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Why might sleeping on the floor alleviate PTSD symptoms?

Why might sleeping on the floor alleviate PTSD symptoms?


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Question:

Does sleeping on the floor have similar neurotransmitter effects, as sleeping under a weighted blanket might? Psychiatrically, would it be expected that a person having PTSD would find similar results sleeping under a weighted blanket as they do when they sleep on the floor?

Could sleeping on the floor actually be a subconscious attempt at regulating neurotransmitters or possibly even to promote better REM sleep?

Background:

There are many views on the interplay of different neurotransmitters and hormones, (dopamine, serotonin, etc.), and PTSD, anxiety, depression, etc.

There is also a lot of consensus on how weighted blankets seem to help alleviate these symptoms, providing that sense of security. They also seem to be used a lot by parents of children with Autism, Aspergers, and ADHD.

There are a variety of theories why people with PTSD sleep on the floor, could a valid rival hypothesis be a neurotransmitter affect?

  1. To be in a position to respond to threats more effectively.
  2. To askew comforts, and lavishness, in view of self-worth.
  3. The sense of security and being "grounded".

Article linking sleeping on the floor with hypervigilance: Posttraumatic Stress Disorder (PTSD) Reactions.


Why might sleeping on the floor alleviate PTSD symptoms?

Question: Does sleeping on the floor have similar neurotransmitter effects, as sleeping under a weighted blanket might? Psychiatrically, would it be expected that a person having PTSD would find similar results sleeping under a weighted blanket as they do when they sleep on the floor?

There is also a lot of consensus on how weighted blankets seem to help alleviate these symptoms, providing that sense of security. They also seem to be used a lot by parents of children with Autism, Aspergers, and ADHD.

Could sleeping on the floor also be related to this, possibly because of the firmness and sense of security felt from being on the floor? (Even if physically uncomfortable.)

No. Don't connect those very different studies and use it as a basis for a conclusion.

The article you reference mentions the word "floor" 3 times, twice to mention that 2 children sleep on the floor and the third time the author writes:

"Children who sleep on the floor instead of their bed after a trauma do so because they fear the comfort of a bed will let them sleep so hard that they won't hear danger coming.".

It is the claim, of proponents of weighted blankets, that they: reduce movement, let you feel as if you are being held, and thus promote better sleep.

Source: "What's the deal with weighted blankets?":

"The thought is that this weight mimics the pressure of being held, which helps release anxiety to let you fall asleep faster. Some studies, including a 2015 one "Positive Effects of a Weighted Blanket on Insomnia" from the Journal of Sleep Medicine and Disorders, back this up (.PDF). The research found that weighted blankets did in fact provide a "beneficial calming effect" for those suffering from insomnia.

In case one it is the decision of a few children that they won't sleep as well, in the second case it is businesses that want to sell weighted blankets to cause you to sleep better. Opposites.

References on beds such as Wikipedia's "Bed" webpage or Mattress Mart's "History of the Bed" ;) attribute the invention of the bed as a means to increase comfort. One must also consider pressure ulcers caused by insufficient padding and reduced movement.

Comparing misread articles, few in number, and extending it to other unreferenced articles and ailments isn't a supported basis on which to advance a theory on psychology involving biological, behavioral, cognitive and social disciplines.

Prior to 3600 BC mankind did without bedding.

Source: "History of the world - Early Humans":

The closest living relatives of modern humans, Homo sapiens, evolved around 4.6 to 6.2 million years ago. Anatomically modern humans arose in Africa about 200,000 years ago, and reached behavioural modernity about 50,000 years ago.

By the reasoning of your theory and extension of those two prior paragraphs one would conclude that prior to 5620 years ago there were no PTSDs, it is the modern bed that is a contributing factor.


Footnotes

Contributors: AD wrote an initial draft manuscript, contributed to critical revisions to the text, and is the guarantor of this article. KAM, MS, and CSS contributed to critical revisions of the text. All authors have been engaged in research and clinical practice with trauma-exposed children for more than a decade.

Funding: AD was funded by the Medical Research Council (grant No P005918) and the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London. KAM was funded by the National Institute of Mental Health (NIMH R01-MH103291, R01-MH106482, R56-MH119194, R37-MH119194). MS was funded by Qatar National Research Fund (QNRF grant No NPRP 7-154-3-034). The views expressed are those of the authors and not necessarily those of the funders.

Competing interests: We have read and understood BMJ policy on declaration of interests and have no relevant interests to declare.

Provenance and peer review: Commissioned externally peer reviewed.

This article is part of a series commissioned by The BMJ for the World Innovation Summit for Health (WISH) 2020. The BMJ peer reviewed, edited, and made the decisions to publish. The series, including open access fees, is funded by WISH.


What Your Sleep Position Says About Your Personality

Depending on who you ask, your Myers Briggs type, astrological sign, and Enneagram number can give you deeper insight into the kind of person you are. But ask a scientist what your sleep position says about your personality, and the short answer is: Not much.

Just so we’re clear, “sleep affects every aspect of our functioning, both physical and psychological,” says Terry Cralle, RN, a sleep educator, author, and advisor with the Better Sleep Council (BSC).

“The better we sleep,” she says, “the better we are in so many ways. We’re more motivated. We’re better in relationships. We perform tasks, communicate, and handle stress better. And we’re less reckless and less likely to get into accidents. So on some level, how we sleep does impact our behavioral tendencies.”

The truth is, we change positions in our sleep as much as ten to 30 times a night! And many factors are entirely external, like how comfortable our mattress is and how our bed partner sleeps. Even though some researchers have linked sleep positions to overall personality types—the most widely cited analysis was based on a survey of 1,000 participants in the UK—ultimately, “the science is lacking on the relationship between personality and sleep positions,” Cralle says, “but not on healthy sleep positions.”

So while the sleep position personality test doesn’t exist, we break down the six most common sleeping styles, the often-associated traits, and what the research really says.


17 Mental Health Symptoms That Stem From Complex Trauma

When we think of trauma, we usually think about a highly stressful event — something that happened one time. This could be a car accident, an isolated instance of sexual assault or a miscarriage.

But what is complex trauma?

