such vitriol in Iraq and the Balkans. When I read or hear about the killings of US or NATO personnel by supposedly friendly Afghan “partners” I have a hard tome sleeping. I spent my time in Iraq traveling and doing a “circuit riding” type ministry with US Marine Corps and Army Advisors to the Iraqi Army and other security forces.  I look at some of those times and it causes me to think of just how easily I could have fallen victim had any Iraq Soldier or Policeman turned on any of the small groups of Americans that I was out with. But it is night when things get weird.

One of the things that I deal with is chronic insomnia. I used to be a very good sleeper but a few months into my time in Iraq I found that I wasn’t sleeping. So for about five years I have had very few good nights of sleep despite numerous attempts by doctors to help with sleep and anxiety meds. Those help sometimes but have side affects. On duty nights when I might be called in to the hospital I can’t take my meds because I want to be able to drive the 23 miles to work down a rural state highway.

Since Iraq my dreams have become rather HD, or High Definition involving some quite terrifying blends of Iraq and other parts of my life. I know that Judy and our dog Molly have been been awakened by me screaming or fighting the things that I battle in these dreams which are often nightmarish. Even relatively benign dreams have the DH quality now.

When I was in Houston a couple weeks ago and staying in a hotel the dreams were quite disturbing. Somehow not being in a familiar setting is bad for my sleep. But even the least disturbing was a dream was rather startling. In the dream I was sitting between the stands and the left field foul line at a major league game about 50 feet from 3rd base. I woke up when dreaming of diving for a baseball I ended up on the floor. I have to admit that the outfield grass was the lushest and most beautiful that I have ever seen. I don’t think that the left fielder and third baseman appreciated me being in their way when tracking down the pop ups and line drives hit towards me in the dream.

Thankfully though startling that dream was benign.  I find that the dreams of wounded Marines and soldiers in Mass casualty situations, night convoys with small teams of advisors, patrols and getting shot at on occasion that are the ones that really get me. When they are intermingled with current life events or other parts of my life in HD it is quite terrifying.

The dreams are almost like horror movies that you can’t leave. I have woken up from a dream, gone back to sleep and have the same dream resume. Other times I cannot go back to sleep.

I wondered why and a few weeks ago I was able to get evaluated with a QEEG or Qualitative EEG. Basically it is a brain map that tracks responses to various stimuli. Some of that testing is done with your eyes closed to see the differences in how the brain works when there are no visual stimuli. Before I had the test I spent a couple of session telling the doctor what I was going through and he would tell me what part of the brain that was affected. When I took the test it showed in graphic form what was going on and validated what I had been experiencing for these past five years.

Normally when people close their eyes they can relax. I used to be able to do this, but it has been a long time. The results of the test showed that unlike normal people when I close my eyes my brain basically goes into overdrive. The doctor remarked “no wonder you can’t sleep and have such vivid dreams.”

I have another couple of evaluation sessions before I begin EMDR and or Biofeedback therapy. For the first time in a long time I am hopeful that I will get some relief and improvement in my condition that may actually help me get off some of my medications. That would be nice. Normal sleep and a decrease in the HD dreams and nightmares would also be a good thing.

Thank you for your prayers and kind words. It has been a while since I have written about this in any detail and I hope as always that what I share will help encourage others suffering from similar issues and hopefully encourage and educate those that have to live with them. Believe me, it has not been easy for Judy.

There are resources available and one that I recommend for those that are dealing with PTSD is the Real Warriors Campaign http://www.realwarriors.net. I also recommend Doonesbury’s The Sandbox http://gocomics.typepad.com/the_sandbox/  Both sites allow military personnel to share their experiences. There are numerous other resources and if someone asks I will gladly post some others. I do have a link to the National Center on PTSD on the site.

Peace

Padre Steve+

 

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PTSD²: Learning to Live Together When Both of You Have PTSD

Judy and Steve[1]_edited-1The Abbess and Me

The Abbess and I have been married 26 years.  We have dealt with PTSD for all of that time. Now we did not always know this was the case, not until she received the diagnosis back in 1989 and even then we did not really appreciate the effect that it was having on her and us.  She has written a wonderful piece over at her place, the Abbey Normal Abbess’s Blog entitled “The Abbess talks about a household with PTSDwhich I have linked here:  http://abbeynormalabbess.wordpress.com/2009/09/18/the-abbess-talks-about-a-household-with-ptsd/

Any regular reader of this website knows that the host, Padre Steve deals with PTSD, a gift that he brought home with him from Iraq.  There are a decent number of articles here that reference my struggles in coming to grips with this, how it affects me and how I am working with Elmer the Shrink to figure this surreal, confusing, illogical and sometimes frightening mess out.

