10 Ways to Boost Trauma Recovery: 8. Better Sleep

Over the years I’ve noticed that my clients who are struggling the most in terms of mental and emotional pain are often the clients who also have the most trouble getting good sleep. Indeed, difficulty sleeping and nightmares are both criteria used for officially diagnosing Post Traumatic Stress Disorder (PTSD). So for the 8th interview in this series, I decided to look into the link between trauma and sleep.

Recently I spoke with Dr. Richard Shane, developer of the Sleep Easily method, about helping people overcome insomnia, and about the link between sleep and trauma. Dr. Shane has been a psychotherapist since 1977, and is the Behavioral Sleep Therapist for New West Physicians, Colorado, with 100 providers serving 200,000 patients. From 2010 through 2014, he was the Behavioral Sleep Therapist for Lutheran Medical Center Sleep Center in Denver. 

Richard’s Background and Development of His Method

Peg: Thanks so much for talking to me about sleep. I’d like to start today by asking how you got into helping people improve their sleep.

Richard: I started out as a psychotherapist in the late 1970s, and along the way developed my own method for mind-body awareness therapy. But then in the early 1990s I had two major crises in my own life, and developed severe insomnia. I was sleeping only a couple of hours a night, and I felt like my life was ruined. I couldn’t find anything that worked, and didn’t want to get hooked on medication. It became apparent that I was going to have to find my own way through this. So I spent years with grueling insomnia, and I trained myself to observe what was going on in my mind and body as I got closer to sleep.

Most people with insomnia initially try to quiet the mind. It became apparent to me that, because of the traumas I’d gone through, I had immense tension in my body. My mind didn’t like feeling that, so it tried to stay busy to avoid the tension. That leads to dissociation. In the end, I found that the path was not in trying to calm the mind, but instead calming the body tension. I discovered my own ways to do that, which are very different than relaxing.

Peg: So, you developed your method through trial and error and your own internal reflection on your own experience. Is that right?

Richard: That’s how I developed the core of my method. But all of the refinements that make it so effective I learned through client sessions.

I was the behavior sleep therapist for Lutheran Medical Center for a number of years, and I’m now the behavioral sleep therapist for New West Physicians, which serves over 200,000 patients. What that means for me is opportunities to continually make the method even more effective and easier. All of that got woven into the method for every client after that. So this is the combination of the wisdom from a lot of clients.

The Sleep Easily Method

Richard: What I discovered about getting to sleep is that it’s not about relaxing the entire body. It’s also not about quieting your mind, in the midst of whatever is going on. It's simpler than that: there are certain body sensations that are like neurological switches for sleep. They give your body the feeling of falling asleep, and when you do that, then the mind becomes calm. These switches are ways to calm the nervous system on a much deeper level than trying to relax your entire body.

Peg: How long does it take to learn how to use these switches?

Richard: My program involves three sessions. Most people sleep better starting the first night. That sounds like a big claim to make. I’m not saying the sleep problems are solved the first night, but most people sleep noticeably better after the first session.  And that, by itself, is such a relief. It’s like the end of a nightmare and the beginning of hope.

In the first session, I teach people the method, which is very simple. The patients also receive a recording that guides them through the method. But very soon it becomes a familiar, comfortable feeling and then they can easily use the method without the recording. Although people like to return to the recording because it feels good to be guided. But the goal is for patients to be able to use the method completely on their own.

Peg: What are the other two sessions focused on?

Richard: In the second session, the client reports both how their sleep has improved, and any ways the method has not been as effective as they would like. I then make refinements so it is easier and more effective. I then give them a second sleep method, that builds on the foundation of the first method, but is effective on an even deeper level. In the third session, I give clients a third sleep method that is quite different from the first two, yet also very easy. Then people have a choice of which method feels best on any night.

Peg: Do you ever run into clients who don’t respond in three sessions? What do you do in that case?

Richard: Offer an additional session or two.

Peg: Can you give me an example of one of these neurological switches?

Richard: Sure. Let me give you one that you can use. This isn’t the whole solution, but it’ll give you a surprisingly simple step:

There are neurological reasons for which your tongue is a switch. Most people who are stressed, especially if they’ve experienced trauma, have tension in their tongue and press it against the roof of their mouth. It’s like they’re bracing for more stress and trauma. So what you do is allow your tongue to relax a little. It can still be touching the roof of your mouth, but just not pressing. Try it right now. And notice the subtle difference in your jaw, your neck, your shoulders, maybe your head. When you do that for a longer period of time, it will begin to calm your mind and emotions. So that’s an example of how simple the method is.