Psychologist and trauma expert Dr. Christine Courtois explained it this way: “[it’s] a type of trauma that occurs repeatedly and cumulatively, usually over a period of time and within specific relationships and contexts.”

For some, complex trauma might be the result of growing up in an abusive household where abuse and neglect were present. For others, complex trauma might have stemmed from fighting for our country in a long-term military deployment. The reality is complex trauma can look different for each person who experiences it, and the impact it has on an individual’s mental health can be, well, complex.

Whether you have a diagnosed mental illness that stems from complex trauma, or live with undiagnosed side effects that impact your well-being, you’re not alone.

There are many ways complex trauma can manifest, so we asked our Mighty community to share with us one mental health struggle they have that stems from their complex trauma.

Here’s what our community shared with us:

  1. “ I completely shut down the second I hear or even sense conflict! Someone can be playfully arguing or raising their voice and my brain goes into protective mode. I feel anxious and the need to escape.” — Megan K.
  2. “Shame. This toxic, recurring sense that I am somehow ‘less than’ despite understanding, knowing, believing and having learned otherwise. They’re just subtle whispers that drive my perfectionism, a tendency to lean toward isolation rather than healthy connection, and other effects that shame ignites. All rooted in complex trauma as a child, due to having a mentally ill, addicted parent, and the stigma that comes gift-wrapped with that scenario.” — Brittany S.
  3. “ I tend to apologize a lot… I don’t notice it and people usually say, ‘You don’t have to apologize!’ They don’t understand why I’m doing it though.” — Angela F.
  4. “My memory, concentration and executive function has diminished so much since my adult trauma. It’s really embarrassing and frustrating, regularly having to apologize and explain in the middle of a conversation that ‘my brain just stopped’ because I can’t get the image in my head to connect with a word especially when it’s a basic and common word, and which makes me look and feel so ‘dumb.’” — Sarah M.
  5. “ I cannot trust anyone with my children. I have severe panic attacks when they are at school. I no longer work to keep them out of daycares.” — Ashley S.
  6. “I’m always so tired because I have recurring nightmares of the events or emotions and hardly get any sleep. It’s very frustrating.” — Katie S.
  7. “The feeling of worthlessness in that I am only here for the gain of their own interest and according to what I’m given in return. It’s a misconception that I was only valued up to their expectations, what I’ve recently learned is I can value myself for who I am and not what they wanted me to be.” — Tatauq M.
  8. “My depression and anxiety stem from my PTSD which is from childhood abuse and neglect. People don’t understand why I have any of those three things… until I go into detail about my past.” — Kayla T.
  9. “ Guilt and perfectionism. Every time I make even the smallest mistake or even just perceive it that way, I automatically start guilt-tripping myself and beating myself up. I have a complete meltdown and cry for hours. Directly related to emotional abuse.” — Raven L.
  10. “When I hear arguments or violent yelling, I automatically assume it’s my presence or that it’s my fault and go into a panic. I shut down and turn almost into a robot completely on auto drive and get sent into a full-blown panic attack and feel the need to run away from the situation.” — Stacey S.
  11. “Psychosomatic insomnia comes from my complex trauma. I also have really intense nightmares where I am known to frantically hit my spouse in my sleep. I am also known for screaming so loudly I woke up a guest on the first floor from dead sleep when I was sleeping on the second… they came to check that I was OK. The connection is these are symptoms sufferers of even complex trauma can have.” — Moon N.
  12. “I have depersonalization/derealization disorder due to childhood and lifelong trauma. I dissociate to block it all out and have for years. It’s the easiest way to get through these experiences and it’s a coping skill. I’m working on getting past dissociation for the most part by practicing mindfulness and joining a DBT program.” — Kristen H.
  13. “My inability to allow myself happiness. I put myself last and consistently find myself in relationships that are one-sided. I tend to make certain those around me are OK, even people I barely know. This leaves me feeling used. I believe this stems from childhood trauma my need to do anything to get positive affection, to stave off abuse and in attempt to satisfy adults who were never happy with me. In adulthood, I am drained and have put myself in financial and social difficulties. Therapy is helping, but it’s a long road.” — Martha F.
  14. “ I don’t trust my judgment. I spent 10 years in an abusive relationship and because of childhood abuse, I couldn’t see the signs. I thought it was normal. I know better now but I don’t date because I don’t trust myself to not see it again.” — Kashmir C.
  15. “I cannot take compliments even from close family. When someone says something nice, I start getting very anxious and change the subject or say something to try and change their mind about me. I feel so uncomfortable and can’t take it.” — Sue S.
  16. “Abandonment and trust issues. I was sexually and emotionally abused as a child and had a pervasive fear of abandonment and sense that attachment and trust are dangerous. Now even with those I trust absolutely, like my therapists and best friend, I still go through bouts of intense fear of being abandoned.” — Monika S.
  17. “Derealisation/depersonalization. I learned to dissociate from scary experiences that felt out of my control. Now I suffer with chronic dissociation and struggle to feel present. The fear associated with old traumas has stuck in my mind and it’s almost impossible to differentiate between real and fantasy fears.” — Harriet L.

If you are a survivor of complex trauma, you’re not alone. Here are some stories written by Mighty contributors that might resonate with you.


The Impacts of Trauma on Sleep

Sleep issues are common after a traumatic experience. Alertness and hyperarousal related to the effects of the body’s stress response often contribute to the symptoms of insomnia. Many people have difficulty falling asleep, wake up more often during the night, and have trouble falling back asleep after a traumatic event.

Trauma can also affect sleep architecture, which means that it can change how the body moves through sleep cycles and stages. Although experts are still working to understand the implications of the changes observed in sleep architecture after trauma, rapid eye movement (REM) sleep appears to be the stage most affected. REM sleep is important for storing memories and processing emotions, and dreams during REM sleep tend to be more fantastical and bizarre.

Distressing dreams and nightmares are common to trauma. Survivors often have dreams about the traumatic event that either directly replay the experience or contain trauma-related emotion, content, and symbols. Researchers hypothesize that trauma-related dreams are caused by the brain’s fear response combined with hyperarousal, and may represent the mind’s attempt at integrating a traumatic experience.