Now before I came home with PTSD and actually figured out what the hell was going on with me and why I was falling apart I had little understanding of what the Abbess was going through.  She suffers from childhood PTSD, abusive father, generally un-protective mother who probably had her own childhood abuse issues going on and a sister who physically abused her.  She also was traumatized when she was between two and three years old when a Doctor removed a cyst from her face without anesthesia, that is one of her earliest memories and for many years caused her to fear going to the doctor.  When we started dating the family was probably in one of their more peaceful states but there were plenty of times where I saw some scary shit going on.  At the same time the Judy that I knew was the confident young college student, gifted artist and President of the Delta College German Club with a vibrant faith.  There were hints back then that she was damaged by her family of origin but I just took it as something that she would simply grow out of.  I had read about PTSD in Vietnam veterans but kind of brushed that aside and had no idea that someone who had not been to war could suffer from PTSD.

After she was diagnosed with childhood PTSD neither of us really knew what to do with it and most of her therapists did not deal with it and instead focused on depression and one even tried to diagnose her and turn her into a sufferer of Dissociative Identity Disorder the diagnosis formerly known as Multiple Personality Disorder.  That was a fiasco brought on by “Christian” therapists who tried to find demons in everything.  Of course if there were demons involved or Satanic ritual abuse that made it easy, you didn’t need to deal with the PTSD or any of the psychological components to what was going on.  I think that these therapists, one of who is now famous for his diagnoses of former NFL star Hershel Walker did great harm to Judy and others in making a psychological diagnosis based on unsupportable “spiritual” causes.  These spiritual “causes” were not based on fact, but rather the therapist’s suppositions which were based on conspiracy theories   usually involving how police worked with satanic groups to conduct satanic rituals and then return the victims to their homes.  If we know what we had known now we would have made a malpractice suit against the therapists and pastoral counselor involved in Judy’s treatment at the time.

It was not until I was on active duty in the Navy that a therapist began to work with Judy’s PTSD.  Even still with her getting treatment I was still learning how to grapple with all the reactions that I had seen for years because to me they were still not logical.  I am a methodical and logical person and if you know anything about PTSD you quickly find that much of what happens to a person has nothing to do with logic, but what the brain and the nervous system are doing and not how a person is deciding to act at a given point.  So when Judy would startle or have some kind of meltdown I would try to counter with logic.  This to my surprise never worked and I was always left frustrated.  Over the years I became a bit more understanding but still would have trouble with the severe startle reflex as well as the occasional meltdowns which over the past couple of years have gotten to be less severe because of a conscious effort to help her work through her PTSD symptoms and become more aware of what was happening and triggers.

Doonesbury ptsd-pmsPMS -PTSD Judy’s Best friend said to me “You’re a girl now”

Then I went to Iraq and came back with PTSD with all the trimmings.  I think that she started figuring it before me so when I finally crashed on June 16th 2008, I do remember the date well, she was not surprised when I came back and told her that the doctors thought that I had PTSD and were referring me for treatment.  The good thing for me was that they did not refer to the Psychology or Psychiatry clinic but to the Deployment Health Office where I met and began to work with Elmer the Shrink.  My first visit to his office I got a copy of the Doonesbury book dealing with coming home from war and PTSD.  I laughed and cried all the way through the book.  Until I went to Iraq I had never been a big fan of Doonesbury but I really appreciate it now.  Military.com has a link to the Doonesbury at War series which I find quite nice to have.

http://www.military.com/warfighters

I appreciate the help and understanding of people that I work with.  That helps; I don’t have the sense of abandonment and isolation that I experienced the first 8 months that I was back from Iraq.  I think that my medications are getting managed a bit better as well.  One thing that is hard to understand when you first start getting treatment is that you are kind of an experiment in progress as the doctor’s figure out what works and what doesn’t work.  This I think can be very frustrating to people who want “fixed” right now.

