Hyperarousal & Reactivity: Navigating Irritability, Risky Behaviors, Hypervigilance & More

Cinnamon:  I'm actually, excited to, do this episode today because I think, if you aren't on board with the idea of understanding what the post traumatic stress symptoms look like, this is the one that Not only can you define for yourself, but this is also the one that your loved ones can help out, they can help tell you what's up with this one.

Erin: right these particular symptoms Are typically blatantly obvious either to you or to those that are around you and they're familiar. These are the kind of symptoms that we might be like, what is wrong with me? Or why am I like this? Or, why can't I remember this? Or whatever the thing is.

Cinnamon: Well, I like this one because when we're looking at different criteria, this is the one that I feel like can get the most, 

Erin: Bang for your buck. Ha ha

Cinnamon: Uh, no, I was like the most traffic in the world of justification.

Erin: Mm.

Cinnamon: so let's take it back. So today we get to talk about criterion E, which is negative alterations in and reactivity. This is the one where we are changing. How we respond and react to things and at what level, it takes for that thing to get a reaction out of us. And this is the criteria that I feel like is, most evident when we start justifying our behavior. If someone brings it to our attention, this is a lot of the yeah, butting, 

So as we go through this, I'm going to throw in some of those, justification behaviors so you can not only read Have it in your own, level of awareness. But also, if you hear somebody in your life, a coworker, a loved one, whatever, pointing these things out to you from a place of love and concern, and you hear yourself saying, yeah, but, then that is, a strong indicator. that were in this zone.

Erin: In the zone. And Cinnamon really loves my... Vanna White reading and how I just present things, it really means a lot to her. So I'm going to read the official DSM 5 language of Criterion E and then we will jump right into what that looks like. So, the DSM 5 definition states, marked alterations in arousal and reactivity associated with a traumatic event or events beginning or worsening after the traumatic event or events occurred, as evidenced by two or more of the following.

One. Irritable behavior and angry outbursts with little or no provocation, typically expressed as verbal or physical aggression toward people or objects. 
Two. Reckless or self-destructive behavior. 
Three. Hypervigilance. 
Four. Exaggerated startle response.
Five, problems with concentration, and six, sleep disturbance, like difficulty falling or staying asleep or restless sleep, which we hear about all the time. 

So yeah, let's jump into each, of these individual symptoms a little bit more and pick those apart a little bit.

Cinnamon: Yay. I love picking them apart. and I think it's important to be able to translate the DSM language to everyday language. So, if I asked you if you're experiencing hypervigilance. Well, not everyone necessarily has that in their vernacular. And, When we talk about justification, Justification is what differentiates vigilance from hypervigilance. And so to be able to give folks examples of what that looks like can help. that translation, move into a language that is more accessible for the general population,

Erin: Precisely. The first one that we mentioned was irritability and aggression. Obviously we know when we're irritable. So the irritability is more about personalization, about how you feel on the inside and then the aggression. Is the outside reaction that others might pick up on. 

Cinnamon: the feeling and the behavior.

Erin: Correct. Yeah.

Cinnamon: So I'm really impressed with you because you say that, we know when we're irritable with so much confidence and I am not always one of those people, I'm not always one of those people that can pick up immediately that I'm irritable, This might be, the thing that somebody has to point out to me and that can look like, are you okay?

And I believe that when I asked somebody if they're okay, or if somebody asked me, if they're okay, they're not really asking a question. They're saying, you are not okay. Are you aware of this? And do you know why?

Erin: Yeah. 

Cinnamon: but I'm impressed. 

Erin: but for me, well, I mean, maybe I'm just like super evolved. I don't know. Emotionally intelligent. I have no idea. So, so much, so much self awareness, but for me, it's like, I can feel it, in my blood, I can kind of feel my blood boiling. I can feel myself being reactive, And so I know that I'm irritable so, yes, I hear what you're saying. Some people might have to have it pointed out. They're not aware of it, but for me, I very much, it goes back to what I talked about, whatever episode to go with as dashboard lights that I have internally that I'm like, Ooh, I'm feeling this sensation in the pit of my stomach.

And this is telling me that stuff's gonna come out sideways pretty soon. So, that's where the attunement really works to become attuned to your body's dashboard lights. 