While sleep issues after a traumatic experience can be distressing, they may also be an important opportunity for treating and healing from trauma. Research suggests that being able to sleep after a traumatic event can reduce intrusive trauma-related memories and make them less distressing. Targeting sleep issues in the early treatment of trauma may reduce the risk of developing PTSD.

Sleep Disorders After Trauma

Insomnia is one of the most common sleep issues related to trauma and resolves on its own in the majority of trauma survivors. More severe and persistent sleep disorders are usually seen in people with higher levels of post-traumatic stress and PTSD. While rare, sleep disorders that may develop after trauma include nightmare disorder, periodic leg movement disorder, sleep terrors, and parasomnias such as REM sleep behavior disorder.


A little victory over CPTSD

I didn’t have a migraine last night.
Read that sentence again because I’m going to explain WHY? that is a big deal. Ready?

One of the symptoms of my Complex PTSD, since I was 12 perhaps, has been debilitating blinding headaches. I could expect expect 3-4 nights out of the year that I would spend sleeping on the bathroom floor. The tile floor was cool and I could close the door and be alone with my pain. Pain that was so bad I saw auras, I suffered muscle contractions that twisted me involuntarily, I would bang my head on the walls to find some focus away from the lancing pain through my skull. The pain was so severe there was the added insult of nausea and puking.

When my parents finally witnessed one these headaches, (huh, I can’t remember how that happened), they took me to the doctor. A neurologist. There was a long day of many tests. At the end of the appointment, the doctor sent my parents home with the knowledge that there was nothing physically wrong with me.

In retrospect, I think I really hate that he did that. Because, of course, for my parents if there was nothing physically wrong then there was nothing to treat. End of story.

Only it wasn’t. I have spent another forty years living in fear of one of these ‘headaches’. For a long time, I had no idea of where these came from and what triggered them. In my 20s when I was in grad-school the general practitioner I was seeing prescribed massage for me as a way to lower my anxiety. Best three months I had experienced in a long time. And that lead me to one of the ways to alleviate these events, touch. A person who would hold me as I writhed, or better before it got that bad. could usually halt or at least soften the episode.

I knew nothing of the sympathetic nervous system or the role it plays in cptsd. This was, like so many of the coping mechanisms we find hard won out of brutal experience. After nearly a decade in and out of therapy I put another pair of pieces together. I found I could predict when I might experience a headache. That knowledge allowed me to attempt to stop it.

Not all of those attempts were wisely chosen. Most of the time I cut to let my demons out. Only once or twice did I turn to alcohol. I still can’t stand the smell of most alcohol. Never chose drugs because my central need is to be able to control myself. With alcohol and drugs I might have been able to stop the pain or blunt it, but I would lose control and that wasn’t acceptable. So I chose to bleed instead. Most of the time it worked. But, not always.

The trigger I found that most commonly lead to this reaction was a case where I felt I had failed or where I had been rejected. If you have cptsd you’ll understand how fundamental those triggers are and how far ripples can travel even decades later.

Over time I discovered the most effective method for me to handle an event that might trigger one of these episodes was to talk to myself. Yeup, I still think it sounds corny – and I know it works. As I started to learn about cptsd, the sympathetic nervous system, triggers, dissociation, integrated family systems I was learning how to better manage those events in my life that at one time would have produced a migraine. (Technically I don’t know if it was migraine, but you get the idea, right?)

I am making progress. Huzzah!

Yesterday one of those events of life happened that would have had me out of commission on the bathroom floor last night. But, it didn’t. I processed that F*er. Ok, probably still processing it, but the major danger of having a reaction headache as some type of punishment that my psyche thinks I believe is low. Perhaps, I would even go so far as to say – very low.

And that feels like a miracle. Feels like. I know it isn’t. The ability to deal with yesterday’s ‘thunk’ was decades of practice and finally understanding my brain.

So here is to recovery and the many little victories it brings.
May you have many, many little victories.


Treatment

While it can be a truly terrifying experience, sleep paralysis is harmless. It will come to an end within a few minutes, either when someone goes back to sleep or fully awakens.   Most people find they are able to cope after getting reassurance that they aren't in any danger.

People who experience sleep paralysis don't typically have it frequently. When they do, the cause is usually relatively benign and there are no serious risks.  

Though these episodes may be frightening and a person might even be afraid of dying during them, sleep paralysis is not harmful and generally resolves on its own without treatment.  

If you're prone to episodes of sleep paralysis, avoiding sleep deprivation, stress, and alcohol and caffeine before bedtime, as well as following other sleep hygiene guidelines may be helpful.

In rare cases, people may suffer from repeated episodes and find they are unable to tolerate the associated psychological distress. Medications that suppress the REM cycle of sleep, such as selective serotonin receptor inhibitors (SSRIs) and tricyclic antidepressants (TCAs) sometimes help.  

It's important that you are evaluated by your doctor to address any sleep, mental health, or other medical disorders that can disrupt sleep. For example, having a condition like sleep apnea or narcolepsy.

If you have multiple or recurring episodes of sleep paralysis and these strategies don't effectively address your distress, your doctor might refer you to a board-certified sleep specialist or have you do a sleep study.


Stretch Your Pecs

Consistently sitting in a slumped, rounded shoulder posture can lead to tightness in your chest muscles and a strain on the neck. Stretching your pecs helps restore proper muscle balance in the cervical region.

HOW TO DO IT: Stand in a corner with your arms out to the side and over your head in the shape of a wide "V." With one palm on each wall, slowly lean forward until you feel a pull in your chest and the front of your shoulder. Hold the stretch for 30 seconds before releasing the tension and repeat it three to five times.


Our Final Thoughts

While sleep jerks are quite common and may happen for no reason at all, they could also be a sign that you need to take a step back and look at your overall lifestyle. If you’re not making time for sleep or have poor habits that are keeping you awake at night, you may find that prioritizing rest helps alleviate twitching.

Take a look at the common causes we’ve listed above, and follow our steps for reducing hypnic twitches. While you may not be able to prevent them entirely, you should be able to minimize them. In the end, remember that they aren’t dangerous (unless you accidentally hit your partner), and in most cases, they go away on their own.


