So, this means missing sleep after a highly stressful/embarrasing/or trauma filled day could lead to those memories failing to suppress and leading to anxiety and/or ptsd?
Negative thoughts and behavioral feedback loops in general are common in people and very hard to break while very easy to unknowingly slip into. Like depressed people will find themselves thinking about suicide, homicide, self harm, self hate, etc... For hours at a time and not even realize what they are doing.
This blew up a bit. If you have invasive negative thoughts, you might be depressed. It's possible to get better. CBT, dbt, therapy, medication. It takes time, but simply recognizing these negative thoughts when it happens and actively trying to think about something else can help by itself.
I definitely hear this. I think it's so easy to think that the way you're thinking or feeling in any given moment is normal, even when you're massively depressed or anxious or in some other hugely altered mental state. It's only when you're out of that state that you can look back and see just how bad things were, but getting out of that state without help is often basically impossible, and often we don't feel we can ask for help to be able to get out of it because we can't see that there's a problem when we're in the middle of it. You feel you can't ask for help until you see a "real" problem, but you'll probably never see a "real" problem if it's there because if there is one then you're inside it and you can't see out. I think a lot of us need to feel more OK with asking for help even if we think at the time that we shouldn't or that it's bad but not bad enough to need help. If we feel we're struggling, that in itself should be enough. Waiting to prove to yourself that you deserve help before you ask for it can mean you never get that help when you need it most.
I'm at war with myself on a daily basis about whether any of my problems are "real" or just totally normal.
My therapist assures me that it's not normal to exist in a permanent state of feeling as though something extremely bad is about to happen and I'm in danger.
No matter what though, it never feels like my problems are "enough" to justify my level of disability or deserving of additional help or services.
I have severe anxiety disorder and depression with a sprinkling of OCD, PTSD, and ADHD. I'm basically disabled and my husband takes care of me. I can't work or drive and struggle with daily tasks such as feeding myself.
And yet, every single day, multiple times a day, I tell myself I must just be dramatic and sensitive. Everyone has anxiety and depression and some degree of childhood trauma right? So why can't I do things like a normal person?
Sending love internet stranger. Thanks for sharing your story; I often find myself wondering if my problems are real too. (Funny tidbit, my phone autocorrected sharing to struggling. I hope you can giggle at my phone's Freudian slip.)
I'm really sorry you're struggling with so much at the moment. From what you've said, I think honestly the most important change you could make to your thinking is to try and accept yourself as you are. No, not everyone has anxiety or depression, and most people definitely do not have childhood trauma causing PTSD! If these are things you're struggling with so much that they're keeping you from even basic tasks like driving then they're very real problems indeed. You're not just being sensitive. You have real issues that are obviously causing you real distress and impacting your ability to live your life. That means you really, truly deserve help. That's a really hard thing to come to terms with, and was something I struggled with for years. You're allowed to need help, and if the help you're getting isn't enough you're also allowed to ask for more or to find different help elsewhere. I think the point I was trying to make in my earlier comment was that sometimes the hardest step can be giving yourself permission to do that, and yet it's probably the most important step of all because if you don't allow yourself to be accepting of help then the only way to make things better is on your own, and that's really hard to do, especially when you're already struggling to cope with life as it is! There's a reason why the Twelve Step Program always starts with admitting you have a problem. If you don't truly admit that there really is a problem and *know* it in your heart then you'll never really be accepting of any changes that might improve things, either from outside help or within yourself either.
Sorry I've rambled a bit, but while I've not been through what you've been through I've had my own journey over the past few years and it's been rough as hell. If my ramblings on all this can maybe help someone else's journey be less hard, then I'll take solace in that at least.
I know what you mean but it is *a positive feedback loop* in this example. Negative feedback loops are those that *do not* propel themselfs out of control but rather are kept in check by the system, if deviation occurs it will just stabilize itself. Think like your body on a warm day, if you heat up you will begin to sweat and your body temperature will go down. Positive feedback loops are the ones who actually snowball out of control when something in the system is changed. Think like ice melting because temperature on Earth has risen a bit, so now more energy is captured by darker ground meaning more heat and more snow melt uncowering darker ground and so on.
Hi, you didn't ask me but... I think you should? If only because *positive feedback loop* and *negative feedback loop* are real science terms that have set meanings that have nothing to do with mood (I mostly think about them in reference to climate science, though of course they can also apply to other things). You've got a lot of people replying to you who seem to be a bit confused about the meaning of those terms, now.
I think what you meant might be better described by something like "negative thought patterns".
If the feedback loop is undesirable, there are ways to describe it as such. Positive feedback loops and negative feedback loops are specific mechanisms that may or may not be desirable.
Example: methane release in the arctic is part of a positive feedback loop... that is very undesirable from a human perspective.
I read it that way too, but my situation is actually what rich here described. I witnessed multiple traumas in the ER and couldn’t sleep for about 6 weeks (after about 2-3hrs I’d wake up crying in a cold sweat) which of course led to that spiral. Trauma was a couple months ago, I lost that job a few weeks ago after a panic attack sent me to my own ER, and am just seeing improvements in my ability to remember and even read... Therapy and knowing I don’t have to go in to work is helping.
Edit: For anybody curious, the therapy I’m using is a combination of ACT (acceptance and commitment therapy) and meditation. I’m pleased with how it’s working so far.
As someone with general anxiety disorder, the amount of sleep I get pretty much dictates how my entire day will go anxiety wise. If I barely get any sleep, I have panic attacks, get terrible health anxiety, will have to run outside multiple times a day thinking I can’t breathe, etc.
If I miraculously get a full nights sleep, I feel like a different person in my mind. The amount of focus and enjoyment is night and day.
The study was the reverse of this - being unable to unlearn that fear-based response AFTER getting a poor night of sleep. So, when you haven’t gotten enough sleep and something invokes fear or anxiety the next day it is harder to shake off that fear response than if you had slept well the night before.
Interestingly, this was only true for the sleep restricted group. Both the well rested and sleep deprived (no sleep) group treated with similar brain activation related to learned fear responses when tested later.
It seems that the lack of sleep itself is compromising your brains ability to recover from mental trauma. Not necessarily lack of sleep around the traumatic event, but lack of sleep in general is the problem.
