Symptoms of PTSD – Hyperarousal.
This post is not just relevant for those wanting to know more about hyperarousal in PTSD sufferers. Having spent the 9 years prior to my accident studying and working in early years education I am often reminded of children I have cared for who have suffered trauma and who display the same symptoms. The child in play group or nursery who seems to target other children with aggression or even violence; the child who cries at the slightest noise or when separated from his main care giver for even the shortest time; the child who arrives at nursery exhausted and will only settle and sleep in a particular persons arms, often at the detriment of the other children in the group. Aware of their background and responsible for their safeguarding I understood these to be responses to trauma in certain children but until now I did not fully understand what it must have been like inside their world. Whether you love an adult or a child suffering the effects of trauma I hope you gain a deeper understanding of hyperarousal from this post because with understanding comes patience, and it takes a lot of that.
Hyperarousal is not as fun as it sounds. When someone has experienced trauma, particularly violent or life threatening, at the time of the event the brain switches to a mode designed to save your life.
It is accelerated into a primitive and acute state of fight or flight with the aim of disabling all other responses that don’t aid your survival. That worked out well for me because without it I probably wouldn’t be writing this post but as with lots of people who have needed this survival response, my brain did not go back to the way it was. It has not yet worked out what is safe and what is not and so it’s continuously perceiving threat that doesn’t exist and keeping me in a constant state of stress to keep me safe. The result can be pretty disabling.
Effect on sleep.
I have not had a full or undisturbed nights sleep since the accident happened. Hyperarousal has affected my ability to fall asleep and stay asleep to the point that I still lie awake shaking and crying uncontrollably because of extreme feelings of fear.
Just last week I went to bed happy and relaxed but once in bed the sound of the wind making the house creak sent my threat responses into overdrive. I could hear the clicking of the iron in another room as though it has been left on and I could not convince myself that it wasn’t real. I got up to check but once I understood it was definitely switched off the fear of the house burning down was replaced with something else. The creaking of the house and the noise of the air vent in the bathroom had convinced my brain that I was at immediate risk and I was frozen with fear. As time went on I was hyperventilating and completely out of control of my feelings. I didn’t know what I was scared of, just that I was terrified. Eventually I was crying so hard I was struggling to catch my breath and I couldn’t move to allow myself to be comforted.
After being pulled into a position where I could be wrapped up tightly in an attempt to make me feel safe I would relax for a few minutes until the next gust of wind when I would again completely lose control. It was hours until this extreme fear response subsided enough to fall asleep and throughout it feels like you’re experiencing it on your own because your brain is struggling to respond to the comfort and reassurance of someone else.
Not all nights are like that and thankfully they have drastically reduced in frequency. I am hyper alert most nights and more often than not it takes me a couple of hours to relax enough to fall asleep. It’s rarely a deep sleep for long and I usually wake up with tension aches in my back, neck and jaw. The brain recovers when you are asleep so I now have a new excuse for excessive napping. I make the most of that!
Outbursts of anger.
Living in a constant state of fear and having all your senses heightened in response to threat makes you grumpy! More than that, it makes you irrational and paranoid. I can become completely unreasonable and at times detached from any emotion, usually followed by a dramatic emotional outburst.
Your brain stops being able to recognise subtle communication clues, for example if a friend even gently disagrees with something you have said, you can’t help but see it as a personal attack. Even if it’s just a suggestion of a different place to meet.
There have been lots of times where I have been blinded by anger and responded completely inappropriately to challenge or even help.
On one occasion Lewis and I were painting a room in his house and I was using a long handled roller struggling to paint the ceiling. He came over and offered a suggestion as to how I might find it easier, and I lost it. As far as I was concerned he was saying I’d done a terrible job and that I was incapable. He was reaffirming everything I had come to think about myself and if I was so useless and unstable, then why didn’t he just leave?!
This is so out of character for me under normal circumstances that it embarrasses me to think about it. No amount of shouting, silence or talking at the time makes a difference to how I feel and the length of time it takes to realise my response is driven by tension and fear varies.
Although subsiding now it has been difficult for those around me to predict how I am going to react or even predict what I will react to. I should probably take this opportunity to apologise to my boyfriend! Although inevitably there have been times he was too exhausted to stop his own reaction and it would descend into an argument, most of the time he ignores my outburst and makes sure I don’t feel bad about it afterwards.
PTSD already means the bit of your brain concerned with concentration and critical thinking is impaired but this issue is further compounded by lack of sleep and hyperarousal. If you’re scared, you can’t concentrate. It is an unnecessary function and that is not the part of your brain that is dominant if you are under threat. If I am a passenger in the car and become hyperaroused for any reason I can’t take in conversation easily. It makes me go quiet, everyone is happy I’m not crying, then I have a nap.
