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Section 3
Sleep Techniques for Returning Veterans

Question 3 | Test | Table of Contents

In the last section, we discussed how returning soldiers/warriors can adjust to civilian life by learning to respond to dumb questions from civilians, talk about their war experience with supportive adults. Furthermore, we discussed how they can relearn to communicate with and discipline their child.

In this section, we will discuss sleep techniques for returning veterans who are struggling to establish healthy sleep routines due to PTSD.

For many clients coping with PTSD, sleep disturbance is a common experience. Ryan, the returning vet that was introduced in the previous section, was having trouble sleeping. He shared, "There is no respite. Even at night my unconscious mind purges me of dreams that make me sweat and shake and vomit. I wake up and the bed is soaked. I gasp for air and try to calm the nightmares, which rattle my soul and activate my entire nervous system. Sometimes it takes a day or two to feel like the fog has cleared from my head after a night like this."

When my clients struggle with sleep related to PTSD, I share the following information to help them develop a healthier sleep routine. I refer to them as the "key practices of good sleep hygiene." The following is what I shared with Ryan over the course of a few sessions:

1. Sleep Space: Your sleeping space should be quiet, free from distraction, and a good temperature. The bedroom should be reserved for only sleeping, not for activities such as work.

2. Pre-sleep Routine: You should create a pre-sleep routine. This should include going to bed at a consistent time and doing something relaxing. This can be anything from a warm shower or bath, stretching, or muscle relaxation.

3. No TV: It is standard advice to not have a TV playing in the bedroom as you go to bed. The visual images can cause stimulation rather than calm you to sleep. If you do rely on a TV to fall asleep, turn the volume low and choose a channel with enjoyable programming so it will not trigger negative thoughts. Set the sleep function on your TV as well so it will not disturb you.

4. White Noise: White noise may be a good addition to your sleep routine as it will cancel out other background noise. This could be as simple as running a fan. There are also machines that play noises such as the ocean, waterfall, rain, or wind that will cancel out other types of noises around.

5. 30 Minute Restart: If you have trouble falling asleep or falling back asleep, allow yourself 30 minutes. After that time if you still have not fallen asleep get up and leave the bedroom. The purpose of this is to associate your bedroom with sleeping.

6. Read: If you do have to leave the bedroom because you cannot fall asleep, do not use electronic devices because they will only stimulate your brain. Do something relaxing such as writing, reading, listen to soothing music, do a puzzle, or drawing. When you begin to feel sleepy enough, return to your bedroom.

7. Exercise and Allow Time: The best time of day to exercise is at the beginning of the day. If you do exercise in the afternoon or evening, allow enough time (at least one hour) to cool off and relax before going to sleep.

8. Lighter Evening Meal: Enjoy larger meals in the earlier part of the day and eat lighter before going to bed.

9. Night Light: When you are suffering from nightmares or waking with the feeling of dread, it may be helpful to put a nightlight or alarm light to help orient yourself when you awaken. It may also be helpful to write down reoccurring nightmares. It can be helpful to think of ways to modify the images in your mind. If this is not enough, talk to your doctor about a medicine that can reduce blood pressure, slow heart rate, and help reduce the revved-up sensation that comes from the nightmare.

10. Limit Caffeine: You should watch your caffeine intake and limit your consumption to the morning and early afternoon. Often drinks such as soda contain caffeine so it is important to examine labels for caffeine content.

11. Monitor Alcohol: It is also imperative to monitor and understand how alcohol affects your sleep pattern.

12. Sleep Log: It may be useful to maintain a "sleep log" which you can use to record the time you awoke, the hours of sleep you got, and any dreams or nightmares you had. Here you can also log any sleep tips you used and if they were helpful or not.

13. Patience: Take the time and have patience to learn what will and won’t work for you to get a good night's sleep. Some of these tips may not work for you and it is ok to not use them if you find that they don’t.

Do you have a client like Ryan who has trouble sleeping because they are coping with combat PTSD? If yes, could he or she benefit from any of the above strategies?

In this section we discussed thirteen sleep techniques for returning veterans who are struggling to establish healthy sleep routines due to PTSD: sleep space, pre-sleep routine, no TV, white noise, 30 minute restart, read, exercise and allow time, lighter evening meals, night light, limit caffeine, monitor alcohol, sleep log, and patience.

In the next section we will discuss how your client making the transition from soldier to civilian can effectively express their anger. We will discuss the following techniques: Expressing Anger Reflection, How Anger Has Helped and Hurt Me Exercise, and Resolving Anger Must-Haves List.

Source: Hoge
Naparstek 100
Reviewed 2023

Impact of the coronavirus disease-2019 pandemic on Veterans Health Administration Sleep Services

Sico, J. J., Koo, B. B., Perkins, A. J., Burrone, L., Sexson, A., Myers, L. J., Taylor, S., Yarbrough, W. C., Daggy, J. K., Miech, E. J., & Bravata, D. M. (2023). Impact of the coronavirus disease-2019 pandemic on Veterans Health Administration Sleep Services. SAGE open medicine, 11, 20503121231169388.

Peer-Reviewed Journal Article References:
DeViva, J. C., Rosen, M. I., Cooney, N. L., & Black, A. C. (2020). Ecological momentary assessment of sleep and PTSD symptoms in a veteran sample. Psychological Trauma: Theory, Research, Practice, and Policy, 12(2), 186–192. 

LaMotte, A. D., Taft, C. T., Weatherill, R. P., Casement, M. D., Creech, S. K., Milberg, W. P., Fortier, C. B., & McGlinchey, R. E. (2017). Sleep problems and physical pain as moderators of the relationship between PTSD symptoms and aggression in returning veterans. Psychological Trauma: Theory, Research, Practice, and Policy, 9(1), 113–116. 

McCarthy, E., DeViva, J. C., Norman, S. B., Southwick, S. M., & Pietrzak, R. H. (2019). Self-assessed sleep quality partially mediates the relationship between PTSD symptoms and functioning and quality of life in U.S. veterans: Results from the National Health and Resilience in Veterans Study. Psychological Trauma: Theory, Research, Practice, and Policy, 11(8), 869–876.

Ord, A. S., Lad, S. S., Shura, R. D., Rowland, J. A., Taber, K. H., & Martindale, S. L. (2020). Pain interference and quality of life in combat veterans: Examining the roles of posttraumatic stress disorder, traumatic brain injury, and sleep quality. Rehabilitation Psychology. Advance online publication. 

What are the thirteen sleep techniques you can share with your client to establish a healthy sleep routine? To select and enter your answer go to Test.

Section 4
Table of Contents