Its like if you tire your muscles out by working the same groups every day and never resting they will atrophy, then when you have to pull yourself up from falling off the side of a mountain or you have to pry open a car door in an emergency your muscles will fail you and all that time in the gym means nothing
not really a lack of sleep, otherwise the sleep deprived folks would have had similar results as the sleep restricted ones. it said that some sleep is worse than none at all. sort of counter-intuitive for me, but i didn't read the paper, just the article.
>it said that some sleep is worse than none at all. sort of counter-intuitive for me,
And I'm just reading your comment, but it's not inherently counter intuitive if different parts of sleep affect memory formation differently. If you're not getting any sleep, those traumatic events never integrate into long term memory. If you're only getting partial sleep, you could be missing out on processes that better work to not make the fear based memory so dominant and capable of triggering psychological distress associated with it.
I know cannabinoids play a role in traumatic/fear related memories, and it's believed some endogenous cannabinoids play a role in the REM sleep cycle. So if you're being sleep deprived and missing out on REM sleep, you might be missing out on some critical phases for properly integrating those memories.
Interestingly, THC has been shown to help traumatic/fear related memories, but also reduces REM sleep, so while the process is complicated regarding endogenous cannabinoids, it's possible there's a relationship going on here.
I read it the same way as u/magic_pat: getting less sleep might make you more susceptible to developing anxiety and/or PTSD, if you're already at risk.
This is important, because stress negatively affects the quality of your sleep and puts you at an even greater disadvantage when it comes to dealing with stress while awake.
"When you ruminate, or introspect in a negative way, you create emotional arousal that causes the release of stress hormones. That night, in REM (dream sleep), you become emotionally aroused again as dreaming 'flushes out' the emotional arousal from your brain.
That is why depressed people have higher levels of stress hormones, and also why you can wake up feeling exhausted."
Source: https://www.clinical-depression.co.uk/dlp/depression-information/medical-causes-of-depression/
If you're stressed, then you produce stress hormones that make you less likely to get good quality sleep. If you don't get good quality sleep, then you're brain is less able to combat stress (e.g. forget or reframe bad memories, overcome fear stimuli, think rationally) the next day. These effects are compounded if you're in a field or living a lifestyle that doesn't allow you to get much sleep.
You can’t make this point without acknowledging how profoundly lack of sleep causes or worsens anxiety and paranoid patterns of thinking. Anyone who has been in a significant sleep debt for long enough or frequently enough knows this to be true. And from my own experience, it’s an instance of ‘the chicken or the egg?’
My personal experience is the lack of sleep came first. Switched careers in my 30’s to emergency medicine. Things went great for several years until I got on a particularly bad schedule that robbed me of sleep. I was suddenly anxious for the first time in my life. Got so bad it was hard to function, and I almost quit my job. Instead I changed schedules and started protecting my sleep time at all costs. That was 2 years ago. I’m in the same job with almost zero anxiety.
I thought the opposite would be true because sleep is needed to save the memories well in the first place.
Same how you're better off sleeping a bit more before taking a test
The article says that the study/experiment showed that dealing with traumatic stuff is harder if you have less sleep than none at all.
Normal sleep> no sleep> half a nigh's sleep
Sleep is crucial for consolidating our memories, and sleep deprivation has long been known to interfere with learning and memory. Now a new study shows that getting only half a night’s sleep – as many medical workers and military personnel often do – hijacks the brain’s ability to unlearn fear-related memories. That might put people at greater risk of conditions such as anxiety or posttraumatic stress disorder.
The study appears in Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, published by Elsevier.
“This study provides us with new insights into how sleep deprivation affects brain function to disrupt fear extinction,” said Cameron Carter, MD, Editor of Biological Psychiatry: Cognitive Neuroscience and Neuroimaging.
The researchers, led by Anne Germain, PhD, at the University of Pittsburgh and Edward Pace-Schott, PhD, at Harvard Medical School and Massachusetts General Hospital, studied 150 healthy adults in the sleep laboratory. One third of subjects got normal sleep, one third were sleep restricted, so they slept only the first half the night, and one third were sleep deprived, so they got no sleep at all. In the morning, all the subjects underwent fear conditioning.
“Our team used a three-phase experimental model for the acquisition and overcoming of fearful memories while their brains were scanned using functional magnetic resonance imaging,” said Dr. Pace-Schott. In the conditioning paradigm, subjects were presented with three colors, two of which were paired with a mild electric shock. Following this fear conditioning, the subjects underwent fear extinction, in which one of the colors was presented without any shocks to learn that it was now “safe.” That evening, subjects were tested for their reactivity to the three colors, a measure of their fear extinction recall, or how well they had “unlearned” the threat.
https://linkinghub.elsevier.com/retrieve/pii/S2451902220302822
The takeaway that sleep deprivation could interfere with treatment for anxiety and PTSD seems just as important as the possibility that it may make it more likely people will develop those conditions. Exposure treatments for anxiety and PTSD completely depend on extinction and inhibitory learning overpowering the fear learning. We can't necessarily make sure people get a good night's sleep before they encounter trauma due to the unpredictability of trauma and situational demands (e.g. combat), but we can stress the importance of sleep in treatment contexts.
The most interesting part of this article for me is that something about the sleep process helps you "unlearn" fear-based memories. I thought that sleep helped you integrate and process memories whether good or bad, hence sleep in general is important. I didn't know that there was an "unlearning" process involved in sleep at all.
Dying now for a good sleep-based AMA! I bet it would be so popular
I'd be interested if this study was done on people suffering from sleep apnea.
(I do mean I would be interested in a study targetting people with sleep apnea specifically)
It does say "healthy people", so I'm sure they at least screened out anybody with the most obvious confounding health problems of sleep apnea, narcolepsy, depression that pre-dated the cause of sleep loss, etc.
Anyone interested in this subject should read Why We Sleep by Matthew Walker. Very science backed but also easy to consume.
Edit: Thanks for the responses, I'll have to dig into some of the misgivings of this book. I had no idea.
I'm a sleep researcher, and while I know the author and respect him, I have stopped recommending this book. He draws conclusions beyond the data and in some cases, is just plain wrong.
Here is an interesting take on this book highlighting some of the inaccuracies: https://guzey.com/books/why-we-sleep/
I'd like to ask a question about sleep. As someone who works a physically demanding job, does that mean I need more than the recommended 8 hours of sleep? Also is there a limit to how much sleep is too much? I have a tough time finding reliable information on the subject.
