ļ»æEp 70 - How can EMDR help sleep
āHello, and welcome back to the EMDR Doctor podcast. I'm Dr Caroline Lloyd,
and today Iām going to chat to you about how EMDR can help sleep.
Great question, and put to me by one of my beautiful clients. I am going to cover a few different aspects of sleep today - anxiety, nightmares and parasomnias.
EMDR obviously canāt help some causes of sleep disruption, like sleep apnoea, a snoring partner, new baby, or menopause for example, but we can definitely work on the psychological causes for insomnia.
Now we all know that EMDR helps anxiety, and anxiety impacts sleep quite substantially. Most people will have an experience of this - before an exam, or important event, or on a day when something has gone awry. If you are worrying about what is happening tomorrow or catastrophising about something in your life, it can be quite hard to get to sleep. So EMDR can definitely help you with those issues - both working on the anxiety and also the catastrophising - we have a special protocol for worries about the future called the Flash Forward technique, and it can be really helpful in reducing the concern about something in the future. And we also work on the future prong (we call the three prongs of EMDR - past prong, present and future prong, to very thoroughly cover all the possible scenarios. In my work, because I work mainly in a short term intervention kind of way, with in hospital and outpatient Intensives, I often work predominantly in the past prong, as this is the best way to drastically and quickly reduce distress, and it is the quick results that I am after when I think about what is affecting my clients). So anxiety is often reduced with EMDR therapy, and this improves sleep.
In fact, on a day when I have had a bad or distressing day, I will often do a bit of self EMDR, just lying in my bed in the dark, looking from one side of the room to the other for the eye movements and maybe tapping on my legs or shoulders, doing standard protocol on whatever is bothering me. I know when itās working because I will get sleepy or sometimes wake myself up with snoring, turn over and go straight to sleep. Such a good self treatment for insomnia.
And aside from insomnia, I really want to talk about the parasomnias - sleep paralysis, nightmares, acting out
Now we know from the literature that EMDR is excellent for PTSD. One of the main symptoms of PTSD is reliving the distressing events, in waking hours and during sleep, and of course the usual description of this is nightmares. So as we treat the PTSD, all the symptoms diminish, and nightmares are one of those symptoms. With my inpatient work, I have found that some people have a really immediate reduction in nightmares. (Of course results differ from person to person, and I am just giving examples, not individual medical advice here).
Sometimes nightmares can involve the acting out of the situation. I've personally experienced this, with trying to fend off an imaginary attacker in the middle of the night, and I have had reports from clients I have worked with who have experienced both sides of this - waking up very scared in the middle of a nightmare, with their partner hitting out at them or occasionally trying to strangle them, which is so distressing for both parties, and sometimes can even mean that they agree to sleep in separate bedrooms as a solution. Not great for a relationship but better than waking up being assaulted.
How do we approach this with EMDR? In this situation I would probably prioritise the nightmares as it is so destructive to the safety of the relationship, and I have found that actually processing the nightmare as the target is really very helpful. Often we find that nightmares have a theme - being lost in a building, being pursued, in conflict with someone, being locked up, as a couple of examples, and I would just take the image of the last remembered nightmare and use that as the target image and use standard protocol from there. After that we would target the initial event related to the nightmare, if it hadnāt been already desensitised by the work on the nightmare itself. Most EMDR therapists would report great results with this and it is so good when we get some fast traction with sleep, as getting enough sleep is so pivotal to wellbeing.
Sleep talking is really common, often seen in teenagers, and mainly is incomprehensible, but the parts that are audible, are often a little bit conflictual, which might indicate that we are having difficult conversations or arguments in our sleep, potentially trying to emotionally work things out. So I donāt know if there is evidence for this, but it makes sense that if we are less stressed but the events in our lives, then we will do less sleep talking, so EMDR could potentially be effective for this if it is a major problem - I havenāt had clients present with this problem, so no results to report here, but Iād be interested if there are any studies on this!
But one really fascinating parasomnia which I have worked on before, is Sleep paralysis. This is when someone wakes from sleep and is unable to move, and can be associated with a hallucination like the sense of a malevolent person in the room.
Now itās really important to understand that everyone has periods of whatās called atonia, which is inability to move, during REM sleep, which is when we dream most vividly. It is possibly the reason that when we have a nightmare about say fighting with someone, we feel unable to hit them back, or frozen and unable to run. this atonia is normal, and not problematic, unless we wake up with the sensation or hallucination of a devil in the room, or someone at the end of the bed about to attack us. This is terrifying, and that few seconds until our movement returns and we can sit up and turn the light on, and know that there is no-one in the room, is really awful. I can actually remember waking with this when I was a kid, being too scared to turn the light on or call out, and just lying there in panic waiting for something awful to happen.
I have worked with a couple of clients who have been so affected by their sleep paralysis experiences that they have developed a real fear of going to sleep, so we have just simply worked on those difficult experiences. With some psycho ed about what is actually happening , the fear of sleep has really dramatically reduced.
And in general, if you are experiencing problems with sleep, good sleep hygiene is so important - regular bedtimes, enough exercise during the day, relaxation before bed, avoiding alcohol, no screens for an hour before bed, making sure you are warm enough, and also not too hot overnight, a dark and quiet room and I also love to recommend a podcast called Nothing much happens, which is a lovely gentle narration of a simple story that I and lots of my clients have found really helpful.
So if you require a little bit more assistance in implementing this in your practice, feel free to reach out for consultation or supervision via my website, emdrdoctor.com.au.
And if you would like to learn more about shame, I held my webinar last week, it went well, and is now available as an on demand webinar on my website emdrdoctor.com.au/training, so come along and see why shame is such an often missed, toxic ingredient in our therapy room. If you have trouble identifying shame, maybe have a little bit of an aversion to it yourself, if you are stuck in collusion with your clients to avoid working on shameful issues, and stuck in your work with your clients, I would love to teach you some more about working with shame, help you with some practical suggestions and help you understand the role and the function of shame in our inner life. So feel free to hop onto my website, emdrdoctor.com.au and it is available as an on-demand webinar.
So I hope this has been interesting or helpful to you in some way. I will talk to you again next week. In the meantime, take good care. Bye for now.
