Sleepy, sleep, sleep

Sleep that knits up the ravelled sleave of care, the death of each day’s life sore labour’s bath balm of hurt minds, great nature’s second course chief nourisher in life’s feast.

William Shakespeare, Macbeth

Notebook in hand, I find myself in the grounds of Norwich prison. I’m attending a workshop at The Walnut Tree Project. As I approach the entrance to The Britannia Veterans Centre I’m trying to imagine just how much can be achieved in a two-hour workshop.

The topic is a complex one. Sleep. More importantly how, by preplanning dream interventions we might bring an end to nightmares. Seems like a bit of a stretch to me if you pardon the prison pun. However, when I think of the participants I’m about to meet, combat veterans, I find it almost impossible to think of any ‘quick fix’ that might be forthcoming for these long-standing, traumatic, and sometimes violent nocturnal happenings.

After the regulatory brew, we’re greeted by Justin Havens, our facilitator for the next two hours. He immediately puts us at ease. As veterans, albeit with totally civilian lives, we tend to build trust faster with those who have also served. Justin, we soon discover is ex-Army and he can certainly speak the language when required. With a successful commercial career behind him, he has spent the last several years retraining to become a qualified integrative therapist specialising in psychological trauma.

He is currently studying towards a PhD at the Veterans and Families Institute at the Anglia Ruskin University, investigating a unique approach to stopping traumatic nightmares. In return for the possibility of relief from these nightmares, he is collecting from volunteers research data which he hopes will validate this innovative behavioural method, known as Planned Dream Interventions® (PDI), and to further develop this method for use with UK combat veterans. It seems a fair exchange to me.

The originator of the concept, is a former US Navy psychologist called Beverley Dexter, who has taught this skill to several hundred US servicemen and veterans, though no formal research or effect quantification has to date taken place. Anecdotally, 8 out of 10 participants are able to stop their traumatic nightmares within a week of being taught Planned Dream Interventions®. That is some claim, and as the workshop gets underway my mind is opened up to the real possibilities of what might be achieved.

With the accuracy, brevity and clarity you would expect, Justin takes us through what normal sleep should look like and what it looks like when we suffer nightmares. He is full of metaphors, some of his own and some that he has picked up around the country from other attendees. He starts by asking us to think about (or imagine, in most cases) how we feel after a good night’s sleep.

We soon have plenty of thoughts up on the flip chart. For some veterans, they haven’t slept properly for years. They have been violent to their bed partners and even attempted to jump out of the bedroom window during their night terrors. Others are less forthcoming, but there is a sadness in their eyes that seems to recognise their problem in those of their more outspoken comrades. Lack of good sleep, or any sleep at all has broken their relationships, lost them jobs and prevented the much-needed healing that needs to take place. Traumatic nightmares are a ubiquitous part of post traumatic stress disorder (PTSD), and can be defined as vivid recreations of past events which often evoke high levels of anxiety and lead to poor sleep and a have a significant impact on daily functioning.

When bad things happen to us, we are designed to dream about them. We normally sleep in 90 minute sleep cycles, which includes periods of rapid eye movement (REM) sleep.

There are many theories about why we dream, but no one knows for sure. Some researchers say dreams have no purpose or meaning, others say dreams are necessary for mental, emotional, and physical health. Research suggests that during this REM phase these strong emotions are believed to be managed by the brain in conjunction with the deep restorative sleep that makes us feel refreshed and ready to face another day. In essence, the brain is thought to be making ‘sense’ of what has happened during the waking hours.

But what happens when what we have experienced events that cause the brain to become overwhelmed? The images and memories so traumatic, often distorted, are just too hard and scary for the brain to deal with properly. Justin invites us to liken the dysfunction of the process to a river that originates high up in the mountains, thundering down to dissipate into the sea, but it is so powerful that it spills out uncontrollably splitting its banks along the way, unable to find its true path.

This ‘spilling out’ results in repetitive nightmares. We get stuck, spending too much time in REM sleep, often waking up during terrifying moments and in the process we do not get that deep restorative, healing sleep we need to function. However long we stay in bed, the quality of sleep is just not there. We are in a vicious cycle and for veterans suffering other health issues, it becomes even more difficult to stabilise them enough to benefit from other treatments and therapies.

Simple not easy
Its half time and after another brew, we are ready to learn the technique. What skills will we need to employ to stop us from getting stuck and allow our lives to move forward in a more productive way?

Justin is keen to point out that the technique he is about to teach us is simple but not always easy. Its going to take commitment and we may have to apply the intervention several times until we find something that fits our particular circumstances.

In true military fashion, he explains how we can outflank this night-time malady. We can get behind it. There is no need to confront the trauma directly; this is a skill to be learnt not a therapeutic treatment.

The mission is to stop us from getting stuck when the brain is processing highly emotive and often traumatic events. It needs a bit of a nudge, so that it can successfully complete it’s task of effectively sorting out highly charged emotions. The end game is clear: train our brains to stay asleep while dreaming, removing the nightmare altogether. Let the water flow all the way down to the sea, without interruption, along it’s true course.

The Technique — a simple 3-step process

It strikes me that we have to approach this technique with an open mind. Justin asks us if we could accept the idea that there are no bad dreams. His premise lies in the fact you can have control over what happens in your dreams. For some, at present, this is a bridge too far, but there is complete willingness in the room to give it our best shot. Here is the technique in full:

Step 1
Think only about the part of the dream which wakes you up. This may or may not be the most distressing part. If you can’t identify or remember this part you can still use steps 2 and 3

Step 2
Think “ what would I like to happen next that feels good and puts me in control?” This is your intervention, that is very specific to you. It is important at this stage to think big and bold. This is pure fantasy. Come up with an idea that feels right for you at gut level. It should be uncensored. Anything can happen in a dream. Note: violent dreams do not lead to violent behaviour (it is in fact the other way around). Examples of interventions might be shrinking the bad guy and then whacking him with a golf club over the horizon. It is what ever works for you. The emotional volume should be turned up to match the intensity of the dream you wish to claim mastery over. Don’t get despondent if it doesn’t work first time; try another planned intervention.

Step 3
Before you settle down to sleep, write down and imagine your intervention. In your mind, put this on your ‘dream shelf’. By placing it on an imaginary shelf you are leaving it there for your brain to find when it is processing your dream. If you wake up in the night, think ‘what would I like to happen next’ and come up with an intervention to suit and then go back to sleep.

As I sat and listened to the video case study of Eric, I was reminded that I use to do something similar when I was a very young child. Although I didn’t have a traumatic childhood, I did experience monster dreams for a short while and I can remember being deliberately able to alter them when they returned, after having giving it some thought during the day. The dreams changed and dropped away. I stopped waking up in the night sweating and screaming. This memory strengthened my belief that this tool has merit.

As our two hours together comes to an end, I hope all those that had taken the workshop would reap the benefits of what might be possible.

Although the concept of rehearsing a preferred ending to a nightmare is not new, I can see that this new approach offers the following significant advantages, particularly to combat veterans, whose very recovery relies on better sleep:

  1. It can be taught in a group setting within 2 hours
  2. It provides stabilisation and preparation for other treatments or therapies
  3. Although not a stand-alone ‘cure’ for PTSD, early indications are that it can bring significant changes and relief to individuals

4. It is safe and non-invasive

5. It is easy replicable and low-cost when weighed against the benefits

For Justin, his work for the day is not finished. He’s into the prison next door, to help veterans on the inside with their nightmares. I just hope he makes it back over the wall, as there are many more people who could benefit from this approach.