Cinnamon: Okay, so you made me just think about something because my thought is this is one of those situations where we may struggle with the justification, Like, I'm not irritable. I am justifiably upset to this degree because of the action, right? So would you say that there is a difference for you between when you know that you're justifiably upset versus when maybe there's a little extra in it because everything's gonna bother you because you Are, irritable. Like, does that feel different? Does that blood boiling feel different to you?

Erin: I think that it's the difference between being hurt or angry and being irritable for me. to me, it's not even about justification, but also it's about the power of choice. Am I choosing to take the bait because of someone else's behavior, you know? And so if somebody does something blatantly obvious and I become angry about it because they were just a jerk or, did something that was completely inappropriate, that's one thing.

But if I'm taking the bait and I'm becoming irritable because of someone else's choices and behaviors, that's a whole different ballgame for me. Does it feel different in my body? Um, I don't know, not really, but I am very aware, like, am I irritable at this point because of someone else's choices and behaviors?

Or, like, it's not even a matter of justification for me, I don't think, anymore. Because I'm clear that I'm either A,choosing to be irritable, you know, I am irritable because of someone else's behaviors or be like, I have every right to be upset or angry because what they did was inappropriate or they were being an a hole.

Does that make sense? I don't know. Did I answer your question?

Cinnamon: you did. And I would even go as far as adding a C, which is I'm not irritable because of somebody else's actions, behaviors, or words. I'm irritable because I'm irritable. And that becomes the filter. that I see everything through, which is gonna be like now, no matter what you do, I'm going to have some degree of annoyance and irritation with it because I'm already pissy.

Erin: Yeah. and I have this great example of something that happened last night with my four year old, we went to go to school orientation and he was acting a fool and being a four year old. But none of the other kids were. And of course, then there's that comparison stuff. But the point is, I found myself becoming very irritated, which I could quickly see coming out as aggression.

 there was an opportunity for me to become aggressive and sharp tongued and all of those things. And so because I could see it coming, I simply communicated with my family. I'm gonna put myself in timeout I'm gonna go to my room and chill because I didn't want to react in aggression because I felt so irritated by the situation that happened.

So that's where the two things go hand in hand, 

Cinnamon: I think something that you shared that I don't want to go unacknowledged is that your son's behavior, I'm sure you were translating as a reflection of the quality of parenting that you

Erin: Of course, no doubt about it. Like why is everybody else's kids sitting there coloring Uhhuh

Cinnamon: Gosh darn it, Brooks, why are you making me look bad? Pull it together and sit in your chair. 

Erin: That he was just doing what four year olds do.

Cinnamon: yes, and it would be very easy to grab an arm and help him sit where you want him to sit and maybe get close to pulling something out of the socket, right? Isn't that what moms and dads in the 70s and 80s did? all of us were walking around with a slightly dislocated, shoulder or. Arm socket in the hole,

Erin: Mm-hmm. 

Cinnamon: whatever. Okay. So the, that irritable behavior those angry outbursts, we want to keep in mind it is with little or no provocation.

So with what we are meaning by that is the idea that your response may be at a 10 and the situation may call for a four or a five or six, but that. no one thought that they did anything wrong to get that level out or like you said, you took the bait, right? Like if I'm poking the bear and then you come with an outburst, then it's like, whoa, 

 we completely lose the fact that I was poking the bear. It now is like you overreacted and that's what's getting highlighted. and then it also says that verbal or physical aggression. We don't have to, I think, go into physical aggression. We know what that looks like to hit or shove people,

Erin: Or punch holes in walls or slam doors, throw things. Yeah, 

Cinnamon: things across the room.

I think what gets trickier is the idea of verbal aggression, So when we Use our voice and our tone to cut to the quick to get a thing to stop, which, when I was little, my dad would say the word Cin. not even my full name. It would just be like, CIN. And I knew whatever I was doing, I needed to

Erin: It's like, uh, sit down and shut the F up immediately before the consequences occur. 

Cinnamon: yes. Like, Cin could have been an acronym, for, you're about, to get your arm pulled out of the socket if you don't stop what you're doing. So when we know that we can generate a very quick reaction that would meet our needs, like if I need Brooks, your son, to sit down and be quiet, I could say his name.  That is a loaded, right? Oh, I'm sure. And, but it's like, it's a loaded thing, So it's communicating more than just, Oh, mom or aunt cinnamon wants my attention, so I should look over that way. Like, no, it's like, that tone is a, uh, oh, and so recognizing when we're, I forgot to take Ben out, I apologize for the tap dancing, uh, so that's when we get to pay attention.

