Welcome, my name’s Leanne Humphreys and today I’m speaking with Associate Professor Andrea Phelps who’s the deputy director of Phoenix Australia.

Today we’ll be talking about sleep disturbances in the aftermath of the experience of disaster. This recording is just a brief summary of relevant points.  So for those of you who’d like to explore the topic further, please feel free to follow the links to more detailed information and resources. Hello Andrea.

Andrea: Hello Leanne and how are you?

Leanne: Good, Andrea in clinical practice you and I see a lot of clients who present with disturbed sleep as a result of the experience of disaster or trauma.  But this is a particular area of expertise for you, so can you tell us how common are sleep disturbances for individuals who experience disaster or trauma?

Andrea: Look they’re very common in the first few days after a disaster or trauma. We see them very commonly, as we, you know, when we go through any stressful life event sleep is often the first thing to be affected. So it’s not at all surprising if it goes on for longer than that, though it can form into a new sleep pattern that is a problem. So you do need to think about getting some help after, you know, if it does continue beyond that,  those first few days.

Leanne: Okay so that’s kind of suggesting to me that for some people things improve by themselves and for others it becomes a bad habit. So do you have a period of time at which you think it’s appropriate for health professionals to be offering interventions around sleep disorders or disturbances?

Andrea: Yes, I think that if you’ve still got a sleep disturbance, and that might be difficulty sleeping, it might also be nightmares, this is people that we also commonly see. If they are persisting beyond a week or so. Then I’d say that’s the time to seek some help.

Leanne: Okay so that kind of  leads into my next question which is – what are the most evidence-based interventions for sleep and you’ve mentioned, both sleep disturbance generally but also nightmares? So what are the most evidence-based interventions in both of those areas?

Andrea: Yes, so for the sleep disturbance a couple of key things. They’re based on cognitive behaviour therapy, and there’s an approach called CBT for insomnia. So thinking about sleep as being habits, so trying to improve your habits around sleep. Having a good routine in the preparation for going to bed, making sure your sleep environment is comfortable. It’s not too hot, not too cold. You haven’t got noise and so on. Trying to get into a routine of getting to bed, waking up at the same time each day, are all really important.

There’s also a particular intervention called stimulus control which is really about conditioning yourself to associate bed with sleep, which means that you don’t sleep anywhere apart from your bed. So you don’t fall asleep on the couch or chair and also when you’re in bed you’re not doing other things. So you’re not sitting up in bed paying the bills or watching television but when you’re in bed you’re there to sleep, so you’re trying to condition and reinforce that for yourself.

When it comes to nightmares the best evidence is for an intervention called imagery rehearsal therapy. There’s more information about this in the material but at a sort of very basic level what it involves is helping the person to change the script of their dream so that they rehearse a new ending to it where something happens that increases their sense of mastery or control. And what we’re hoping by changing the script of the nightmare it actually allows them to sleep through, rather than be woken up at the most distressing point which interferes with that normal process of the emotional processing function of dreams.

Leanne: Yes, so how do you find Andrea, because that sounds like a really interesting way of addressing a dream or a nightmare, how do you find individuals kind of accept that treatment?

Andrea: Look almost invariably when I first describe that to a client they look at me as I possibly lost the plot!

Leanne: Yes exactly.

Andrea: How could I possibly control something when I’m asleep, how can I control what’s happening? But I just really encourage people to go into it with an open mind we know that that we can increase our capacity to recognize we’re dreaming, while we’re dreaming, and so just encourage them to be open mind about it. And as soon as they start to experience any success, you know, you really see people just turn around and actually get quite excited, sometimes about, I’m going to sleep, if this dream happens I know what I’m going to do with it.

Leanne: Absolutely.

Andrea: It changes their attitude towards a nightmare.

Leanne: Okay fantastic thanks Andrea so I’m just going to summarize the points that you’ve made today sleep disturbance is very, very common in the aftermath of the experience of disaster or trauma.  Ideally we would like to see them starting to settle down within days, if not weeks. If folks are experiencing problems with their sleep there are some very effective interventions that as health practitioners we can offer, and generally we find that individuals might be a little bit reluctant initially but certainly can benefit and once they’ve experienced a change they’re quite enthusiastic about continuing to use the techniques.

Andrea: Quite hooked.

Leanne: Yes fantastic. Thanks very much Andrea.

Andrea: That’s a pleasure, thank you.