Season of hibernation

My favorite sentence that comes out of my patient’s mouth is “I’ve been sleeping 14 hours a day and I’m still tired.” And no, they are not overmedicated. It’s usually after we have been working together for several months to a year, they have made excellent progress and are beginning to stabilize. A few weeks later they will return and say that they’ve never slept so much in their life and still felt tired. 

This tells me something vital about where they are in their healing. They feel safe enough to sleep. Like -really- sleep. Often these patients have experienced significant trauma. Sometimes just being inside of their own mind is the trauma. This may be the first time in their life that they have slept like that and it can feel rather disconcerting. 

Sleep is by far and away the best possible prescription to obtain a healthy brain. Sleep is the time when neurotransmitters are built, waste is cleared, memory is stored. Poor sleep quality and decreased sleep duration causes brain injury that increases severity of addiction. (Demerci et. al, 2023) It is well established (not to mention quite intuitive) that anxiety worsens sleep quality, but the inverse is true as well. Irregular and broken sleep also contributes to mood disruption. (Chellappa, S & Aeschbah, D. 2022) Whenever I start the diagnostic process, my first question is “how is your sleep?” When prescribing medications, sleep is always the first thing I work on. Because everything else cascades down from unstable sleep for the mind. Improved mood, anxiety, decreased hallucinations and delusions, and positive sense of self - all of these things begin with quality sleep. 

Beyond all of this, the more exciting thing that this statement from a patient tells me is the level of safety that my patient is feeling. Healing sleep cannot happen without safety. The ability to surrender to deep, restorative sleep signifies that the body’s hypervigilance has finally eased. For someone whose nervous system has been perpetually set to "threat," this shift from fight-or-flight to rest-and-digest is monumental. It is the clearest indicator that the therapeutic space—and their own internal world—is now perceived as a secure base, allowing the profound work of repair and integration to commence.

I am always looking for ways to use fewer and less potent medications with my patients. I know that sleep isn’t sexy, it seems too easy. Shouldn’t you have to try harder to be healed? For the mind, at least, the answer is no. Trying harder isn’t the way, creating safety and sleep for the brain to repair itself prevents the unnecessary use of extra medications to compensate for the lack of sleep. With any other illness or surgery, it is intuitive that we would take time to rest in bed to allow the body to heal. Why is then, that we expect psychiatric patients to pretend they are fine when old wisdom of rest and recover is what most of them really need. This is the key to healing that means fewer medications and a starting place for a cure for many psychiatric disorders.  

Rachel Ward, PMHNP-BC is the founder of Something Human Mental Health. She believes strongly in removing barriers to access to mental health and creating a holistic person centered and welcoming place for people to receive care.

References:

Chellappa, S., Aeschbach, D. (2022) Sleep and anxiety: From mechanisms to interventions, Sleep Medicine Reviews, (61) https://doi.org/10.1016/j.smrv.2021.101583.

Demirci, E., Tastepe, N., Kevser Gul, M., Ozmen, Sevgi., Kilic, E. (2023) S100B and Neuron-Specific Enolase Levels as Brain Injury Biomarkers in Internet Addiction: Effect of Sleep. Pediatric Neurology (149)93-99 https://doi.org/10.1016/j.pediatrneurol.2023.08.029.