And so when I talk about that justification. I'm talking about, if I do something that would be justified to get a level 4 reaction out of you, but you come at me at a 9, then that's when I may say, Hey, it didn't require all of that. And then we start with the, yeah, but I'd had a long day.

I had just walked in the house, you know, uh, we've told the kids this a thousand times, right? Like all of those things that you've heard yourself or other people say that are that justification, when the disproportionate reaction is acknowledged,

Erin: Well, and that's where it's like, I was already irritated before I walked in this house and you didn't know that. You had no clue that I was already feeling irritated, so it might feel really, really extra. But, that is what it felt like it called for, the reaction called for, for me in that moment because I was already irritated from my rough day. Or, whatever the boss said. Mm

Cinnamon: and so if this is a subjective thing that we are, quote, having a negative alteration in our own behavior, it is a subjective thing that we can't always assess properly. we've talked about this before. If I have two runs after midnight, then it's not up for negotiation. I know I'm going to go in the back door and go straight upstairs, I'm not going to pass, go collect 200, say hi to the kids. or whatever your number is, because when we're having to ask ourselves, did I have a rough night last night, did I have a rough shift? We may not be able to assess that accurately. So when. we're suggesting that it's not great to go into the house straight from work when we know everybody has got, these shorter commutes home, that we don't want you to fail to stop and take that minute to, kind of like reset yourself and make it this very significant delineation between I'm taking off my first responder hat and I'm about to put on my, dad and husband, mom, wife hat, and I get to shift gears and I get to treat the people who I'm about to encounter in the way that they deserve to be treated. 

Erin: Yeah. It's like setting yourself up to win by having those little tools of just going upstairs like I did just go to your bedroom and 

Cinnamon: Yes. Like Samuel L. Jackson would say, 

Erin: what go the eff to bed. Yep. It's better for everybody. So then we're looking into that risky or destructive behavior, which that can look like. We see this often, the excessive drinking, the drinking and driving, taking excessive risks That might look like, to put yourself in danger, not intentionally, but you're doing these risky behaviors where you know you're putting yourself in a more of a dangerous situation at work,

Cinnamon: right. You're disregarding maybe the safer, less zealous way to do something, but then not only are you setting yourself up for potential, harm, but you're dragging your crew and colleagues into that too. we actually have an upcoming episode where we hear our guest, Michael, talk about that a little bit.

Bye. Bye. Bye.

Erin: Mm hmm. 

Cinnamon: I would even put under this category that adrenaline junkie stuff, so not only is it a disregard for my own well being, in the early 2000s, I hiked angels landing, out in Utah and I remember we were on our way up and one of my brothers just, in law said, you guys, I have kids. And he turned around and went back down. 

Erin: Yeah, 

Cinnamon: and to me, that was an accurate assessment of the risk whatever he would have gained by saying that he hiked that to what it would mean for my sister. and their kids to live lives without them, right? So when you are not using a healthy measuring stick to decide what is worth the risk and what is not where you're just completely disregarding your own safety.

And if something happens to you, inevitably, that means that you're bringing your people into it and, not by any means an exact example, but we had a line of duty death here in Cincinnati a few years ago where one of our officers after a car accident, he was just on the road helping clean up and helping direct traffic and he got hit, So if I'm doing something that's high risk and, creating, a fallout from my behavior, I'm inevitably setting my people up to be in a dangerous position. Even though that was not the situation, I want to be clear, with, Officer Woods, but he was on the road and was hit by a car while managing the scene of another MVA.

Erin: hmm.

Cinnamon: So when we make these decisions or don't make these decisions, we inevitably are going to bring other people into it that aren't necessarily, going to take that same risk. They're just helping cleaning up yours.

Erin: Yeah. Absolutely. And another one that we do see a lot, too, unfortunately, is the And with infidelity, it is the risky behavior, and what also correlates with the risky behavior is that adrenaline dump. it's the chase of it. it's the

Cinnamon: Getting caught, not getting caught, trying to be

Erin: white. Yeah. And, that daredevil behavior.

