Post-Traumatic Stress Disorder and Sleep: My Interview With Captain Ken LeBlanc

I want to tell you about my old and dear friend, Ken LeBlanc, a Captain in the United States Army. Ken and I went to high school together and have watched our lives and careers evolve in recent years.  He lives in and is stationed in Wiesbaden, Germany, near Frankfurt, and he works at US Army Headquarters for the G-34 Force Protection Directorate at Wiesbaden Army Airfield.  He is an Operations Officer.  His responsibilities include the entire Black Sea region of eastern Europe. He assesses and mitigates risk by developing site-specific guidelines for force protection and personnel safety, including counter-surveillance, stand-offs, and personnel access.  He develops travel guidelines, working with the DIA and Department of State for any individual and group travel to foreign lands. He has been deployed several times.  I consider Captain LeBlanc a hero, not only because of what he’s done for the benefit of our country, but also how he has handled the many intense experiences he has had as part of his military duties over the years.

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Ken tells me that he has had some genuine difficulties with his sleep since relocating to Germany.  Troubled by vivid dreams, he suffers from disrupted sleep, frequently awakening with a sensation of anxiety and in a cold sweat.

Ken has been diagnosed with post-traumatic stress disorder (PTSD).  He tells me that he’s not alone:  many of his colleagues have had similar symptoms upon returning from their deployment and have been diagnosed with PTSD, reflecting recent Veterans Administration reports that indicate that nearly 30% of VA patients who served in the Iraq and Afghanistan wars have been diagnosed with this disorder.  He also believes that PTSD is still under-recognized and under-treated in the military.

PTSD is commonly associated with sleep problems, often stemming from a combination of factors:  the self-protective mode of constantly being “on alert,” worry, physical symptoms (such as chronic pain) associated with previous trauma, and frequent nightmares which may or may not be directly related to previous traumatic experiences.  Chronic sleep-onset and sleep-maintenance insomnia and daytime fatigue are commonly observed in those suffering from PTSD.

Captain LeBlanc was kind enough to agree to describe some of his experiences with Sleep Help Desk from his home in Wiesbaden.

MC:  You’ve been in the military for many years, Ken; you’ve visited many countries and you’ve seen many things most Americans never will see. How does a soldier process all of the intense experiences such as the ones you’ve had?

KL:  If possible, by processing the good and bad with groups of others. The Army has many specific programs to help deal with and process activities and experiences. As an Officer I have a duty to help younger Soldiers with any issues that might arise from their combat- and noncombat-related experiences. Sometimes being far away from your family causes things to happen such as divorce and bankruptcy, and this can be as difficult to process as combat. As Soldiers one hopes that the foundation they have morally and psychologically helps them to diffuse critical events but being with like-minded others brings a support system unlike any other I have been involved with.

MC:  How do you perceive your experiences have affected your sleep?

KL:  Sleep is a critical and performance-altering behavior. I am an older Soldier who has witnessed many things younger Soldiers have not experienced and I’ve thought from the very beginning that this would be my personal asset. They aren’t, however, like good experiences (like the birth of a child or success at work), which do not replay in your head during times of attempted sleep. It might be thunder or loud noises or strange noises, but they all bring me back to unfavorable experiences. Dreams become more vivid and after awakening one goes through a litany of questions concerning that event. After a few months it gets a little better but when one least expects it one might dream of something as innocuous as a large crowd and begin to feel the anxiety that accompanies it. My military experiences cause many sleepless nights because after waking up (usually in a sweat) it becomes hard, if not impossible, to regain drowsiness and fall back to sleep.

MC:  So let’s talk more about your dreams, Ken.  How often and how intensely do your dreams relate to your current work or previous military experiences?

KL:  After returning stateside I had incredibly vivid dreams every night. I would wake up and go through them repeatedly. I would feel foolish for having them. Most of the time they relate directly to military experiences but after a while they lose that flavor and start to relate to difficult periods in my life. It feels as if it becomes a habit:  waking up to dredge over bad experiences no matter what the setting. I would normally not associate one with the other except that in prior times this never happened. The causality of combat and dream behavior is in my opinion directly linked.

MC:  What helps?

KL:  The honest truth is that alcohol and I have self-medicated many a night in order to fall asleep. This is not a good sleep, but it is the ability to get to sleep that one desires more than any other thing. Once in the habit it is very hard to break (thankfully I have recognized this as a direction I did not want to go and have stopped drinking as a habit). It affects performance at work and weight and psychological issues so this is not something I would recommend to anyone. I have also tried prescription medications. This is not a good alternative for me either as I still wake up, unknowingly, and re-medicate. I remember one night in particular, in which I woke up the next day to find that out of 30 prescription pills, some time during the night I had ingested 20 (and lived). This was my wake-up call and I stopped all medication thereafter. Now I read as long as I can before trying to sleep. It gets me to sleep but not for very long. I awaken again, usually in a sweat, and either get up for the day or lie in bed all night until a reasonable hour and then get up. I have tried many nights to stay awake for several days and then “reset” my body clock only to find I experience the same outcome as if I had gone to bed every night. It truly makes me wonder why I can function on such little sleep.