Peg: Ah, yeah. I only did it for a minute there, but I totally felt that ripple through all those parts of my upper body.

Richard: Let me explain another neurological switch for sleep. When people can’t sleep, they’re dealing with their mind, their emotions, their body, their life. All of that is overwhelming to deal with during the day, and even more when also trying to get to sleep. So we need to make it all simpler. One way to do that is using your heart. We all know that when we’re anxious our hearts beat faster, and when we’re calmer our heart beats more slowly. So there’s a very simple way to get your heart to feel calmer and more protected. And when your heart calms down, it automatically calms mind, emotions and body. So we can work with just that one part of it, instead of trying to deal with it all.

Peg: So you help people focus on the heart for this switch?

Richard: It’s not thinking about the heart. It’s all body sensation, and then mind follows. There is a simple way to have a feeling of protection and safety around your heart. I won’t go into that one in detail here, but it gives you a sense for the types of body sensations that are neurological switches for sleep.

Peg: I love what you’re saying about the body sensation of protection. I know a lot of people that I work with struggle mightily to feel safe. Part of that is not thinking they actually are safe, but for people who actually are currently physically safe, part is that neurologically through trauma they’ve learned to never feel safe. So they don’t know how to get that sensation.

Richard: Safety is the absolute center of my sleep method. It’s also the center of trauma resolution. So the question is how do I feel safe when I haven’t been feeling safe. The first level you need to address is the external physical level. Are you actually safe? Most people can easily get physically safe, but then they still have memories of what’s happened and they still can’t feel safe. There’s an analogy I use a lot, which is if you are outdoors in a storm without proper protection, you have to be braced and it’s stressful. Then you come inside. You can usually calm down right away, even though there’s a storm still going on outside. So the principle is, “indoors, safe and protected, away from what is going on out there.” The Sleep Easily method gives you a simple way to feel a particular feeling of comfort and safety deep in the body. Then you go with your awareness to that feeling and you rest in it. Inside yourself, safe and protected, even though all the stressors of your external life are still going on.

Peg: So you have a series of body sensations that you guide people to find, which create sensations of calm and safety, and those are the neurological switches.

Richard: Yes, and together they create the body sensation of falling asleep.

Effectiveness of the Sleep Easily Method

Peg: Do you have any information about how effective your method is?

Richard: In 2012 there was a study done involving United Airlines pilots, the Denver Police Department and the Boulder Fire Department. 81.6% of the participants reported that they slept better, and most reported that they slept better the first couple of nights.

Peg: Those seem like really good results, especially for a method that involves so little intervention.

Richard: Yes! Thank you

How Does Sleep Affect Us, Especially in Healing from Trauma?

Peg: I’ve worked with many people who are struggling with poor sleep and then find some way to improve their sleep. What I’ve noticed is that it often seems like a miracle occurred in their life. I see so many parts of people’s lives improve when they start getting good sleep.

Richard: Yes, when you sleep better, it has a positive effect on almost every area of life. That’s why I switched from being a psychotherapist to just working with sleep. I feel like I’m having so much of an influence on people’s lives. It’s like flipping this one switch that improves everything.

Peg: I would like to hear you talk more about your understanding of what sleep does for us, especially in terms of nervous system activation and recovery from trauma. But also in terms of health in general.

Richard: In general, the list includes decreased sickness, decreased risk for diabetes, decreased weight, decreased risk for hypertension, decreased risk for cardiovascular disease, decreased stress, decreased depression, decreased anger, and decreased irritability. There are also increases in immune system functioning, alertness, productivity, energy, quality of relationships, all areas of cognitive functioning including attention, decision making, and memory.

Peg: I know intuitively that what you’re saying must be true. We all know that when we’re not getting enough sleep, we’re not our best selves in any realm. And it all feels so much more workable when we finally get some good sleep.

Richard: Poor sleep increases the baseline tension in your body -- your anxiety. It also increases hypervigilance [a state of increased alertness to possible signals of danger]. Which is important because trauma can also create hypervigilance, as the person constantly does not feel safe and is scanning for threats. Calming some of the hypervigilance by getting good sleep can help a lot.

There are a lot of neuropsychologists who do neurological testing after trauma, and some of them will not even do the testing if someone is having major trouble sleeping, because the results won’t be accurate. It’s hard to untangle the trauma-related results from sleep-related results. So, whether it’s getting them on sleep medication or referring them to me or other sleep therapists, it’s important to take care of sleep as the first step in healing trauma.