And we might be, very clear of the consequences of being caught, but the, juice is in the action. The juice is in the risk and it's. New fun exciting makes us feel wanted makes us feel Needed it makes us feel appreciated or hot or whatever the thing is, but it's so short lived in those moments, we're not thinking about the consequences of the action and who it could hurt including ourselves or What it could jeopardize with our jobs.

We're thinking about quick dump of adrenaline that quick dopamine hit like all the feel good juicy stuff that's getting dumped when we're in that Behavior because for one second it makes us feel good until it doesn't and then when it's over it's over. 

Cinnamon: and I'm not saying that this is everybody's experience But I do think it's a significant Experience is that I may not go into this situation Thinking you know what today is the day. I'm gonna cheat on my spouse. Here we go. But what it may look like is I've talked to this nurse in the ER every time I, go in for weeks or months and now all of a sudden maybe there's some flirting and I don't expect it to go any further than that.

And then all of a sudden I realize that they're slipping me a phone number and then I don't expect it to go any further than that or I get added on Snapchat or, you know, I think that should be one of like the advertisements for Snapchat. Uh, where unfaithful people come together. Snapchat, 

Erin: Yeah, you said snack chap 

Cinnamon: Um. Oh, Snapchat. Yes. Um, I am so not savvy with the social media of Snapchat. I just actually, I don't know how to use it, but I do like to take funny pictures. Um, so it can be a slow descent into how do I keep getting that same level of a high, which when we're talking about drugs, we know we need to use more.

And when we're talking about this kind of high risk behavior, we know we have to go a little further. And that's what gets tricky. So it's a slippery slope.

Erin: It is a slippery slope and it's the same with alcohol those two go hand in hand as far as the chase and everything else And we see it with gambling, too. It's like, well, I'm not drinking anymore, and I'm not having affairs anymore, but I'm gonna put, five bucks in the machine 

But it's like, then it turns into more, and more, and more, and then it's just that whole risk, that chase, that chase, and the risky behavior.

Cinnamon: Ohio just recently, allowed, legalized gambling. And so one of the advertisements that we were seeing all the time was, we'll start you off with a free 200. And my God, if that isn't just like, Hey, every, gambling addict come this way. We have a lovely pile of cocaine here for you.

You know, we'll start you off. Like we'll give you this bag for free if you buy this bag. And so, I mean, that sounds like a great deal, right? Like I can lose up to 200 and it doesn't affect me,

Erin: Except for the fact that you can't stop. 

Cinnamon: Right. And that only applies to the people who don't have a problem.

Erin: hmm.

Cinnamon: Or haven't developed a problem yet.

Erin: Precisely. 

Cinnamon: So, watch those slippery slopes.

Erin: yeah. but then we're, jumping into this term of hypervigilance and what I hear and I hear this a lot and I have to differentiate when we're doing assessments for departments is, we'll ask questions specifically related to hypervigilance the elevated state of constantly assessing potential threats around you, you know, that, looking around in restaurants, not having your back to the door, being, um, Aware of your surroundings in the crowded events.

That's one thing. That's the vigilance. Those are the things that you're trained to do. And so whenever I'm asking these people this question in assessments, they're always like, yeah, well, of course, I'm aware of my surroundings. Of course, I'm, checking out the individuals in this space.

And I'm like, yeah, you're trained to do that. That is part of your job. But we're talking like excessive. This is like over the top I guess I see it as there is an awareness, like this is a lot that I'm feeling like I need to look over my shoulder every two seconds.

Cinnamon: yeah, I think you kind of hit the nail on the head. Uh, the idea of like, as a law enforcement officer, we'll use this as an example. I am trained to be aware of my surroundings. And so no, I'm not going to walk into a restaurant and sit with my back to the door. 

Erin: hmm. Mm hmm. 

Cinnamon: However, there are going to be times when I walk into a restaurant and despite what I want to do, that may not be possible.

And so maybe I try to sit somewhere else and my anxiety gets so bad that I can't sit there through the whole meal because it is just too distressing to me to sit with my back to the door, so it's one thing to like, yeah, of course you probably want to face the door, but if you can't, how do you handle that?

and that's where it gets. A little over the top and I think again this pulls in that justification, you know, well Yeah, like I would want to be ready. I'd want to be prepared So if somebody came in and held the diner up and so that's when I'm like how many times? Have you been out to eat?