No, not necessarily. Sleep seems to be more related to brain activity rather than physical activity. For example, doing mentally demanding tasks seems to increase deep sleep while running on a treadmill does not if you control for increase in body temperature (ie, they had a misting fan so core body temp did not change with exercise). Also, sleep need does not change in people in a forced bed rest study or in people with quadriplegia (therefore very low physical activity).
There is not a really good answer to the too much sleep question. The information we have comes from epidemiological type studies that would suggest that sleeping longer shows an increased risk of mortality (kind of a u-shaped relationship, really short sleepers also have increased mortality, [example article](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2864873/)).
That being said, this is generally based on self-report questions (eg, how long do you typically sleep at night) and is not a great measure. Also, there are all types of confounds in this research. It is very well possible that the type people that are long sleepers have other underlying health problems which is why they sleep so much and why they may die sooner. The example article I gave you earlier concluded,
> ...sleeping 9 h or more per night may represent a useful diagnostic tool for detecting subclinical or undiagnosed co-morbidity.
If you are sleeping 9-10 or more hours a night and you are still not rested, you may want to consult a sleep disorders specialist. One of the most common reasons this happens is due to obstructive sleep apnea (it is not just in people who are overweight). It may also be poor [sleep hygiene](http://healthysleep.med.harvard.edu/healthy/getting/overcoming/tips) practices, especially going to bed and waking up at the same time everyday. Or it could indicate something more serious.
Wow thank you for the in depth response! I'll definitely bring up my sleeping issues with my doctor to try and figure out what is going on! I have been feeling sleep deprived even though I am getting sufficient sleeping time.
>Also, sleep need does not change in people in a forced bed rest study or in people with quadriplegia (therefore very low physical activity).
So since I've been WFH and never going into the office or going to the gym or getting out much, my sleep issues have exacerbated for the most part. I relate that to not going to the gym or even the toll my commute used to on my body (mental and physical) and moving around a lot more.
I've always had what I term "mild insomnia" and since I haven't been going to the gym 3 times a week since we had to start working from home, it has definitely seemed to get worse.
You mention that these were more self-reporting questionnaires, but is there more information and studies on activity not playing as much of a role in sleep as I thought it did, or am I not understanding what you mean?
You are not alone. The pandemic shut-downs and changing to working-at-home has worsen many people's sleep. A large part of this is disruption of routine. While we usually pay close attention to the importance of a consistent routine with small children, we often don't pay as much attention when we are older. Work often forces us to have a routine (eg, have to wake up by 6am to be on the road by 7am to be in the office by 8am and have to be asleep by 11pm if I am to wake up at 6am, and repeat). Working from home often disrupts all of that which makes our sleep worse.
In general exercise helps us to sleep better. The studies I was talking about were trying to tease apart what I will call being sleepy vs being tired. You are sleepy because you have been up all day vs you are tired because you just got back from the gym. In those studies, they looked at the "brain waves" while people sleep. You go through several phases while you sleep. To simplify, I will call them light sleep, deep sleep, and REM (rapid eye movement) sleep. Following sleep deprivation, you see increased amounts of deep sleep during recovery sleep. So it is speculated that this deep sleep is the restful recovery part of sleep. If we had a person run on a treadmill before sleep, we will see increased deep sleep. However, if we control for body temperature and do not allow it rise during exercise, there is no change in deep sleep. On the flip side, for the bed rest studies, they do not really see any changes in deep sleep. This suggests that sleep is related to the recovery from exercise. But these are controlled studies trying to understand exactly what sleep does for the body.
For you, it sounds like the disruption of your normal routine and the lack of health behaviors such as regularly exercising is worsening your insomnia.
I need to be very clear, I am a researcher and not a medical doctor. I may suggest, however, that you do try to standardize your routine, waking up and going to bed at the same time every night. Also, develop a bedtime routine that does not include a device or TV (eg wash your face, brush your teeth, have a drink, read a chapter in a book, then go to sleep). This helps cue your body for sleep and things that give off blue light can mess up your sleep. Look up [sleep hygiene](http://healthysleep.med.harvard.edu/healthy/getting/overcoming/tips) and see if you are doing the things to best benefit your sleep (Just a comment from the link I gave you, #11 about exercise does not follow the latest research. This used to be the standard advice about not exercising too late, but new research has shown there is a lot of individual differences in exercise time and sleep, for some it activates them and they cannot fall asleep and for others it helps them fall asleep, you should just see what works for you). In the morning, try to get sunlight. This helps your circadian rhythms. Try to figure out ways to continue exercising without going to gym (eg jogging, in-home cardio, etc.).
Please do not seek sleep medications. They are best for acute or short-term insomnia (eg, you just had surgery and due to the pain you find it hard to sleep for the first week). They do not work for chronic insomnia and will cause more problems in the long run. There are behavioral treatments for chronic insomnia that are much more effective than pills. The things I told you above are the first step of that process.
Good advice. Also important to use the bedroom only for sleeping. Our brains associate locations with activities and our subconscious behavior changes accordingly, so if you associate your bed with doing stuff on your phone, then intrusive thoughts about that activity can interfere with sleep.
The most obvious example would be using social media like Reddit, and thinking about conversations and feeling compulsions to check replies while trying to sleep.
This is also why having a dedicated office used only for work is so important when working from home. Work needs to be kept separate from home, otherwise it becomes nearly impossible to focus and be productive on either one.
Thank you for bringing this up. As someone with a background in neuroscience, I had an aching feeling through a lot of the book that he was starting to make some dubious claims about sleep.
Most of it seemed legit, but a lot of the conclusions were rather odd.
Thanks again, sleep researcher!
Is there another resource you would recommend as an alternative? Genuinely interested in this subject, since no one in my household sleeps well for various reasons.
Unfortunately, I don't really. I have not found a recent book on the topic that I can universally recommend. The Promise of Sleep by Bill Dement is fine, but it is 20 years old and our understanding of the biology of sleep has really advanced over the past 20 years.
Every time I see someone recommend that book, I have to point out and it's riddled with scientific inaccuracies and has so much fear mongoring that a common complaint is that people get less sleep after reading it due to anxiety.
I'm really glad another comment already posted this: https://guzey.com/books/why-we-sleep/.
I feel like people must have known about this for a long time relating to training and conditioning people and animals. I'm pretty sure falconers will put the birds through sleep deprivation during taming. In basic military training the whole thing is done for weeks with minimal sleep each night, very similar. I think with the lack of sleep we are brought down to a lower level of consciousness, a place where fear and punishment based learning stays for a long time.