Discussion

In the present study, medium-firm bedding systems reduced back pain by approximately 48% (37.1 [pre mean] − 19.3 [post mean week 1-4] = 17.8/37.1 = .48) and improved sleep quality by 55% (43.5 [pre mean] − 21.0 [post mean week 1-4] = 22.5/43.5 = .52). Indeed, greater proportional improvement would have been possible had only the fourth (last) week mean rather than the mean for the total 4-week period been used for sleep quality (17.4 vs 21.0, respectively) and low back discomfort (15.1 vs 19.3, respectively) in the calculation because improvement continued each week over the 4-week posttest measures. Furthermore, the present study found that the significant increase in sleep quality and pain reduction was paralleled by a significant decrease in stress. Some studies have concluded that the sleep surface can contribute to discomfort 24,25 and that sleeping on certain sleep surfaces may be more beneficial than others. Yet, others 27 found no significant differences in sleep stages or sleep efficiency when comparing sleep surfaces. For instance, Bader and Engdal 40 found no difference in sleep quality when comparing subject's personal beds and 2 commercially available beds, one labeled “soft” the other “hard.” Conflicting conclusions likely stemmed from contrasting research protocols such as the duration in which the participants slept on the beds, method of assessment, and environmental factors (ie, laboratory vs home) in addition to the sleep surfaces.

Previous studies in agreement with the present data also concluded that medium-firm mattresses positively affected sleep quality 29 and that medium-firm mattresses can be recommended to ease nonspecific low back pain. 41 Several studies have concluded that stress is highly related to poor sleep quality 6,15 , 18-20 , 42-45 and that stress has been associated with insomnia and insufficient sleep. 14,42,46,47 Less defined is the reverse association between sleep quality and stress. The results of the current investigation agree with those who have concluded that sleep quality is associated to stress, suggesting that improved sleep quality may reduce stress and stress-related behavior. For instance, Fuligni 18 found that obtaining less sleep at night is related to greater anxiety and depressive feelings. Meltzer and Mindell 48 also concluded that sleep quality was a significant predictor of mood and stress. Furthermore, others have reported an association between poor sleep quality and insomnia, depression, anxiety, irritability, and anger. 21,49,50 One study 43 reported a very high (P < .0001) correlation between poor sleep quality and depression and anxiety. Fuligni 18 found that less sleep was related to more negative and less positive moods and that more sleep yielded lower depressed feelings.

The results of the present study indicate that participants' sleep quality significantly improved with the replacement of the old (mean, 9.5 years) sleeping surface. Furthermore, the improvement in sleep quality was realized within the first week of the presentation of the new bedding system and not only sustained but also improved for the remainder of the posttesting period by 24.2%% from week 1 to week 4. Similarly, stress symptoms and behavior as measured by the factored items from the questionnaire were significantly reduced after 4 weeks of sleeping on the new bedding. For factors 1 and 2, stress abated by 19.5% and 21.5% from pre- to posttest, respectively. Fig 3 illustrates the relationship between improved sleep quality and efficiency and stress.

Relationship between sleep quality, back pain, and stress.

Stress can be chronic or acute, and unabated stress has been associated with mental health disorders. 51 No participant in the current study had chronic stress or had been treated for related emotional disorders however, it is remotely possible that some participants were faced with acute stress at the time of completing the pretest stress survey before the introduction of the new bedding system and it is further possible that this stress had abated naturally at the end of the 28-day recording session after sleeping on the new bedding system. However, it is doubtful that most of the participants experienced such an event at precisely the same time and to the degree that stress changed so drastically from the pre- to posttest. Furthermore, the increase in perceived sleep quality follows the same trend as the abatement of stress. Such results serve as further indication that sleep and stress are interrelated. It may be likely that a reduction in physical discomfort may have accompanied greater sleep quality and efficiency, 29,52 thus reducing stress levels.

As is common with most sleep surface research, no control group was used for comparisons, 28,29,32,37,40,41 but rather the group served as its own control. It is axiomatic that a control group strengthens the research design by reducing the threat for a Rosenthal effect. Jacobson et al 29 suggested that a 𠇌ontrol” or placebo bedding system is inconceivable in this type of study because there is no definition of a placebo bed, and if a sham bed could be put in place, the 𠇌ontrol” bedding system would serve as an additional experimental bedding system and not a standard of measurement. 30 Several other similar studies 29,37,40 followed the protocol used in the current study by having the participants use their personal bedding systems as the baseline for data collection.

Another limitation of study was that the mean age of the participants' bed was 9.5 years. It may be reasonable to assume that any bed with a certain amount of use will not provide the same benefit as a newer model. Yet, analysis comparing categories of bed age and sleep quality did not yield any significant differences in pretest sleep quality.

It may be argued that subjects favored the experimental bedding system simply because it was new and/or that the positive changes could be attributed to a Hawthorne or Rosenthal effect. Although there are several examples/definitions of the Hawthorne effect in literature, a common combination of definitions suggests that people will respond to any novel change, not because of any specific condition being tested but because of the attention they receive. Without a control group, it is impossible to compare true treatment with sham treatment. However, participants were not obtrusively observed nor continually monitored but rated their sleep for 2 full months privately and with no change in attention during the experimental phase. Yet, we did not rule out the possibility that given a 𠆏ree’ bed, participants wished to please the researchers by overstating their benefits. With respect to the Rosenthal effect, it may be argued that subjects favored the experimental bedding system simply because it was new and that they could have concluded by the questionnaires and the VAS that the desired outcome should be greater sleep quality and a reduction in stress. However, subjects were not overtly given any information as to what outcome was expected. One may anticipate that the initial installation of the new bedding systems would have accounted for an immediate peak in perceived improvement, followed by a return toward pretest ratings. Although the first week of the posttest yielded a significant improvement (P < .0001) in sleep quality over the pretest period, improvement for posttest weeks 2, 3, and 4 continued to increase rather than diminishing. Furthermore, the follow-up questionnaire supported sustained improvements and satisfaction when compared to the responses of the initial questionnaire.