Hyperarousal and hyper vigilance sound like the same thing but one causes the other. Hyperarousal, like with the example with extreme fear responses to the wind, is an altered arousal response to actual stimuli. Hyper vigilance is being on permanent high alert to possible threat.
Either way it results in my senses becoming overwhelmed leaving me unable to function normally. Unfortunately I’d say over time this is getting worse. It has made me socially anxious which has meant I rarely go out with friends anymore. I avoid crowded places and I am over sensitive to noise. Excessive noise in a busy group situation recently meant my senses become so overwhelmed that I fainted.
Even at home I struggle with the volume of the TV and can become anxious if it is much louder than a whisper.
When I’m out I am no longer able to block out background noise. This is another symptom that has reminded me of children I have cared for or even adults I know with conditions such as ASD, Dyslexia or ADD. Hyper vigilance does not allow you to ‘fade out’ background noise such as other people in a busy restaurant, to allow you to take in information from elsewhere.
I am not a good date. If there are lots of people around us and you are talking to me I am going to smile and nod at you but I have no idea what you are saying. If you can stop people chatting, scraping their chairs, chewing loudly, laughing, clinking glasses and cutlery and generally having a good time then you will have my full attention. If not, there’s a chance I look like a rabbit it headlights and have sweaty hands. Sitting in the corner with my back to the wall helps (it was good enough for Baby) but it’s probably best not to try and talk about anything important until I’m not deafened by the sound of people breathing.
Eventually my brain will stop being so affected by adrenaline surges and will start being able to distinguish between a safe situation and a dangerous one but until then I will be scared. A lot. Even if I don’t know what I’m scared of.
It’s exhausting and if I’m honest I’ve spent many hours in tears wishing I could go to sleep and wake up when I’m fixed.
I recently had a flashback following a conversation with someone who asked me what it would be like driving that same route to work again. The initial conversation was uncomfortable and made me feel panicked and sick but the hyper arousal and hyper vigilance that followed lasted for days. Jumpy, scared and hallucinating I cried every day for a week because of the chain adrenaline surges it caused. Once they start they feed themselves and it becomes a cycle that’s difficult to break.
That said, the list of things that generate an extreme fear response is getting shorter and some things that would have put me in a childlike state of terror a few months ago have little effect any more. Although rarely driving I am much more relaxed as a passenger which is encouraging. It also makes it easier for the one driving me around! Chauffeurs with a nervous disposition need not apply.
Risk of substance abuse.
It is worth mentioning here that anyone dealing with daily extreme fear responses are at risk of substance abuse, poor physical health and impulsive behaviours. Having been prescribed sedatives just after the accident I worried about addiction so didn’t take them at first, however as documented elsewhere in my blog I quickly found myself looking for escape and turning to sedated sleep. I only did it twice but between this and (very) occasional strong painkillers that have had a sedative effect, I can see how easy it would be to slip into misuse of substances that give you some relief from being scared and hyper alert.
Medicated sleep has been the only restful sleep I have had so far and if someone suffering is not getting the right support and understanding from those around them I can see how a dependence could quickly develop.
*Amusing anecdote about the effect of sedatives or stimulants when dealing with PTSD and hyperarousal.
I have been trying to put myself in positions that are outside my comfort zone (pretty much all of them!) and one example was climbing Snowdon. It took ages, I freaked out a lot, but once at the top I celebrated with a full fat Coke. I had avoided all caffeine for the best part of a year and didn’t even drink full sugar drinks before the accident so it was never going to end well.
3500ft up in the snow, shrouded in cloud with visibility at roughly the end of my nose I decided I was too scared to climb back down. There was no way I would possibly make it without having to be rescued in an embarrassing display by mountain rescue so I would stay at the top. Right there in the cafe. I asked (begged) for a space on one of the few remaining train journeys back down but they were full, so I sat down and said I would wait. They couldn’t possibly leave me there all night. I was prepared to make a scene.
Not saying much but no doubt wondering how on earth he was going to fix this Lewis made me a pillow out of coats and scarves and I had a nap on the table while the caffeine and panic wore off. I woke up an hour or so later, took the climbing poles he had just bought me, put my coat back on and started the descent. Crisis averted, nobody needed a helicopter and we laughed all the way down.
There is another response to stimuli called hypo arousal that I will address in a future post. A bit like a ‘hyper’ or a ‘hypo’ in a diabetic, it basically means the brain numbs your senses in response to fear as opposed to magnifying them. I prefer this, it means I can nap! That is for another day.