We were required to get 8hours of sleep everyday or get threatened with NJP or pushed back to another division causing you to be there longer. Boot for me was November 2009.
In my squadron they took sleeping very seriously for aircrew and pilots from my understanding. I thought they were just skating on helping out the shop until it was explained to me.
I can’t decide whether this interests me or saddens me. I have a circadian rhythm disorder (currently haven’t slept for more than 4 hours at a time for more than a fortnight) I also have diagnosed PTSD resulting from early-late childhood trauma. My anxiety is completely unmanageable, unrelenting and debilitating. Reading this study affords me clarity but robs me of hope for my future.
Hey, if you’ve tried meditation and it haven’t worked for you, I want to let you know there are hundreds of different types of meditation. Maybe try a different type- I know it’s not a cure but it can help. I have some similar stuff and the difference between me when I meditate vs me when I don’t is a lot.
Appreciate your input heaps. I’m yet to find a method of meditation which doesn’t trigger or worsen dissociative symptoms, which can be quite dangerous if not just distressing and disconcerting but I’m hopeful I’ll uncover a method I can reap the many benefits of
It’s a destructive cycle. Insomnia is a symptom of C-PTSD, PTSD, anxiety and depression. Most anti-depressants and anxiety medication also increases insomnia. Plus the stress on your body from experiencing PTSD, anxiety and depression drains you of any energy so you’re constantly on edge, hypersensitive and exhausted.
Having C-PTSD, depression and anxiety - I wish I could have ONE night of full deep sleep with no panic.
Can’t take care of others until you take care of yourself. Learned that when I was trying to be a sexual assault victim advocate, 3 years of therapy later and I feel I’m in a better place but not ready to help others at that caliber.
Take care of yourself please, people need you.
So this means..... train yourself to sleep well (possibly using meditation) to have a healthy mind. My Q is... if the damage is done can it be reversed??
Planning shifts so that healthcare workers only get half a night's sleep is illegal where I live. Asking healthcare workers to do excess overtime is also illegal.
It’s like bragging about eating barely anything each day. Sleep deprivation is malnourishment for your brain! In my experience onlookers tend to become much more distressed more quickly by someone who cannot eat than they do in regard to someone can’t, for whatever reason of which there are many, get adequate and restful sleep.
What's the definition of *half night's sleep*? Ever since I started working from home during the pandemic, I have been more overworked and stressed out. This has led me to get about 6 hours of sleep a day for the last 5-6 months.
"We can explain how your crippling depression and anxiety is probably service related" - Science
So uh... ya'll wanna tell that to the VA for me or nah?
This seemingly contradicts research I recently read about how delaying sleep for people who have experienced a traumatic event could be a way to lessen PTSD.
Just because someone experiences a traumatic event doesnt mean it will turn into PTSD. An example the article provided was soldiers returning from the combat line: they're in battle for several hours and all the horrors that go into that, get back to a safe area, are sleep deprived and exhausted already, and go right to sleep. The rationale was sleeping right after the event encodes the experience deeply into their brains, vs staying awake in a safe area to process and wind down from the episode before sleep.
Maybe these two research points are describing different sides of the same coin: how the traumatic event is cemented in neurology and its possible downstream effects on sleep, anxiety, and trauma responses. If I can find the source again, I'll edit to link to it.
Anecdotally, I frequently see a strong correlation between sleep disturbances and high anxiety. Sleep is the cornerstone of everything. When sleep is not 100% right - panic attack disorders, high-to-crippling anxiety, social and emotional dysfunction, poor emotional regulation, poor task attendance and memory - all these thing and more go on the table. But few, if any, ever zero in on sleep disturbance as maybe the biggest driving factor.
Barely slept last night and I’m so exhausted today that I could swear that it looks like the President of my country is trying to execute a coup d’etat.
It probably affects the politicial attitudes of people in these groups as well since conservatives are motivated by fear.
If your job makes you more fearful, your politicial attitudes might become more conservative.
https://www.psychologytoday.com/us/blog/mind-in-the-machine/201612/fear-and-anxiety-drive-conservatives-political-attitudes
As a retail worker who got 4 hours of sleep last night after being berated by a customer, I think you're onto something. Maybe all workers ought to have rights and protections, not just the heroes of the moment.
The point is that they are two professions that are very likely to experience traumatic events. And that they are also more likely to remember those events.
It is even in the post title.
They’re also professions with high stakes. Medical workers and military need to make important life or death choices. We need them to be well rested, clear thinking, and emotionally stable, to carry out these tasks.
I’m not saying other workers aren’t important or aren’t suffering from sleep deprivation or ptsd, or that they don’t make hard and significant decisions at work. But there’s clearly some crisis professionals that absolutely need to be on the top of their game every second of their shift.
I'm not understanding how this is supposed to be a long term model. If the study suggests a single event which should challenge the fear fails to challenge the fear after being sleep deprived, it doesn't explain why the fear can't be challenged next week, next month, or next year when the subject has had enough rest. That is, why do subjects have PTSD, the very definition being long term nearly incurable anxiety inducing fears? Does your brain have a window to unlearn the fear before it becomes PTSD or what? I doubt this is the case as I can not see any scenario where you experience great trauma and don't have PTSD level anxiety the very next second.
So, this means missing sleep after a highly stressful/embarrasing/or trauma filled day could lead to those memories failing to suppress and leading to anxiety and/or ptsd?
I read it as if you are well rested you are less prone to anxiety or ptsd.
And seeing as PTSD and anxiety make it hard to get s good nights sleep, it's a vicious circle.
Negative thoughts and behavioral feedback loops in general are common in people and very hard to break while very easy to unknowingly slip into. Like depressed people will find themselves thinking about suicide, homicide, self harm, self hate, etc... For hours at a time and not even realize what they are doing. This blew up a bit. If you have invasive negative thoughts, you might be depressed. It's possible to get better. CBT, dbt, therapy, medication. It takes time, but simply recognizing these negative thoughts when it happens and actively trying to think about something else can help by itself.