doonesbury ptsd onsetSome of my dreams get pretty physical

Before I went to Iraq she was the more observant one of us.  Now I am the more observant. The one value of PTSD that I don’t really want to lose is my awareness of what it happening around me.  It has I’m sure been more help than hindrance getting me out of dangerous situations quickly because in many cases I sense things even before I see or hear them.  As I have pointed out in other posts this has come in handy especially in our nutty Hampton Roads traffic and the “kill or be killed” mindset that you have to have to survive on I-64 or I-264.  While I like the ability to do this the startle response that I have now is really annoying.  We have a phone in our house that the ringer sends me into orbit.  If I am sitting in the living room when it goes off it scares the absolute shit out of me as it does Judy.  It is interesting to see both of us almost jump through our asses when that damned thing goes off. Inevitably it is the damned Rite Aide Pharmacy automated line or a equally damned telemarketer that does this.  Other loud noises get me.  I was driving to work and there was a vintage Chevy Camaro just ahead of me and in the adjacent lane to my right. It was still in that morning twilight when the Camaro started backfiring out of its twin exhaust pipes.  The backfire sounded like a burst of semi automatic weapons fire close up and the flashes from the pipes looked like muzzle flashes.  Other unexpected loud noises get me as does the sound of helicopters, especially at night.  I don’t do crowds well unless they are at a baseball game.  I went to do the invocation yesterday at the Norfolk Naval Shipyard to kick off the annual Combined Federal Campaign.  I was expecting a small rather sedate event.  It was nothing of the sort.  There were at least a couple of hundred people in a relatively small auditorium, a band, reports and photographers, a color guard and drill team from a local ROTC unit even balloons and banners.  The noise and light, many moving pieces gave the event a pep rally feel which drove up my anxiety level pretty bad. I was able to keep from having a panic attack or a meltdown, but it took work not to fall apart especially with the week that I had had and the fact that in the previous 31 hours I had only 3.5 hours of sleep.  I don’t like my outbursts of anger which can border on rage depending on the sense of danger that I feel although some expressions that I have come up with in these events are pretty funny as I question the parentage and oedipal tendencies of some people.  Anxiety, tremors, muscle tension, insomnia and nightmares are no fun either.

I guess for me that the war is not over and I know that if I was to go back I would do just fine. I almost think that another deployment to either Iraq of Afghanistan would help me in some ways. I guess I might get another shot at it as things continue to develop over there.  Personally I think I need it to close the loop and one day when peace comes to Iraq to go back there to visit some of the Iraqis that I got to know while there.

Dundas at HitSomehow I was More Relaxed in Iraq than I am Here

So now I am much more understanding of what Judy has lived with since childhood.  She has been a help to me in understanding my struggle as well and what I have experienced has helped me have a lot more compassion and understanding for her.  The only one without PTSD is our little dog Molly so it does make for interesting living around our little household.

Peace,

Padre Steve+

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Filed under iraq,afghanistan, PTSD

The Art and Science of Staying Awake and Going to Sleep When You Have PTSD

“The blood level in my caffeine is getting too high” Woody Paige on ESPN’s Around the Horn

opus coffeeToday: 3 24 Ounce Cups of Southern Pecan Coffee with French Vanilla Creamer and Splenda

Which came first the chicken or the Egg McMuffin?  That is the type of life I have when it comes to a little thing that you never notice until you can’t do it…something called sleep.  Today is one of those days where the inner Chinese kids, Yin and Yang are trying to get themselves into some kind of equilibrium, or maybe even equilibriumnumnum after a pretty rough week and a night on call at the medical center.  As usual my insomnia and anxiety have joined their ever loving hands together to ensure that I have had less than optimal sleep.  Yesterday’s on call duty and that of last night was fairly relaxed.  I had my new residents with me getting oriented to pulling duty and I have to say they are a fun bunch. We have two Americans and two Canadians all with great senses of humor and all who have had some kind of combat tour.   I actually like being around them which I cannot say of everyone that I have worked with in 28 plus years in the military.  They are a joy.  Likewise I love being around the hospital staff doing my rounds at night and to top things off there were no tragedies.

This being said I still could not get to sleep last night which kind of tops off a week of crappy or too little sleep.  Love them or leave them crappy or insufficient sleep over a long period of time beat the hell out of you.  I know, it has me and to make an astute observation it makes me tired.

My battles with insomnia began about a third of the way into my Iraq tour. When we came back from a mission I would go to my “Can” and just sit awake either reading, playing chess on my computer or going out and watching the Dustoff helicopters coming in and out of the Surgical Shock Trauma Platoon helipad or looking off to the perimeter to see illumination rounds lighting up the night sky and hearing occasional gunfire and explosions.  It was incredibly hard to get to sleep no matter how tired I was.  That continued the whole tour and got worse.  Part was the late night flights that we so often took, part the danger that we faced and part the conditions that we slept in. At one FOB in Ramadi we stayed in an old trailer that we could hear the rats chewing on the ceiling. When we had to stay in Al Asad to catch a morning flight after having flown in our tents were near the flight line and F-18s flying in and out all night do not make for a quiet and restful night’s rest.  In some of the more remote FOBs the isolation and vulnerability made it hard to rest.  I think that it was about two-thirds of the way through that the dreams and nightmares started.

