A Night With Autonomic Hyperarousal and PTSD

One of the primary symptoms of post-traumatic stress disorder (PTSD) is autonomic hyperarousal, meaning a person’s body kicks into fight or flight mode without there being any actual danger present. This can cause a myriad of symptoms including flashbacks, panic attacks, and sleep disorders. For me, the most persistent manifestation of my hyperarousal has been through sleep disorders, including nightmares, night terrors, and overall discomfort at night. My sleep doctor equated it with running a marathon all night. He’s not wrong. Every morning, I wake up feeling more exhausted and irritable than I was when I went to bed the night before. 

• What is PTSD?

While everyone’s experience might look slightly different, I thought it would be helpful for those who do not have PTSD to see what it looks and feels like to experience autonomic hyperarousal at night. Here’s a blow-by-blow account of a night in the life of someone who experiences this phenomenon to a greater or lesser degree every night. 

9:00 p.m. to 9:30 p.m.

I start getting dozy and climb into bed under my 15-pound weighted blanket and two fleece blankets. I fall asleep fairly quickly, often while listening to some music that calms me via headphones.

12:30 a.m.

I bolt awake from my first nightmare. My heart rate has spiked to between 125 bpm and 145 bpm. (My normal resting heart rate is about 85 bpm.) It feels like my heart is literally going to fly through my chest and catapult across the bedroom. My breathing sounds like I’ve just done an intense aerobic workout. I’m flop sweating, my body sticking to the sheets like glue. My weighted blanket and fleece blankets are piled on top of me in a twisted mess, looking like they were snatched up by a tornado and then plopped back down on top of me, suffocating me.

12:45 a.m.

After attempting to calm myself down with deep breathing exercises, I’m still reeling from the details of my nightmare, which are so vivid that I recall them after every one. Sometimes they resemble my trauma, but more often they are some permutation of feeling helpless, out of control, or unsafe. Often I’ve been swimming, running, climbing, or fighting my way to safety in my dream. My Apple Watch actually registers 30 minutes of working out on my fitness app, all of which occurred while I was in fact asleep. 

1:00 a.m.

I finally climb out of bed. I can’t sleep so I go to the bathroom and check my phone. I spend a few minutes on FB or reading emails. Not the healthiest thing to do, but I’m trying to distract my mind from my nightmare. I go into the kitchen to grab something to drink because my mouth is so parched it feels like the Sahara Desert. I quickly down a huge glass of herbal ice tea and then work my way back to bed. 

1:15 a.m.

My heart rate is still high and now my stomach feels distended from drinking so much so quickly. I can’t seem to calm myself down. Thoughts begin to race through my head. The “what-ifs” and “shoulds” taunt me and agonize me, spinning my brain into a panic attack. I resume my breathing exercises and try to shift my thoughts to something nice and calming, but the runaway train of catastrophic thinking has left the station and is now about three states away.

2:00 a.m.

My panic attack has subsided but now my stomach hurts. I feel cramping in my intestines. I try to ignore it, tossing and turning while trying not to wake my husband up. I’m repeating “shut up brain” over and over again, trying to convince myself to go back to sleep. It isn’t working, though. 

2:30 am

My stomach finally rebels, sending me to the bathroom with diarrhea which seems to have come out of nowhere. I didn’t eat anything out of the ordinary and yet my gut is behaving as though I had consumed a bowl of salmonella.

3:00 am

My system is finally empty and I can return to bed. I’m dehydrated and my legs are half-numb from having spent half an hour sitting on the toilet. I’m also fighting the chills and can’t get warm.

3:30 am

I have finally fallen asleep again. Sadly, when I slip into REM sleep, my nightmares resume. Sometimes they are a continuation of the one I had before, and other times they are a completely new scenario.

5:00 a.m.

I scream and my husband wakes me up to tell me I was having a nightmare. I’m back to square one with my heart racing and my body feeling like it’s just done another workout. My fitness app confirms this sensation, having registered another 30-minute workout. The likelihood of actually falling back asleep is slim. I note that if I fell asleep now, I could get maybe one more hour of rest before my alarm goes off. This doesn’t help me feel better. 

5:30 a.m.

I slowly start slipping into sleep again, but just barely.

6:30 a.m.

My alarm goes off. It startles me awake. I feel like I’ve been hit by a bus. I slither my way out of bed, climb into the shower to help wake myself up. Dress and stumble my way into the kitchen to begin my workday cooking for guests of our bed and breakfast. I’m on autopilot, moving through the motions in silence. My husband asks if I’m OK. I grumble something incomprehensible. He knows I had a rough night and gives me a hug. I grab some liquid energy in the form of coffee and slowly begin to feel more myself.

This may sound like an extreme experience, and to be fair, it is the worst-case scenario of what happens nightly. But… a version of this does in fact occur daily, particularly the nightmares, elevated heart rate, racing thoughts, and difficulty falling back asleep. And I have tried seemingly everything to manage it. Aside from being in trauma therapy for years, which has helped me manage my flashbacks, anxiety, and other PTSD symptoms, I have run the gamut of treatments for my sleep issues. I have taken over-the-counter medications including melatonin, magnesium, and other herbal supplements. I have tried prescription medications commonly prescribed for this exact type of situation but couldn’t tolerate the grogginess I felt in the morning when I needed to function in the kitchen. I’ve tried ASMR, guided meditations, Headspace, and other apps geared toward helping with sleep. Some of these exacerbated my nightmares, presumably triggering some kind of trauma response. I tried focusing on sleep hygiene like not using my phone before bed, got a new mattress, had my blood work done to check for hormonal imbalances, and even did an at-home sleep study to rule out anything medical that could be causing my issues. 

As a last resort, I enrolled in a clinical trial for an app using my Apple Watch, which was designed to help veterans with PTSD-related nightmares get better sleep. The idea behind it is that it learns your sleep patterns and when it senses a nightmare based upon elevated heart rate and movement, it vibrates gently so as not to wake you but simply to shake you out of the nightmare. The app wouldn’t work for me, however, because I had such a persistently high heart rate and was moving so much all night that it constantly thought I was having nightmares and would buzz at me up to 30 times in a night, causing me to not be able to go to sleep at all. After almost two months of using the app, I was beginning to hallucinate and struggle with depersonalization due to lack of REM sleep, so I discontinued the clinical trial.

All of this to say that I have stumped my doctor, sleep doctor, and therapist, all of whom are at a loss as to why my dreams are so vivid that I recall them in agonizing detail, why I can’t get restful sleep and what we can do to combat it. We continue to work on processing my trauma in hopes that eventually my brain will resolve everything that it’s trying so desperately to make sense of in my dreams. I may at some point investigate hypnosis but am reticent because finding a good practitioner is difficult in my rural community. Neurofeedback has shown some promise but is not covered by insurance and is cost-prohibitive for someone self-employed in the hospitality industry. So for the time being, I just do the best that I can to manage my symptoms, listen to my body when it’s tired and not allow feelings of hopelessness to consume me. I do believe eventually something will come along that works and that one day, I will get a good night’s sleep. Until then, I hope that this helps folks understand when those of us with PTSD-related sleep disturbances are grumpy; we are really just so exhausted that we are having trouble staying emotionally regulated.