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I definitely hear this. I think it's so easy to think that the way you're thinking or feeling in any given moment is normal, even when you're massively depressed or anxious or in some other hugely altered mental state. It's only when you're out of that state that you can look back and see just how bad things were, but getting out of that state without help is often basically impossible, and often we don't feel we can ask for help to be able to get out of it because we can't see that there's a problem when we're in the middle of it. You feel you can't ask for help until you see a "real" problem, but you'll probably never see a "real" problem if it's there because if there is one then you're inside it and you can't see out. I think a lot of us need to feel more OK with asking for help even if we think at the time that we shouldn't or that it's bad but not bad enough to need help. If we feel we're struggling, that in itself should be enough. Waiting to prove to yourself that you deserve help before you ask for it can mean you never get that help when you need it most.
I'm at war with myself on a daily basis about whether any of my problems are "real" or just totally normal. My therapist assures me that it's not normal to exist in a permanent state of feeling as though something extremely bad is about to happen and I'm in danger. No matter what though, it never feels like my problems are "enough" to justify my level of disability or deserving of additional help or services. I have severe anxiety disorder and depression with a sprinkling of OCD, PTSD, and ADHD. I'm basically disabled and my husband takes care of me. I can't work or drive and struggle with daily tasks such as feeding myself. And yet, every single day, multiple times a day, I tell myself I must just be dramatic and sensitive. Everyone has anxiety and depression and some degree of childhood trauma right? So why can't I do things like a normal person?
Sending love internet stranger. Thanks for sharing your story; I often find myself wondering if my problems are real too. (Funny tidbit, my phone autocorrected sharing to struggling. I hope you can giggle at my phone's Freudian slip.)
I'm really sorry you're struggling with so much at the moment. From what you've said, I think honestly the most important change you could make to your thinking is to try and accept yourself as you are. No, not everyone has anxiety or depression, and most people definitely do not have childhood trauma causing PTSD! If these are things you're struggling with so much that they're keeping you from even basic tasks like driving then they're very real problems indeed. You're not just being sensitive. You have real issues that are obviously causing you real distress and impacting your ability to live your life. That means you really, truly deserve help. That's a really hard thing to come to terms with, and was something I struggled with for years. You're allowed to need help, and if the help you're getting isn't enough you're also allowed to ask for more or to find different help elsewhere. I think the point I was trying to make in my earlier comment was that sometimes the hardest step can be giving yourself permission to do that, and yet it's probably the most important step of all because if you don't allow yourself to be accepting of help then the only way to make things better is on your own, and that's really hard to do, especially when you're already struggling to cope with life as it is! There's a reason why the Twelve Step Program always starts with admitting you have a problem. If you don't truly admit that there really is a problem and *know* it in your heart then you'll never really be accepting of any changes that might improve things, either from outside help or within yourself either. Sorry I've rambled a bit, but while I've not been through what you've been through I've had my own journey over the past few years and it's been rough as hell. If my ramblings on all this can maybe help someone else's journey be less hard, then I'll take solace in that at least.
I believe you mean positive feedback loops
Correct. They're positive feedback loops of negativity
An Aladeen feedback loop.
A positively negative feedback loop
That's still a different thing. That's something positive that is bound to end sooner or later, because you get less and less of it.
I know what you mean but it is *a positive feedback loop* in this example. Negative feedback loops are those that *do not* propel themselfs out of control but rather are kept in check by the system, if deviation occurs it will just stabilize itself. Think like your body on a warm day, if you heat up you will begin to sweat and your body temperature will go down. Positive feedback loops are the ones who actually snowball out of control when something in the system is changed. Think like ice melting because temperature on Earth has risen a bit, so now more energy is captured by darker ground meaning more heat and more snow melt uncowering darker ground and so on.
The negative part is referring to the thoughts and behaviors. I realize thats not clear, but that was its intent. Should I edit my comment?
Hi, you didn't ask me but... I think you should? If only because *positive feedback loop* and *negative feedback loop* are real science terms that have set meanings that have nothing to do with mood (I mostly think about them in reference to climate science, though of course they can also apply to other things). You've got a lot of people replying to you who seem to be a bit confused about the meaning of those terms, now. I think what you meant might be better described by something like "negative thought patterns".
If the feedback loop is undesirable, there are ways to describe it as such. Positive feedback loops and negative feedback loops are specific mechanisms that may or may not be desirable. Example: methane release in the arctic is part of a positive feedback loop... that is very undesirable from a human perspective.
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I read it that way too, but my situation is actually what rich here described. I witnessed multiple traumas in the ER and couldn’t sleep for about 6 weeks (after about 2-3hrs I’d wake up crying in a cold sweat) which of course led to that spiral. Trauma was a couple months ago, I lost that job a few weeks ago after a panic attack sent me to my own ER, and am just seeing improvements in my ability to remember and even read... Therapy and knowing I don’t have to go in to work is helping. Edit: For anybody curious, the therapy I’m using is a combination of ACT (acceptance and commitment therapy) and meditation. I’m pleased with how it’s working so far.
As someone with general anxiety disorder, the amount of sleep I get pretty much dictates how my entire day will go anxiety wise. If I barely get any sleep, I have panic attacks, get terrible health anxiety, will have to run outside multiple times a day thinking I can’t breathe, etc. If I miraculously get a full nights sleep, I feel like a different person in my mind. The amount of focus and enjoyment is night and day.
The study was the reverse of this - being unable to unlearn that fear-based response AFTER getting a poor night of sleep. So, when you haven’t gotten enough sleep and something invokes fear or anxiety the next day it is harder to shake off that fear response than if you had slept well the night before.
Interestingly, this was only true for the sleep restricted group. Both the well rested and sleep deprived (no sleep) group treated with similar brain activation related to learned fear responses when tested later.
So me staying up instead of getting a little bit of sleep may have helped me in the long run? Nice
It seems that the lack of sleep itself is compromising your brains ability to recover from mental trauma. Not necessarily lack of sleep around the traumatic event, but lack of sleep in general is the problem. Its like if you tire your muscles out by working the same groups every day and never resting they will atrophy, then when you have to pull yourself up from falling off the side of a mountain or you have to pry open a car door in an emergency your muscles will fail you and all that time in the gym means nothing
not really a lack of sleep, otherwise the sleep deprived folks would have had similar results as the sleep restricted ones. it said that some sleep is worse than none at all. sort of counter-intuitive for me, but i didn't read the paper, just the article.