Bader and Engdal 40 suggested that new bedding systems may improve sleep initially due to a “pseudo placebo effect.” A placebo effect may have been reflective of the first week or two with the new bedding system but should have begun to weaken over time. Again, in the present study, the benefits in sleep quality and efficiency were greater for each of posttest observations, suggesting a continued benefit. Bader and Engdal 40 suggested that it may take more than 5 nights to adapt to the new sleep surface. Daily data for the present study suggested that improvement was realized more immediately.

Caution should be had in assuming generalizability of these data. For instance, stress stems from many sources and the abatement of stress may be difficult to achieve. Certainly, sleep is associated with stress however, it would be an oversimplification to suggest that a new bedding system is a panacea for stress management.

A wide selection of sleep surfaces with varying levels of firmness and support are available at a broad range of prices. 30 It has been estimated that more than 80% of the American public sleep on innerspring mattresses. 53 As previously done by others the current study used a medium-firm 29,31,41 innerspring mattress as the experimental bedding system and found immediate and significant improvements in sleep quality, sleep efficiency, and stress among participants. No benchmark standards presently exist for recommending bedding systems, whether for the purpose of alleviating pain-related sleep disturbance, stress, or for the purpose of enhancing sleep quality. Recommendations of medium-firm mattresses, 29-31 hard beds, 28 or suggesting that no difference exist between sleep surfaces 27 add to the confusion. Indeed, the ideal mattress is yet to be determined and likely depends on many variables illustrating the need for additional research. It may be overly optimistic to conclude that one type of mattress fits all individuals because of the range of varied anthropometric characteristics of the human body.

In this instance, the participants' beds averaged more than 9 years old, suggesting that they had spent an average 3 years in their beds. It is highly plausible that although mattresses and bedding surfaces are accompanied by extended warranties, the life of the support, structure, and comfort of the mattress as it relates to sleep quality may be considerably less than commonly assumed. Continued research in the area should focus on sleeping surface comparisons and assessment longevity and sustainability of the support and comfort of the bedding system.


Stretch Your Pecs

Consistently sitting in a slumped, rounded shoulder posture can lead to tightness in your chest muscles and a strain on the neck. Stretching your pecs helps restore proper muscle balance in the cervical region.

HOW TO DO IT: Stand in a corner with your arms out to the side and over your head in the shape of a wide "V." With one palm on each wall, slowly lean forward until you feel a pull in your chest and the front of your shoulder. Hold the stretch for 30 seconds before releasing the tension and repeat it three to five times.


What Your Sleep Position Says About Your Personality

Depending on who you ask, your Myers Briggs type, astrological sign, and Enneagram number can give you deeper insight into the kind of person you are. But ask a scientist what your sleep position says about your personality, and the short answer is: Not much.

Just so we’re clear, “sleep affects every aspect of our functioning, both physical and psychological,” says Terry Cralle, RN, a sleep educator, author, and advisor with the Better Sleep Council (BSC).

“The better we sleep,” she says, “the better we are in so many ways. We’re more motivated. We’re better in relationships. We perform tasks, communicate, and handle stress better. And we’re less reckless and less likely to get into accidents. So on some level, how we sleep does impact our behavioral tendencies.”

The truth is, we change positions in our sleep as much as ten to 30 times a night! And many factors are entirely external, like how comfortable our mattress is and how our bed partner sleeps. Even though some researchers have linked sleep positions to overall personality types—the most widely cited analysis was based on a survey of 1,000 participants in the UK—ultimately, “the science is lacking on the relationship between personality and sleep positions,” Cralle says, “but not on healthy sleep positions.”

So while the sleep position personality test doesn’t exist, we break down the six most common sleeping styles, the often-associated traits, and what the research really says.


Footnotes

Contributors: AD wrote an initial draft manuscript, contributed to critical revisions to the text, and is the guarantor of this article. KAM, MS, and CSS contributed to critical revisions of the text. All authors have been engaged in research and clinical practice with trauma-exposed children for more than a decade.

Funding: AD was funded by the Medical Research Council (grant No P005918) and the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London. KAM was funded by the National Institute of Mental Health (NIMH R01-MH103291, R01-MH106482, R56-MH119194, R37-MH119194). MS was funded by Qatar National Research Fund (QNRF grant No NPRP 7-154-3-034). The views expressed are those of the authors and not necessarily those of the funders.

Competing interests: We have read and understood BMJ policy on declaration of interests and have no relevant interests to declare.

Provenance and peer review: Commissioned externally peer reviewed.

This article is part of a series commissioned by The BMJ for the World Innovation Summit for Health (WISH) 2020. The BMJ peer reviewed, edited, and made the decisions to publish. The series, including open access fees, is funded by WISH.


Our Final Thoughts

While sleep jerks are quite common and may happen for no reason at all, they could also be a sign that you need to take a step back and look at your overall lifestyle. If you’re not making time for sleep or have poor habits that are keeping you awake at night, you may find that prioritizing rest helps alleviate twitching.

Take a look at the common causes we’ve listed above, and follow our steps for reducing hypnic twitches. While you may not be able to prevent them entirely, you should be able to minimize them. In the end, remember that they aren’t dangerous (unless you accidentally hit your partner), and in most cases, they go away on their own.


A little victory over CPTSD

I didn’t have a migraine last night.
Read that sentence again because I’m going to explain WHY? that is a big deal. Ready?

One of the symptoms of my Complex PTSD, since I was 12 perhaps, has been debilitating blinding headaches. I could expect expect 3-4 nights out of the year that I would spend sleeping on the bathroom floor. The tile floor was cool and I could close the door and be alone with my pain. Pain that was so bad I saw auras, I suffered muscle contractions that twisted me involuntarily, I would bang my head on the walls to find some focus away from the lancing pain through my skull. The pain was so severe there was the added insult of nausea and puking.

When my parents finally witnessed one these headaches, (huh, I can’t remember how that happened), they took me to the doctor. A neurologist. There was a long day of many tests. At the end of the appointment, the doctor sent my parents home with the knowledge that there was nothing physically wrong with me.

In retrospect, I think I really hate that he did that. Because, of course, for my parents if there was nothing physically wrong then there was nothing to treat. End of story.