Doonesbury-082108Too True I can Relate

Having talked to others with PTSD or other combat related injuries of the brain and nervous system I find that I am not alone and most of us are mid-grade to senior career officers.  It’s kind of weird because when you are young in the military you are taught just to “suck it up” and as you go through your career you tell others the same thing until it happens to you. Thus for us old guys I think PTSD is actually harder than for young people because it destroys our world view and our tough personas which most up us have cultivated over a long period of time.  My friends and I share the same or similar experience and we all are trying some way of managing it.  All of us have some drugs, the legal kind of course to help us with anxiety, panic, depression and insomnia.  However there are times when the drugs don’t work as well as they should, or they need to be adjusted or changed.  In those times you still have to find ways of getting to sleep and for the times where you can’t sleep ways of keeping sharp so you can stay in the game and not screw anything up.

bean church 1Staying Awake

Some guys I know have added to the mix other kinds of over the counter drugs and supplements.  I don’t do that, not that there’s anything wrong with it, but I guess I never grew up.  I like my medicine whenever possible to taste good.  Thus my self-medication is limited to caffeine and really good beer.   My choice in caffeine is coffee which I have been drinking since I was 12 and I believe that by my junior year of high school Navy Junior ROTC my index finger was beginning to mould itself into the shape of a coffee cup handle.  With caffeine there is little moderation because since I don’t sleep I need to stay awake.  My alcohol consumption is moderate and I don’t drink hard liquor.  I always try to maintain the Yin and Yang of the blood to medicine to caffeine and alcohol at some kind of balance so I can get to sleep and then not be exhausted the next day.  I make sure that I don’t mix alcohol with my meds since I don’t want to do the Karen Anne Quinlan thing and end up in a coma, and end up in a broccolitative or asperagative state (I don’t do just any vegetables thank you).  However I know guys who have a lot heavier load of meds than I do who have no problem ingesting them and alcohol close together and most of these guys don’t just drink limited amounts of beer.  I’m quite happy not to be there and mixing meds and alcohol.  So for me the equation looks like this.  Please note I am a historian and not a mathematician and that since this is a new field of study for me that it does not yet factor in sleep quality:

Drugs- caffeine² ± beer÷ “defensive factor” (anxiety+ hyper-vigilance) + normal work and life stress ÷ spirituality factor² = sleep

Now also since I am a Priest and Chaplain there is the spirituality factor which is hard to quantify but can be stated very simply “Please God let me sleep + have I been to a baseball game.”  This is hard to quantify but I have given it a numeric value for the sake of argument. Now I’m not a mathematician by any means but this seems to work somehow.

axieties and dreamsYep…Them Iraqi Snorklewackers Show up Often

Now back to me and the guys I know who struggle with this.  Pretty much to a man we all still manage to do our jobs.  In fact we all love what we are called to do which probably helps us as far as the management of our situation.  Many of the folks I know are like me and if we had the chance would go back to the fight.  You put us together with men and women who have similar experiences in combat and we are in our element, there is a shared brotherhood because of the real dangers that we faced.  However that is not necessarily true of others that we serve alongside who have not been, as is oft said “in the shit.” Within that category there are those who are people that help us and care for us, they are appreciated even if they have not been in our shoes.  The often exude a kindness and love that helps us make it when we have bad days.  But there are also those that don’t always seem to have our interests at heart or who would appear by their words and sometimes their actions to use our injury against us.

garfield show me the coffeeAmen!

So this whole deal gets weird when you can’t sleep due to anxiety or insomnia and have to maintain your ability to do your job.  Now this is where the art and science of self medication come together. You have to be able to figure out how things balance out. Medications are set by prescription unless you throw in a wild card of over the counter meds and supplements.  Thus for me they are a relatively stable factor.  Then you factor in the caffeine factor.  This may vary but in my case I drink 24-72 ounces a day of coffee which is usually spread over a 4-8 hour period, and maybe 12-24 ounces of Diet Coke, Coke Zero or Diet Dr Pepper later in the day.  My caffeine level is variable based on how tired I am. If I am well rested the amount consumed goes down.  Today I was maxing out the caffeine factor because my ass was whipped and it was all I could do to get through the day.  Today I was so wiped that I added in the Skittles factor to get the quickie sugar rush.  I hate skittles, when we were poor in seminary it was the only candy we got because the church food bank gave them out.  Skittles, Boston Baked Beans, Swee Tarts and Smarties are all great instant energy, the problem with them is that they are like lighting the afterburner; they are only good for short spurts.  Beer varies but if I am home I might have two beers at dinner.  I have stopped any late night drinks.  Then there is the “defensive factor” which for me includes my anxiety and hyper-arousal levels.  This is combined with normal life and stress and divided by the spirituality factor to get a night’s sleep.  That is the science.  The art is how to make the adjustments to the factors that are variable fit the current life situation and find those illusive Chinese kids, Yin and Yang.

pub1

So the week is coming to a close, I have now been up 36 of the last 40 hours and have worked every day since last Monday, though Saturday and Sunday were just a few hours each despite having the duty pagers. I am tired I had a decent meal complete with vegetables, several portions of fruit and other healthy things.   As soon as the Orioles game is over I plan on heading to bed and hoping my meds and my general sense of exhaustion will overcome any anxiety or insomnia that might join hands to interfere with me.  I think I have managed to bring old Yin and Yang into balance for the evening and if I didn’t I I do hope that the Deity Herself will assist this effort tonight.

Peace, Padre Steve+

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