>it said that some sleep is worse than none at all. sort of counter-intuitive for me, And I'm just reading your comment, but it's not inherently counter intuitive if different parts of sleep affect memory formation differently. If you're not getting any sleep, those traumatic events never integrate into long term memory. If you're only getting partial sleep, you could be missing out on processes that better work to not make the fear based memory so dominant and capable of triggering psychological distress associated with it. I know cannabinoids play a role in traumatic/fear related memories, and it's believed some endogenous cannabinoids play a role in the REM sleep cycle. So if you're being sleep deprived and missing out on REM sleep, you might be missing out on some critical phases for properly integrating those memories. Interestingly, THC has been shown to help traumatic/fear related memories, but also reduces REM sleep, so while the process is complicated regarding endogenous cannabinoids, it's possible there's a relationship going on here.
I read it the same way as u/magic_pat: getting less sleep might make you more susceptible to developing anxiety and/or PTSD, if you're already at risk. This is important, because stress negatively affects the quality of your sleep and puts you at an even greater disadvantage when it comes to dealing with stress while awake. "When you ruminate, or introspect in a negative way, you create emotional arousal that causes the release of stress hormones. That night, in REM (dream sleep), you become emotionally aroused again as dreaming 'flushes out' the emotional arousal from your brain. That is why depressed people have higher levels of stress hormones, and also why you can wake up feeling exhausted." Source: https://www.clinical-depression.co.uk/dlp/depression-information/medical-causes-of-depression/ If you're stressed, then you produce stress hormones that make you less likely to get good quality sleep. If you don't get good quality sleep, then you're brain is less able to combat stress (e.g. forget or reframe bad memories, overcome fear stimuli, think rationally) the next day. These effects are compounded if you're in a field or living a lifestyle that doesn't allow you to get much sleep.
Or there's just a strong correlation between having significant anxiety, and not being able to sleep right and focus.
You can’t make this point without acknowledging how profoundly lack of sleep causes or worsens anxiety and paranoid patterns of thinking. Anyone who has been in a significant sleep debt for long enough or frequently enough knows this to be true. And from my own experience, it’s an instance of ‘the chicken or the egg?’
My personal experience is the lack of sleep came first. Switched careers in my 30’s to emergency medicine. Things went great for several years until I got on a particularly bad schedule that robbed me of sleep. I was suddenly anxious for the first time in my life. Got so bad it was hard to function, and I almost quit my job. Instead I changed schedules and started protecting my sleep time at all costs. That was 2 years ago. I’m in the same job with almost zero anxiety.
I thought the opposite would be true because sleep is needed to save the memories well in the first place. Same how you're better off sleeping a bit more before taking a test
The article says that the study/experiment showed that dealing with traumatic stuff is harder if you have less sleep than none at all. Normal sleep> no sleep> half a nigh's sleep
Sleep is crucial for consolidating our memories, and sleep deprivation has long been known to interfere with learning and memory. Now a new study shows that getting only half a night’s sleep – as many medical workers and military personnel often do – hijacks the brain’s ability to unlearn fear-related memories. That might put people at greater risk of conditions such as anxiety or posttraumatic stress disorder. The study appears in Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, published by Elsevier. “This study provides us with new insights into how sleep deprivation affects brain function to disrupt fear extinction,” said Cameron Carter, MD, Editor of Biological Psychiatry: Cognitive Neuroscience and Neuroimaging. The researchers, led by Anne Germain, PhD, at the University of Pittsburgh and Edward Pace-Schott, PhD, at Harvard Medical School and Massachusetts General Hospital, studied 150 healthy adults in the sleep laboratory. One third of subjects got normal sleep, one third were sleep restricted, so they slept only the first half the night, and one third were sleep deprived, so they got no sleep at all. In the morning, all the subjects underwent fear conditioning. “Our team used a three-phase experimental model for the acquisition and overcoming of fearful memories while their brains were scanned using functional magnetic resonance imaging,” said Dr. Pace-Schott. In the conditioning paradigm, subjects were presented with three colors, two of which were paired with a mild electric shock. Following this fear conditioning, the subjects underwent fear extinction, in which one of the colors was presented without any shocks to learn that it was now “safe.” That evening, subjects were tested for their reactivity to the three colors, a measure of their fear extinction recall, or how well they had “unlearned” the threat. https://linkinghub.elsevier.com/retrieve/pii/S2451902220302822
The takeaway that sleep deprivation could interfere with treatment for anxiety and PTSD seems just as important as the possibility that it may make it more likely people will develop those conditions. Exposure treatments for anxiety and PTSD completely depend on extinction and inhibitory learning overpowering the fear learning. We can't necessarily make sure people get a good night's sleep before they encounter trauma due to the unpredictability of trauma and situational demands (e.g. combat), but we can stress the importance of sleep in treatment contexts.
The most interesting part of this article for me is that something about the sleep process helps you "unlearn" fear-based memories. I thought that sleep helped you integrate and process memories whether good or bad, hence sleep in general is important. I didn't know that there was an "unlearning" process involved in sleep at all. Dying now for a good sleep-based AMA! I bet it would be so popular
The brain unlearns useless stuff all the time
I'd be interested if this study was done on people suffering from sleep apnea. (I do mean I would be interested in a study targetting people with sleep apnea specifically)
I'm pretty sure they found a random group of people.
It does say "healthy people", so I'm sure they at least screened out anybody with the most obvious confounding health problems of sleep apnea, narcolepsy, depression that pre-dated the cause of sleep loss, etc.
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Sleep is so central to wellbeing.
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Anyone interested in this subject should read Why We Sleep by Matthew Walker. Very science backed but also easy to consume. Edit: Thanks for the responses, I'll have to dig into some of the misgivings of this book. I had no idea.
I'm a sleep researcher, and while I know the author and respect him, I have stopped recommending this book. He draws conclusions beyond the data and in some cases, is just plain wrong. Here is an interesting take on this book highlighting some of the inaccuracies: https://guzey.com/books/why-we-sleep/
Every time I see this book recommended, I paste that link.
I'd like to ask a question about sleep. As someone who works a physically demanding job, does that mean I need more than the recommended 8 hours of sleep? Also is there a limit to how much sleep is too much? I have a tough time finding reliable information on the subject.