Only it wasn’t. I have spent another forty years living in fear of one of these ‘headaches’. For a long time, I had no idea of where these came from and what triggered them. In my 20s when I was in grad-school the general practitioner I was seeing prescribed massage for me as a way to lower my anxiety. Best three months I had experienced in a long time. And that lead me to one of the ways to alleviate these events, touch. A person who would hold me as I writhed, or better before it got that bad. could usually halt or at least soften the episode.

I knew nothing of the sympathetic nervous system or the role it plays in cptsd. This was, like so many of the coping mechanisms we find hard won out of brutal experience. After nearly a decade in and out of therapy I put another pair of pieces together. I found I could predict when I might experience a headache. That knowledge allowed me to attempt to stop it.

Not all of those attempts were wisely chosen. Most of the time I cut to let my demons out. Only once or twice did I turn to alcohol. I still can’t stand the smell of most alcohol. Never chose drugs because my central need is to be able to control myself. With alcohol and drugs I might have been able to stop the pain or blunt it, but I would lose control and that wasn’t acceptable. So I chose to bleed instead. Most of the time it worked. But, not always.

The trigger I found that most commonly lead to this reaction was a case where I felt I had failed or where I had been rejected. If you have cptsd you’ll understand how fundamental those triggers are and how far ripples can travel even decades later.

Over time I discovered the most effective method for me to handle an event that might trigger one of these episodes was to talk to myself. Yeup, I still think it sounds corny – and I know it works. As I started to learn about cptsd, the sympathetic nervous system, triggers, dissociation, integrated family systems I was learning how to better manage those events in my life that at one time would have produced a migraine. (Technically I don’t know if it was migraine, but you get the idea, right?)

I am making progress. Huzzah!

Yesterday one of those events of life happened that would have had me out of commission on the bathroom floor last night. But, it didn’t. I processed that F*er. Ok, probably still processing it, but the major danger of having a reaction headache as some type of punishment that my psyche thinks I believe is low. Perhaps, I would even go so far as to say – very low.

And that feels like a miracle. Feels like. I know it isn’t. The ability to deal with yesterday’s ‘thunk’ was decades of practice and finally understanding my brain.

So here is to recovery and the many little victories it brings.
May you have many, many little victories.


17 Mental Health Symptoms That Stem From Complex Trauma

When we think of trauma, we usually think about a highly stressful event — something that happened one time. This could be a car accident, an isolated instance of sexual assault or a miscarriage.

But what is complex trauma?

Psychologist and trauma expert Dr. Christine Courtois explained it this way: “[it’s] a type of trauma that occurs repeatedly and cumulatively, usually over a period of time and within specific relationships and contexts.”

For some, complex trauma might be the result of growing up in an abusive household where abuse and neglect were present. For others, complex trauma might have stemmed from fighting for our country in a long-term military deployment. The reality is complex trauma can look different for each person who experiences it, and the impact it has on an individual’s mental health can be, well, complex.

Whether you have a diagnosed mental illness that stems from complex trauma, or live with undiagnosed side effects that impact your well-being, you’re not alone.

There are many ways complex trauma can manifest, so we asked our Mighty community to share with us one mental health struggle they have that stems from their complex trauma.

Here’s what our community shared with us:

  1. “ I completely shut down the second I hear or even sense conflict! Someone can be playfully arguing or raising their voice and my brain goes into protective mode. I feel anxious and the need to escape.” — Megan K.
  2. “Shame. This toxic, recurring sense that I am somehow ‘less than’ despite understanding, knowing, believing and having learned otherwise. They’re just subtle whispers that drive my perfectionism, a tendency to lean toward isolation rather than healthy connection, and other effects that shame ignites. All rooted in complex trauma as a child, due to having a mentally ill, addicted parent, and the stigma that comes gift-wrapped with that scenario.” — Brittany S.
  3. “ I tend to apologize a lot… I don’t notice it and people usually say, ‘You don’t have to apologize!’ They don’t understand why I’m doing it though.” — Angela F.
  4. “My memory, concentration and executive function has diminished so much since my adult trauma. It’s really embarrassing and frustrating, regularly having to apologize and explain in the middle of a conversation that ‘my brain just stopped’ because I can’t get the image in my head to connect with a word especially when it’s a basic and common word, and which makes me look and feel so ‘dumb.’” — Sarah M.
  5. “ I cannot trust anyone with my children. I have severe panic attacks when they are at school. I no longer work to keep them out of daycares.” — Ashley S.
  6. “I’m always so tired because I have recurring nightmares of the events or emotions and hardly get any sleep. It’s very frustrating.” — Katie S.
  7. “The feeling of worthlessness in that I am only here for the gain of their own interest and according to what I’m given in return. It’s a misconception that I was only valued up to their expectations, what I’ve recently learned is I can value myself for who I am and not what they wanted me to be.” — Tatauq M.
  8. “My depression and anxiety stem from my PTSD which is from childhood abuse and neglect. People don’t understand why I have any of those three things… until I go into detail about my past.” — Kayla T.
  9. “ Guilt and perfectionism. Every time I make even the smallest mistake or even just perceive it that way, I automatically start guilt-tripping myself and beating myself up. I have a complete meltdown and cry for hours. Directly related to emotional abuse.” — Raven L.
  10. “When I hear arguments or violent yelling, I automatically assume it’s my presence or that it’s my fault and go into a panic. I shut down and turn almost into a robot completely on auto drive and get sent into a full-blown panic attack and feel the need to run away from the situation.” — Stacey S.
  11. “Psychosomatic insomnia comes from my complex trauma. I also have really intense nightmares where I am known to frantically hit my spouse in my sleep. I am also known for screaming so loudly I woke up a guest on the first floor from dead sleep when I was sleeping on the second… they came to check that I was OK. The connection is these are symptoms sufferers of even complex trauma can have.” — Moon N.
  12. “I have depersonalization/derealization disorder due to childhood and lifelong trauma. I dissociate to block it all out and have for years. It’s the easiest way to get through these experiences and it’s a coping skill. I’m working on getting past dissociation for the most part by practicing mindfulness and joining a DBT program.” — Kristen H.
  13. “My inability to allow myself happiness. I put myself last and consistently find myself in relationships that are one-sided. I tend to make certain those around me are OK, even people I barely know. This leaves me feeling used. I believe this stems from childhood trauma my need to do anything to get positive affection, to stave off abuse and in attempt to satisfy adults who were never happy with me. In adulthood, I am drained and have put myself in financial and social difficulties. Therapy is helping, but it’s a long road.” — Martha F.
  14. “ I don’t trust my judgment. I spent 10 years in an abusive relationship and because of childhood abuse, I couldn’t see the signs. I thought it was normal. I know better now but I don’t date because I don’t trust myself to not see it again.” — Kashmir C.
  15. “I cannot take compliments even from close family. When someone says something nice, I start getting very anxious and change the subject or say something to try and change their mind about me. I feel so uncomfortable and can’t take it.” — Sue S.
  16. “Abandonment and trust issues. I was sexually and emotionally abused as a child and had a pervasive fear of abandonment and sense that attachment and trust are dangerous. Now even with those I trust absolutely, like my therapists and best friend, I still go through bouts of intense fear of being abandoned.” — Monika S.
  17. “Derealisation/depersonalization. I learned to dissociate from scary experiences that felt out of my control. Now I suffer with chronic dissociation and struggle to feel present. The fear associated with old traumas has stuck in my mind and it’s almost impossible to differentiate between real and fantasy fears.” — Harriet L.

