[bkw]

I have been struggling with severe insomnia for four months following a low-dose psychedelic mushroom trip. Prior to this I had no problems with sleep. Without going into too many details (see the link below for the fuller story), there was some aggravating surrounding trauma (relatively mild) that seems to have been amplified by the mushrooms, so that my sympathetic nervous system somehow got stuck in fight-or-flight mode and has not been able to relax since. The initial onset was three or four nights with no sleep at all, which settled into a pattern of no sleep every other night, with maybe 3 or 4 hours of light, non-restorative sleep on alternate nights. Meds or supplements would occasionally help on the resting nights, but had no effect at all on the nights after I had some sleep. Initially, whenever I began to fall into REM sleep, I would be awakened by vivid nightmares. I have also completely lost the ability to nap during the day, no matter how tired I am. I tried CBTi, but couldn’t make it through the two-week sleep journal portion. Rather than getting out of bed, my provider had me read whenever I was awake in bed. I stuck to my sleep schedule religiously, but since I never got sleepy, this became a horror after several eight-hour nights of continual reading, which led to daytime distress. I was subsequently diagnosed with PTSD and put on prazosin for the nightmares and mirtazapine for insomnia.

The sedatives helped for awhile, but as with all meds, the effectiveness has now mostly waned, though I do continue to take them (and no longer have the nightmares). With the supplement of CBN (cannabinol), I’m usually able to get at least a few hours of restorative sleep these days, though that too is waning. I will also regularly doze off deeply in front of the television around 8pm. But when there’s an anticipated stressor in the morning, it’s back to nearly no sleep.

I’m curious about a few things:

(1) Has anyone else seen or experienced this kind of sudden-onset trauma-induced insomnia? It’s some comfort to realize that everyone thinks their insomnia is uniquely incurable, but I worry that in my case it might actually be, since my nervous system seems so intractably stuck. It’s as if there is some terrifying image stuck in my amygdala that will not allow me to fall into a resting state without some level of sedation.

(2) Now that I’m a bit more regulated, could CBTi work given the clear traumatic origins of my sleep issues, or do I have to figure out how to address this trauma first?

(3) Assuming that CBTi might be effective, how important is it to get off the mirtazapine? Like I said, it no longer has much of an effect, but I’m stressed about the possibility of revenge insomnia. Are there circumstances where CBTi could work in conjunction with an antidepressant or other med?

Thanks in advance for any insights or guidance you might be able to provide.

If you want more details, here’s the write-up of my story: https://www.ecstaticintegration.org/p/post-psychedelic-sleep-issues

[Martin Reed]

Hello bkw and thanks for sharing your experience.

You mentioned that eight hours of continual reading at night led to daytime distress. What was the alternative to eight hours of reading at night (in other words what did you do before you read for eight hours) and did that create less daytime distress?

Many people find that when there’s an anticipated stressor, sleep becomes a lot more difficult — and that’s often (but not always) because we can put more pressure on ourselves to sleep. Quite often, the more we try to make sleep happen the more elusive it becomes.

To answer your questions:

(1) Has anyone else seen or experienced this kind of sudden-onset trauma-induced insomnia?

I am not a doctor, but I have heard of many people describing their onset of insomnia as coming from a specific trauma or a specific event in their lives.

It can sometimes feel as though sleep is impossible without sedation (and is sedation the same as sleep?) — and yet, the human body will ALWAYS sleep once it has been awake for long enough, just as it will always generate a breath when enough time has passed since the last breath.

Typically, we need to stay awake for longer and generate more sleep drive the more we are trying to make sleep happen and/or the more we are trying to control what we are thinking or feeling, because that can make our brain think there’s some kind of threat to wakefulness and so stays alert to protect us from that threat. This temporarily overrides sleepiness (and sleep) — we’d all be dead without that safety mechanism — but sleep will still win out in the end.

(2) Now that I’m a bit more regulated, could CBTi work given the clear traumatic origins of my sleep issues, or do I have to figure out how to address this trauma first?

I would suggest discussing that with a CBT-I therapist to get their opinion.

(3) Assuming that CBTi might be effective, how important is it to get off the mirtazapine?

It’s possible to engage in CBT-I while taking medication — again, that is a question best directed toward a CBT-I therapist.

I hope this helps and I wish you all the best.

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