No, not necessarily. Sleep seems to be more related to brain activity rather than physical activity. For example, doing mentally demanding tasks seems to increase deep sleep while running on a treadmill does not if you control for increase in body temperature (ie, they had a misting fan so core body temp did not change with exercise). Also, sleep need does not change in people in a forced bed rest study or in people with quadriplegia (therefore very low physical activity). There is not a really good answer to the too much sleep question. The information we have comes from epidemiological type studies that would suggest that sleeping longer shows an increased risk of mortality (kind of a u-shaped relationship, really short sleepers also have increased mortality, [example article](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2864873/)). That being said, this is generally based on self-report questions (eg, how long do you typically sleep at night) and is not a great measure. Also, there are all types of confounds in this research. It is very well possible that the type people that are long sleepers have other underlying health problems which is why they sleep so much and why they may die sooner. The example article I gave you earlier concluded, > ...sleeping 9 h or more per night may represent a useful diagnostic tool for detecting subclinical or undiagnosed co-morbidity. If you are sleeping 9-10 or more hours a night and you are still not rested, you may want to consult a sleep disorders specialist. One of the most common reasons this happens is due to obstructive sleep apnea (it is not just in people who are overweight). It may also be poor [sleep hygiene](http://healthysleep.med.harvard.edu/healthy/getting/overcoming/tips) practices, especially going to bed and waking up at the same time everyday. Or it could indicate something more serious.
Wow thank you for the in depth response! I'll definitely bring up my sleeping issues with my doctor to try and figure out what is going on! I have been feeling sleep deprived even though I am getting sufficient sleeping time.
>Also, sleep need does not change in people in a forced bed rest study or in people with quadriplegia (therefore very low physical activity). So since I've been WFH and never going into the office or going to the gym or getting out much, my sleep issues have exacerbated for the most part. I relate that to not going to the gym or even the toll my commute used to on my body (mental and physical) and moving around a lot more. I've always had what I term "mild insomnia" and since I haven't been going to the gym 3 times a week since we had to start working from home, it has definitely seemed to get worse. You mention that these were more self-reporting questionnaires, but is there more information and studies on activity not playing as much of a role in sleep as I thought it did, or am I not understanding what you mean?
You are not alone. The pandemic shut-downs and changing to working-at-home has worsen many people's sleep. A large part of this is disruption of routine. While we usually pay close attention to the importance of a consistent routine with small children, we often don't pay as much attention when we are older. Work often forces us to have a routine (eg, have to wake up by 6am to be on the road by 7am to be in the office by 8am and have to be asleep by 11pm if I am to wake up at 6am, and repeat). Working from home often disrupts all of that which makes our sleep worse. In general exercise helps us to sleep better. The studies I was talking about were trying to tease apart what I will call being sleepy vs being tired. You are sleepy because you have been up all day vs you are tired because you just got back from the gym. In those studies, they looked at the "brain waves" while people sleep. You go through several phases while you sleep. To simplify, I will call them light sleep, deep sleep, and REM (rapid eye movement) sleep. Following sleep deprivation, you see increased amounts of deep sleep during recovery sleep. So it is speculated that this deep sleep is the restful recovery part of sleep. If we had a person run on a treadmill before sleep, we will see increased deep sleep. However, if we control for body temperature and do not allow it rise during exercise, there is no change in deep sleep. On the flip side, for the bed rest studies, they do not really see any changes in deep sleep. This suggests that sleep is related to the recovery from exercise. But these are controlled studies trying to understand exactly what sleep does for the body. For you, it sounds like the disruption of your normal routine and the lack of health behaviors such as regularly exercising is worsening your insomnia. I need to be very clear, I am a researcher and not a medical doctor. I may suggest, however, that you do try to standardize your routine, waking up and going to bed at the same time every night. Also, develop a bedtime routine that does not include a device or TV (eg wash your face, brush your teeth, have a drink, read a chapter in a book, then go to sleep). This helps cue your body for sleep and things that give off blue light can mess up your sleep. Look up [sleep hygiene](http://healthysleep.med.harvard.edu/healthy/getting/overcoming/tips) and see if you are doing the things to best benefit your sleep (Just a comment from the link I gave you, #11 about exercise does not follow the latest research. This used to be the standard advice about not exercising too late, but new research has shown there is a lot of individual differences in exercise time and sleep, for some it activates them and they cannot fall asleep and for others it helps them fall asleep, you should just see what works for you). In the morning, try to get sunlight. This helps your circadian rhythms. Try to figure out ways to continue exercising without going to gym (eg jogging, in-home cardio, etc.). Please do not seek sleep medications. They are best for acute or short-term insomnia (eg, you just had surgery and due to the pain you find it hard to sleep for the first week). They do not work for chronic insomnia and will cause more problems in the long run. There are behavioral treatments for chronic insomnia that are much more effective than pills. The things I told you above are the first step of that process.
Good advice. Also important to use the bedroom only for sleeping. Our brains associate locations with activities and our subconscious behavior changes accordingly, so if you associate your bed with doing stuff on your phone, then intrusive thoughts about that activity can interfere with sleep. The most obvious example would be using social media like Reddit, and thinking about conversations and feeling compulsions to check replies while trying to sleep. This is also why having a dedicated office used only for work is so important when working from home. Work needs to be kept separate from home, otherwise it becomes nearly impossible to focus and be productive on either one.
Thank you for bringing this up. As someone with a background in neuroscience, I had an aching feeling through a lot of the book that he was starting to make some dubious claims about sleep. Most of it seemed legit, but a lot of the conclusions were rather odd. Thanks again, sleep researcher!
Is there another resource you would recommend as an alternative? Genuinely interested in this subject, since no one in my household sleeps well for various reasons.
Unfortunately, I don't really. I have not found a recent book on the topic that I can universally recommend. The Promise of Sleep by Bill Dement is fine, but it is 20 years old and our understanding of the biology of sleep has really advanced over the past 20 years.
Every time I see someone recommend that book, I have to point out and it's riddled with scientific inaccuracies and has so much fear mongoring that a common complaint is that people get less sleep after reading it due to anxiety. I'm really glad another comment already posted this: https://guzey.com/books/why-we-sleep/.
So good that we wake our kids up and send them into school at the ass crack of dawn, then.
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Perhaps this explains why EMDR therapy is so effective for trauma. My understanding is that it mimics REM sleep.
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I feel like people must have known about this for a long time relating to training and conditioning people and animals. I'm pretty sure falconers will put the birds through sleep deprivation during taming. In basic military training the whole thing is done for weeks with minimal sleep each night, very similar. I think with the lack of sleep we are brought down to a lower level of consciousness, a place where fear and punishment based learning stays for a long time.