If you are a survivor of complex trauma, you’re not alone. Here are some stories written by Mighty contributors that might resonate with you.


Treatment

While it can be a truly terrifying experience, sleep paralysis is harmless. It will come to an end within a few minutes, either when someone goes back to sleep or fully awakens.   Most people find they are able to cope after getting reassurance that they aren't in any danger.

People who experience sleep paralysis don't typically have it frequently. When they do, the cause is usually relatively benign and there are no serious risks.  

Though these episodes may be frightening and a person might even be afraid of dying during them, sleep paralysis is not harmful and generally resolves on its own without treatment.  

If you're prone to episodes of sleep paralysis, avoiding sleep deprivation, stress, and alcohol and caffeine before bedtime, as well as following other sleep hygiene guidelines may be helpful.

In rare cases, people may suffer from repeated episodes and find they are unable to tolerate the associated psychological distress. Medications that suppress the REM cycle of sleep, such as selective serotonin receptor inhibitors (SSRIs) and tricyclic antidepressants (TCAs) sometimes help.  

It's important that you are evaluated by your doctor to address any sleep, mental health, or other medical disorders that can disrupt sleep. For example, having a condition like sleep apnea or narcolepsy.

If you have multiple or recurring episodes of sleep paralysis and these strategies don't effectively address your distress, your doctor might refer you to a board-certified sleep specialist or have you do a sleep study.


The Impacts of Trauma on Sleep

Sleep issues are common after a traumatic experience. Alertness and hyperarousal related to the effects of the body’s stress response often contribute to the symptoms of insomnia. Many people have difficulty falling asleep, wake up more often during the night, and have trouble falling back asleep after a traumatic event.

Trauma can also affect sleep architecture, which means that it can change how the body moves through sleep cycles and stages. Although experts are still working to understand the implications of the changes observed in sleep architecture after trauma, rapid eye movement (REM) sleep appears to be the stage most affected. REM sleep is important for storing memories and processing emotions, and dreams during REM sleep tend to be more fantastical and bizarre.

Distressing dreams and nightmares are common to trauma. Survivors often have dreams about the traumatic event that either directly replay the experience or contain trauma-related emotion, content, and symbols. Researchers hypothesize that trauma-related dreams are caused by the brain’s fear response combined with hyperarousal, and may represent the mind’s attempt at integrating a traumatic experience.

While sleep issues after a traumatic experience can be distressing, they may also be an important opportunity for treating and healing from trauma. Research suggests that being able to sleep after a traumatic event can reduce intrusive trauma-related memories and make them less distressing. Targeting sleep issues in the early treatment of trauma may reduce the risk of developing PTSD.

Sleep Disorders After Trauma

Insomnia is one of the most common sleep issues related to trauma and resolves on its own in the majority of trauma survivors. More severe and persistent sleep disorders are usually seen in people with higher levels of post-traumatic stress and PTSD. While rare, sleep disorders that may develop after trauma include nightmare disorder, periodic leg movement disorder, sleep terrors, and parasomnias such as REM sleep behavior disorder.


Discussion

In the present study, medium-firm bedding systems reduced back pain by approximately 48% (37.1 [pre mean] − 19.3 [post mean week 1-4] = 17.8/37.1 = .48) and improved sleep quality by 55% (43.5 [pre mean] − 21.0 [post mean week 1-4] = 22.5/43.5 = .52). Indeed, greater proportional improvement would have been possible had only the fourth (last) week mean rather than the mean for the total 4-week period been used for sleep quality (17.4 vs 21.0, respectively) and low back discomfort (15.1 vs 19.3, respectively) in the calculation because improvement continued each week over the 4-week posttest measures. Furthermore, the present study found that the significant increase in sleep quality and pain reduction was paralleled by a significant decrease in stress. Some studies have concluded that the sleep surface can contribute to discomfort 24,25 and that sleeping on certain sleep surfaces may be more beneficial than others. Yet, others 27 found no significant differences in sleep stages or sleep efficiency when comparing sleep surfaces. For instance, Bader and Engdal 40 found no difference in sleep quality when comparing subject's personal beds and 2 commercially available beds, one labeled “soft” the other “hard.” Conflicting conclusions likely stemmed from contrasting research protocols such as the duration in which the participants slept on the beds, method of assessment, and environmental factors (ie, laboratory vs home) in addition to the sleep surfaces.

Previous studies in agreement with the present data also concluded that medium-firm mattresses positively affected sleep quality 29 and that medium-firm mattresses can be recommended to ease nonspecific low back pain. 41 Several studies have concluded that stress is highly related to poor sleep quality 6,15 , 18-20 , 42-45 and that stress has been associated with insomnia and insufficient sleep. 14,42,46,47 Less defined is the reverse association between sleep quality and stress. The results of the current investigation agree with those who have concluded that sleep quality is associated to stress, suggesting that improved sleep quality may reduce stress and stress-related behavior. For instance, Fuligni 18 found that obtaining less sleep at night is related to greater anxiety and depressive feelings. Meltzer and Mindell 48 also concluded that sleep quality was a significant predictor of mood and stress. Furthermore, others have reported an association between poor sleep quality and insomnia, depression, anxiety, irritability, and anger. 21,49,50 One study 43 reported a very high (P < .0001) correlation between poor sleep quality and depression and anxiety. Fuligni 18 found that less sleep was related to more negative and less positive moods and that more sleep yielded lower depressed feelings.