MC:  Is there anything that happens in your current work life that triggers a worsening of your sleep, other than jet lag from travel?

KL:  As a Soldier I always have different report times as the events I manage don’t stop to allow me to get some rest. At the risk of sounding cavalier, they are life-and-death situations and as a result I never really know when I will be able to shut work out completely and rest. This is true for all Soldiers, not just me. In what other career can something happening 10,000 miles away affect your daily life? Sometimes it’s just the Army philosophy of early to rise. My days have started as early as 0345 to 0900 and there usually isn’t a cut-and-dry schedule as to when that will be.

MC:  Ken, tell me about how your colleagues handle their own problems with sleep.

KL:  Honestly, alcohol is pretty prevalent. Some medicate with sleep aids; some try relaxation techniques. Most Soldiers diagnosed with any form of PTSD is prescribed some form of selective serotonin reuptake inhibitors (SSRIs). This helps many deal with what I would refer to as “sleep anxiety.” I can only speak for myself when I say going to bed is one of the hardest events of my day. I know I’m not going to sleep, or the sleep will be lousy, but I also know if I don’t try I’ll be worthless the next day.

My deepest thanks go to Captain LeBlanc for bringing attention to this important problem, and for his honorable and courageous work in securing and protecting our country.

Nightmares vs. Night Terrors

Hello everybody!  I’m writing this brief entry tonight to address something a lot of people, particularly parents of young children, can be confused about:  the difference between nightmares and night terrors.  I’ve heard people use these terms interchangeably, but they represent entirely different clinical entities.  Herein I provide a simple distinction between the two.

 

Night terrors–also known as “sleep terrors” or “pavor nocturnus“–are very memorable for parents.  Here’s a typical scenario.  Your child goes to bed the way she usually does at night.  Later that night, suddenly, from her bedroom comes a loud, blood-curdling scream that scares the hell out of you.  You jump out of bed and run to your daughter’s bedroom.  You find her sitting up in bed, appearing awake and dazed, eyes wide open in fear.  She may or may not respond to you.  She appears distressed and freaked out, sweating and breathing hard; she may move her arms and legs nonspecifically but frenetically as well, compounding your concern as you observe her.  She seems panicked and inconsolable, almost possessed.  After several minutes, though, she calms down, lies down again, and returns to sleep.  The next morning, when you ask her about the event, she tells  you she has no idea what you’re talking about:  she recalls nothing of what happened.

Here’s a nightmare.  You hear your child crying or crying out for you in the middle of the night.  You enter his room.  He’s clearly awake and clear-headed, and answers your questions appropriately and quickly.  He may hug you for comfort.  You ask him what happened.  He tells you he had a terrible dream; a monster was out to get him, for example, or he was about to be pushed off a cliff by someone mean.  He has good recollection of what he was dreaming about.  After some reassurance, he eventually feels comfortable enough to return to bed, and the following morning he may or may not recall the full details of the disturbing dream, but he does remember that he had a terrible dream that caused him substantial distress.

The reason why it’s important to recognize the difference between these two clinical entities is because both can concern and frighten parents, particularly night terrors.  As frightening as they may be to watch, however, they are in and of themselves generally benign in nature and prognosis.

Night terrors represent a type of parasomnia (sleep-related unusual movements or behaviors) typically occurring out of deep non-REM sleep.  As such, dreams are not recalled, and the child is usually completely amnestic of the event.  Though some adults may experience night terrors, they are by far most common in children 3-12 years of age.  As scary as these events are for parents, they are usually not indicative of an underlying abnormality or medical problem, and children with night terrors usually outgrow them over time.  In some children, sleep deprivation or other reasons for going to bed particularly fatigued or sleepy may play a role in the likelihood of night terrors occurring, so make sure that your child gets proper amounts of sleep and sleeps in reasonably predictable, regular schedules night after night.

Nightmares are simply particularly unpleasant and/or frightening dreams.  They occur out of rapid eye movement (REM) sleep, and are usually recalled–and often recalled well–upon abrupt awakening from dream sleep.  For whatever reason, 2/3 – 3/4 of human dreaming is emotionally negative in nature (I had a distinctly negative dream early this morning, for example, though I wouldn’t classify it as a nightmare; hence I’m writing this entry today!).  Most people don’t need specific treatments for nightmares, and how to treat recurring nightmares is controversial.

I think I’ll write a little about recurring nightmares some time soon.  It might be cathartic for me.

Have a good evening, everybody.  I hope your dreams tonight are positive and pleasant.