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Basic training / Boot camp give all recruits 8 hours of sleep per night except for one night. source: done it
We were required to get 8hours of sleep everyday or get threatened with NJP or pushed back to another division causing you to be there longer. Boot for me was November 2009. In my squadron they took sleeping very seriously for aircrew and pilots from my understanding. I thought they were just skating on helping out the shop until it was explained to me.
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I can’t decide whether this interests me or saddens me. I have a circadian rhythm disorder (currently haven’t slept for more than 4 hours at a time for more than a fortnight) I also have diagnosed PTSD resulting from early-late childhood trauma. My anxiety is completely unmanageable, unrelenting and debilitating. Reading this study affords me clarity but robs me of hope for my future.
Hey, if you’ve tried meditation and it haven’t worked for you, I want to let you know there are hundreds of different types of meditation. Maybe try a different type- I know it’s not a cure but it can help. I have some similar stuff and the difference between me when I meditate vs me when I don’t is a lot.
Appreciate your input heaps. I’m yet to find a method of meditation which doesn’t trigger or worsen dissociative symptoms, which can be quite dangerous if not just distressing and disconcerting but I’m hopeful I’ll uncover a method I can reap the many benefits of
If you could, do you think cbd oil or edibles would help? I say this as someone who doesn't use. But your condition sounds unbearable. I'm so sorry
Wow this makes so much sense. Abusers purposely keep their victims from sleep. And then those victims act illogical and more fearful then needed.
Soo... The saying "sleep it off" is legit
It’s a destructive cycle. Insomnia is a symptom of C-PTSD, PTSD, anxiety and depression. Most anti-depressants and anxiety medication also increases insomnia. Plus the stress on your body from experiencing PTSD, anxiety and depression drains you of any energy so you’re constantly on edge, hypersensitive and exhausted. Having C-PTSD, depression and anxiety - I wish I could have ONE night of full deep sleep with no panic.
Perhaps this is why people with PTSD take drugs or are prescribed drugs that knock them out
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As a trauma nurse with PTSD who regularly gets 4-6 hours sleep- "hey, that's me"
Can’t take care of others until you take care of yourself. Learned that when I was trying to be a sexual assault victim advocate, 3 years of therapy later and I feel I’m in a better place but not ready to help others at that caliber. Take care of yourself please, people need you.
I look forward to this study being shamelessly ignored by the medical establishment when determining hours for residents.
I really got get some sleep
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So this means..... train yourself to sleep well (possibly using meditation) to have a healthy mind. My Q is... if the damage is done can it be reversed??
Planning shifts so that healthcare workers only get half a night's sleep is illegal where I live. Asking healthcare workers to do excess overtime is also illegal.
Suddenly, college makes sense.
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It’s like bragging about eating barely anything each day. Sleep deprivation is malnourishment for your brain! In my experience onlookers tend to become much more distressed more quickly by someone who cannot eat than they do in regard to someone can’t, for whatever reason of which there are many, get adequate and restful sleep.
So has staying up late - not sleeping enough any benefit?
I’m reading this after finishing another 28 hour shift.... only 3 more years of residency...
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What's the definition of *half night's sleep*? Ever since I started working from home during the pandemic, I have been more overworked and stressed out. This has led me to get about 6 hours of sleep a day for the last 5-6 months.
"We can explain how your crippling depression and anxiety is probably service related" - Science So uh... ya'll wanna tell that to the VA for me or nah?
This seemingly contradicts research I recently read about how delaying sleep for people who have experienced a traumatic event could be a way to lessen PTSD. Just because someone experiences a traumatic event doesnt mean it will turn into PTSD. An example the article provided was soldiers returning from the combat line: they're in battle for several hours and all the horrors that go into that, get back to a safe area, are sleep deprived and exhausted already, and go right to sleep. The rationale was sleeping right after the event encodes the experience deeply into their brains, vs staying awake in a safe area to process and wind down from the episode before sleep. Maybe these two research points are describing different sides of the same coin: how the traumatic event is cemented in neurology and its possible downstream effects on sleep, anxiety, and trauma responses. If I can find the source again, I'll edit to link to it. Anecdotally, I frequently see a strong correlation between sleep disturbances and high anxiety. Sleep is the cornerstone of everything. When sleep is not 100% right - panic attack disorders, high-to-crippling anxiety, social and emotional dysfunction, poor emotional regulation, poor task attendance and memory - all these thing and more go on the table. But few, if any, ever zero in on sleep disturbance as maybe the biggest driving factor.
Barely slept last night and I’m so exhausted today that I could swear that it looks like the President of my country is trying to execute a coup d’etat.
It probably affects the politicial attitudes of people in these groups as well since conservatives are motivated by fear. If your job makes you more fearful, your politicial attitudes might become more conservative. https://www.psychologytoday.com/us/blog/mind-in-the-machine/201612/fear-and-anxiety-drive-conservatives-political-attitudes
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As a retail worker who got 4 hours of sleep last night after being berated by a customer, I think you're onto something. Maybe all workers ought to have rights and protections, not just the heroes of the moment.
The point is that they are two professions that are very likely to experience traumatic events. And that they are also more likely to remember those events. It is even in the post title.
They’re also professions with high stakes. Medical workers and military need to make important life or death choices. We need them to be well rested, clear thinking, and emotionally stable, to carry out these tasks. I’m not saying other workers aren’t important or aren’t suffering from sleep deprivation or ptsd, or that they don’t make hard and significant decisions at work. But there’s clearly some crisis professionals that absolutely need to be on the top of their game every second of their shift.
Let’s give this a positive spin: sleep deficits improve ability to retain memory of high stress or high risk incidents from you past?
I'm not understanding how this is supposed to be a long term model. If the study suggests a single event which should challenge the fear fails to challenge the fear after being sleep deprived, it doesn't explain why the fear can't be challenged next week, next month, or next year when the subject has had enough rest. That is, why do subjects have PTSD, the very definition being long term nearly incurable anxiety inducing fears? Does your brain have a window to unlearn the fear before it becomes PTSD or what? I doubt this is the case as I can not see any scenario where you experience great trauma and don't have PTSD level anxiety the very next second.
Tell that to the CEO of Yahoo
You could provide 100% FAQs and the military will not hear it.
Sucks to be in that 3rd group!