The results of the present study indicate that participants' sleep quality significantly improved with the replacement of the old (mean, 9.5 years) sleeping surface. Furthermore, the improvement in sleep quality was realized within the first week of the presentation of the new bedding system and not only sustained but also improved for the remainder of the posttesting period by 24.2%% from week 1 to week 4. Similarly, stress symptoms and behavior as measured by the factored items from the questionnaire were significantly reduced after 4 weeks of sleeping on the new bedding. For factors 1 and 2, stress abated by 19.5% and 21.5% from pre- to posttest, respectively. Fig 3 illustrates the relationship between improved sleep quality and efficiency and stress.

Relationship between sleep quality, back pain, and stress.

Stress can be chronic or acute, and unabated stress has been associated with mental health disorders. 51 No participant in the current study had chronic stress or had been treated for related emotional disorders however, it is remotely possible that some participants were faced with acute stress at the time of completing the pretest stress survey before the introduction of the new bedding system and it is further possible that this stress had abated naturally at the end of the 28-day recording session after sleeping on the new bedding system. However, it is doubtful that most of the participants experienced such an event at precisely the same time and to the degree that stress changed so drastically from the pre- to posttest. Furthermore, the increase in perceived sleep quality follows the same trend as the abatement of stress. Such results serve as further indication that sleep and stress are interrelated. It may be likely that a reduction in physical discomfort may have accompanied greater sleep quality and efficiency, 29,52 thus reducing stress levels.

As is common with most sleep surface research, no control group was used for comparisons, 28,29,32,37,40,41 but rather the group served as its own control. It is axiomatic that a control group strengthens the research design by reducing the threat for a Rosenthal effect. Jacobson et al 29 suggested that a 𠇌ontrol” or placebo bedding system is inconceivable in this type of study because there is no definition of a placebo bed, and if a sham bed could be put in place, the 𠇌ontrol” bedding system would serve as an additional experimental bedding system and not a standard of measurement. 30 Several other similar studies 29,37,40 followed the protocol used in the current study by having the participants use their personal bedding systems as the baseline for data collection.

Another limitation of study was that the mean age of the participants' bed was 9.5 years. It may be reasonable to assume that any bed with a certain amount of use will not provide the same benefit as a newer model. Yet, analysis comparing categories of bed age and sleep quality did not yield any significant differences in pretest sleep quality.

It may be argued that subjects favored the experimental bedding system simply because it was new and/or that the positive changes could be attributed to a Hawthorne or Rosenthal effect. Although there are several examples/definitions of the Hawthorne effect in literature, a common combination of definitions suggests that people will respond to any novel change, not because of any specific condition being tested but because of the attention they receive. Without a control group, it is impossible to compare true treatment with sham treatment. However, participants were not obtrusively observed nor continually monitored but rated their sleep for 2 full months privately and with no change in attention during the experimental phase. Yet, we did not rule out the possibility that given a 𠆏ree’ bed, participants wished to please the researchers by overstating their benefits. With respect to the Rosenthal effect, it may be argued that subjects favored the experimental bedding system simply because it was new and that they could have concluded by the questionnaires and the VAS that the desired outcome should be greater sleep quality and a reduction in stress. However, subjects were not overtly given any information as to what outcome was expected. One may anticipate that the initial installation of the new bedding systems would have accounted for an immediate peak in perceived improvement, followed by a return toward pretest ratings. Although the first week of the posttest yielded a significant improvement (P < .0001) in sleep quality over the pretest period, improvement for posttest weeks 2, 3, and 4 continued to increase rather than diminishing. Furthermore, the follow-up questionnaire supported sustained improvements and satisfaction when compared to the responses of the initial questionnaire.

Bader and Engdal 40 suggested that new bedding systems may improve sleep initially due to a “pseudo placebo effect.” A placebo effect may have been reflective of the first week or two with the new bedding system but should have begun to weaken over time. Again, in the present study, the benefits in sleep quality and efficiency were greater for each of posttest observations, suggesting a continued benefit. Bader and Engdal 40 suggested that it may take more than 5 nights to adapt to the new sleep surface. Daily data for the present study suggested that improvement was realized more immediately.

Caution should be had in assuming generalizability of these data. For instance, stress stems from many sources and the abatement of stress may be difficult to achieve. Certainly, sleep is associated with stress however, it would be an oversimplification to suggest that a new bedding system is a panacea for stress management.

A wide selection of sleep surfaces with varying levels of firmness and support are available at a broad range of prices. 30 It has been estimated that more than 80% of the American public sleep on innerspring mattresses. 53 As previously done by others the current study used a medium-firm 29,31,41 innerspring mattress as the experimental bedding system and found immediate and significant improvements in sleep quality, sleep efficiency, and stress among participants. No benchmark standards presently exist for recommending bedding systems, whether for the purpose of alleviating pain-related sleep disturbance, stress, or for the purpose of enhancing sleep quality. Recommendations of medium-firm mattresses, 29-31 hard beds, 28 or suggesting that no difference exist between sleep surfaces 27 add to the confusion. Indeed, the ideal mattress is yet to be determined and likely depends on many variables illustrating the need for additional research. It may be overly optimistic to conclude that one type of mattress fits all individuals because of the range of varied anthropometric characteristics of the human body.

In this instance, the participants' beds averaged more than 9 years old, suggesting that they had spent an average 3 years in their beds. It is highly plausible that although mattresses and bedding surfaces are accompanied by extended warranties, the life of the support, structure, and comfort of the mattress as it relates to sleep quality may be considerably less than commonly assumed. Continued research in the area should focus on sleeping surface comparisons and assessment longevity and sustainability of the support and comfort of the bedding system.