It is very common for people experiencing dissociative disorders to have trouble sleeping. This can be for all the reasons that non-dissociative people have sleep problems such as drinking caffeine or alcohol; poor sleep routine; disturbed sleep-wake patterns; or too much screen time close to bedtime.

However people with dissociative disorders typically have other additional reasons for sleep problems. These include:

• Traumatic nightmares and flashbacks;
• Child parts feeling scared at night;
• Activity of Dissociated parts during the night, including parts who feel they don’t get enough ‘out’ time during the day; and
• Flashbacks (even hallucinations) when you are on the cusp of sleep or waking.

Steps to Help

Firstly look at your basic ‘sleep hygiene’.

‘Sleep hygiene’ is a rather strange expression psychologists use to describe good sleep practices. While people with DID often need specific practices to help them get to sleep, attending to general healthy sleep practices can also help. This includes: developing a ‘bedtime routine’ that begins an hour before bedtime; turning off screens 45 minutes before bed; avoiding caffeine in the afternoon; avoiding alcohol; getting enough exercise etc. See you counsellor or psychologist to discuss your daytime activity. It might be necessary to speak to them about working internally with parts to develop a healthy daytime routine, as that often helps sleep as well.

Make sure parts have time during the day

Talk inside, using whatever method works for you, to establish unmet needs and unexpressed desires. Make sure parts have a chance for expression during the day. Sometimes there will need to be a compromise, as there are only 24 hours in the day, no matter how many parts you have. This is where the concept of a timetable, rostering or ‘taking turns’ comes in handy. Most child parts can understand this and can wait if they know that they too will soon have ‘their turn’ for an activity.

Prepare your bedroom

Your bedroom should be a nice place to sleep and should feel safe and comfortable for all parts, especially the child parts. Tips to help include:

• Removing items from the bedroom that might be triggering. This DOES include screen devices. Not only do screens disrupt sleep but they also can be used by various parts to look up or research things which can be triggering. It is easier to put them away or disable the internet during the night.
• Ensure that there are soothing items for the child parts. This could include a soft toy, a soft ‘cuddle blanket’ or soothing music.
• Sometimes child parts benefit from the creation of “safe anchors” in the bedroom. These are items in the bedroom that are safe, attractive, soothing or reminders of the present. See the separate information sheet on creating safe anchors.
• Consider ‘background noise’ carefully. Scared parts often want some background noise in order to sleep. However the TV or radio are not good for sleep. In addition topics and content can change quickly, meaning that you can be exposed to something scary when you least need this! It is better to play a steady, droning ‘white noise’ or a special relaxation/nature noises recording. You may also like to create your own soothing music playlist. Classical music can be very soothing, particularly Baroque music, but there are also many lists of ‘relaxation music’ available on the internet.

Prepare all parts for Sleep

Child parts, in particular, often live in the past and feel like they are still at risk of being traumatised. It is essential to work with them and find ways for them to feel safer at night.

Ask inside – what do you need to feel safer at night? Ideas might include: a special soft toy, a special blanket, quiet nature sounds. Sometimes it helps to try a creative approach. Child parts sometimes need child-like and play based steps to feel safe. Some child parts like to put a “guardian” soft toy in front of the door to “protect” them. This could be a lion or a dragon. Other child parts like to cuddle this toy in bed with them. It doesn’t really matter if adult parts don’t believe in this. What matters is that by doing the ritual they show the child parts that they care and want to soothe them. This helps the child parts feel heard, cared for and therefor safer. Work with your therapist to discuss these ideas and explore this.

Remind the child parts/traumatised parts that they are safe, that the time of abuse is now over. This might include developing a saying such as “It is 2017. I am now 36 years old and I live in XXX. I live in a nice house and that doesn’t happen here.” Work with your therapist to develop these statements.

Develop a ‘safety anchor ritual’ for the bedroom. This involves looking around the bedroom and focussing on items and objects from the bedroom that did not exist in your childhood bedroom. This reminds the child parts that they are in the present time and is very grounding for all parts. Do this step by step with your therapist.

Consider creating a safe place in your head for child parts/traumatised parts. This could be a special room in a house or some other special place. Scared child parts can choose to go there at night.

Use creative visualisation to soothe yourself before sleep. Creative visualisations are best developed with your therapist or somewhat planned out first. In this step you visualise a special place for yourself that feels nice and calm and as safe as possible. It is important to imagine yourself at this place using all your senses. Examples of places include a garden, the beach, a park, a special room that can be as secure and impenetrable as you want it to be. Your therapist can also provide some examples of pre-written visualisations which you can adjust to suit your needs.

Create a “Sleep Kit”. This can be a box or a container which has all the things you and your parts need to help them feel calm and reassured. This box could contain photos, pictures of beautiful places, a recording of soothing music or sounds, a special blanket, pillow or soft toy, a smooth stone or beautiful crystal to look at or touch, a memento of a positive experience, something beautiful a special friend gave you etc.

© Kate McMaugh Psychology, 2017

• This resource has been developed based on:
  Suzette Boon, Kathy Steele, Onno van der Hart (2011) Coping with Trauma-Related Dissociation: Skills Training for Patients and Therapists, W. W. Norton & Company
• Janina Fisher Webinar Program Level 3: Working with Trauma related complexity and dissociation and Level 4: Advanced topics in Trauma and dissociation
• Lots of feedback and ideas from clients!