Peg: One of the most effective and well-researched trauma therapy interventions that we have is EMDR. My understanding is that EMDR induces a brain state that has some relationship to REM sleep. When I do EMDR with people, it always looks from my perspective as if they become able to file away their traumatic experiences in a more effective way, so that they can put them to rest better. And I understand that dreaming does the same thing for us.

Richard: Absolutely. Both sleep, itself, and dreaming. Science is not able to explain exactly how sleep and dreams affect us, but sleep and dreams do reorganize the day’s experiences. They also seem to reorganize memories and help someone process and resolve their trauma.

Peg: So if someone is coming in to me to do EMDR, but they aren’t getting good sleep, I notice that it tends to take longer to get good results. What we’re saying here is that if they can start getting better sleep, then any EMDR we do is probably going to be more effective.

Richard: This is going to make your work more effective. Someone who is getting good sleep is going to be more effective in whatever you are doing.

What About Medication for Sleep?

Peg: A couple of minutes ago you mentioned medication. I’m interested in your thoughts about medication for sleep, because that’s where a lot of people start in looking for help.

Richard: While the ultimate goal is to sleep without medication, I absolutely think that there is a role for medication to get someone out of crisis, so they’re getting some sleep. It is widely known that medicated sleep is lower quality than non-medicated sleep. But it is far better than no sleep. So I am very supportive of medication in some circumstances.

In fact, I work a lot with people who are on sleep medications but want to sleep without medication. So I have a protocol in my program to gradually get people to reduce and eliminate sleep medications without withdrawal. What often happens is that when people reduce medications on their own, they get a reaction from their nervous system. What I do instead is have them keep taking the medication and simultaneously use the Sleep Easily method. People find they sleep more easily, quickly and deeply with the method plus the medication, compared with the medication alone. They then have proof they are not just being drugged; they are doing something that is helping them sleep. As their confidence in this builds, the need for medication falls away.

Peg: That makes sense to me. I know that when I have trouble sleeping, the fear that I won’t get to sleep then makes it less likely that I’ll be able to get to sleep. It’s a vicious cycle. So building confidence in getting to sleep sounds like it would help a lot.

Richard: A lot of that phenomenon is the mind thinking, “I don’t know what to do!” So what I do is provide simple steps of what to do.

How Does This Method Compare to Other Common Approaches?

Peg: When I started learning about approaches for helping people with sleep, I learned that there are a lot of providers around who do what’s called CBT-I, or cognitive behavioral therapy for insomnia. What do you think of that approach relative to your approach?

Richard: Glad you asked. With CBT-I, two primary tools are: 1. If you are not asleep in 20 minutes, get out of bed and don’t return until you feel sleepy. If again not asleep in 20 minutes, get out of bed again. 2. Your time in bed should be restricted to the amount of time you sleep. So if you are sleeping only 5.5 hours, you should go to bed later and get out of bed earlier. The understandable goal is not wanting people to be in bed awake and anxious. However, many people say the CBT-I sleep restriction protocol increases agitation and sometimes feels like “torture.”

Even if you are not yet fully asleep, Sleep Easily gives you a way to have a feeling of “leaning into sleep inside your body” and “opening the pathway to sleep inside your body.” That feels very satisfying, so you stay in bed and feel that. Your body then recognizes this feeling and carries you into sleep.

There is no one solution that works for everybody. So, I’m glad there are multiple approaches so that people can find what works best for them.

How Would Someone Look Into What You Offer?

Richard: I offer a free 15-minute introductory phone consultation. So people can describe their sleep difficulty, and I can explain how this method will address that and help them sleep. They can visit my website at www.drshane.com, and there is a form on the main page to ask for the consultation.  I want people to feel safe and know what they’re getting into and who they’ll be working with.

Because I am nationally known for my sleep method, I work with people nationwide via telephone. The sessions are as effective as in person; we are just not looking at each other. You then have the session in the comfort and convenience of your home.

Peg: I appreciate your concern about that. We’ve been talking about how important a sense of safety is in achieving sleep, especially for people who have experienced trauma and have had real experiences of not being safe.

Conclusions and Contact Info

I think that answers all of my questions! Thank you so much for talking to me. Is there any last thing you’d like to tell my readers?

Richard: I’d just like to say that I experienced such horrific insomnia and life showed me the way through it. I’m so grateful, and I love sharing this with people. I love how it changes people’s lives.

For anyone who would like to reach out to Richard for more information or to explore working with him, please contact him through drshane.com.

Was this interview helpful to you in your journey to heal or help others heal? Is there anyone else you would like me to interview, or additional information you’d like to see in these posts? Please add a comment below!