And the joint's been robbed, and you were able to take down the perp because you saw him coming.

Erin: Mm hmm.

Cinnamon: And I've never had anyone not say, never. 

So, 

Erin: in the event. But in the event.

Cinnamon: in the event I'm ready. 

Erin: Mm hmm. 

Cinnamon: Yep.

Erin: Or even for our fire service folks, it's, knowing where all the exits are, assessing, how am I going to get all of these people out of this movie theater in a timely fashion, because I know where the exits are. Well, we just might not know.

But then you're, you can't enjoy the movie with your kids because you're feeling trapped in not having the answers.

Cinnamon: this past January, I had one of my girlfriends come down and visit me for the weekend from Columbus. And, she's a chief of EMS. But, I put her in the guest room, and the first thing, She did was get down on her knees and start telling me what horrible extension cords I was using and how it was a fire hazard And I was like, oh my god, like that is not why I invited you to my house and what that brought up She was like, oh, there's no way that I couldn't have said something or no way that I would have not noticed that and What I told her was this has happened before where I had a new client come into an old office.

And the first thing they said was, um, you can't have those extension cords and those outlets. set up like that and, it's like, doesn't usually a fire inspector have to get paid, but you're just like giving me this for free, like, what are you, what are you here for? Right. To make sure that I, you know, don't die in a fire or to get counseling.

but it's those things that you can't shut off and they can't sit in the discomfort of not saying anything or walking up and unplugging it.

Erin: Yeah, oh gosh people would have a heyday. Our people would have a heyday in my house 

Cinnamon: Oh, your house is like, uh, yeah,

Erin: It's like just one giant, 

Cinnamon: liability 

Erin: just one giant, one giant extension cord.

Cinnamon: What is the, the power bars that you just live off of one power bar? and you never know how long the cord is going to be, for each of the things that poke out of it.

Erin: Okay. La la la. It's like cover your 

Cinnamon: on.

Erin: All 

Cinnamon: Good thing Callihan told you about the ladder, to help get your kids out

Erin: I know, which I have yet to order. I, Oh my gosh. We were just talking about this the other day about fire safety and about the game plan for our house and the ladder. So I'm working on it, folks. Don't worry. I'm working on it. But yeah, so anyways, then we're looking at this heightened startle reaction and the exaggerated startle reflex.

Cinnamon: Yeah.

this one still, I would say, has me by the balls, and it is one of the more annoying, symptoms that an individual can experience, that jumping or being startled Over any loud noise and to be honest, it doesn't even have to be loud. Like since we've been recording, my husband came in and told me goodbye.

And he has gotten to a place where he will start saying my name a few steps outside my office door. And then he never approaches me without making sure that I know he's coming because he could whisper my name and it would make me jump out of my seat. And usually I'm distracted. I'm not concentrating.

And, I will turn around and swing on you.

Erin: Yeah. It's not so much about the, volume of the noise, it's about the abrupt and out of the middle of nowhere and not expecting it kind of thing. And I do the 

same thing with you, where I'm like, I'm coming, I'm walking towards you, we're happening. It's gonna happen. Yeah. Mm hmm.

Cinnamon: Well, in the flip side of that, like, I appreciate that. wish I didn't do it. this isn't, certainly not something that I choose. It annoys me, because I'm doing it all the time, and you guys are experiencing it when you encounter me. But also, I would imagine the misery on my face immediately after it happens.

Like, that doesn't make you guys feel good because, you don't want to do that to me. and I am a firm believer that what is happening is in that moment, think I'm gonna die.

And that is the best explanation. And it's not a conscious thing. It's like, somebody is going to hit me up in the head with a two by four.

I wasn't looking, I was caught off guard. And then as soon as I realized that it actually wasn't a life or death situation, then I shift into anger or rage. I mean, poor Ben. The pug. Like, he just does what dogs do, which is bark incessantly. And I can get so upset with him that I have to, like, remove myself from the situation.

And it's not a reasonable anger, it's just the natural process of having that exaggerated startle reflex where you're minding your own business, you get startled, you think you're gonna die, you realize you're not, and then you get mad. And it can take a while to come back down to what we might consider that homeostasis.

Erin: Yeah. And as far as the exaggeration goes, it goes back to what we were talking about earlier, which is the reaction, you know, probably called for like a three, like a, Oh, you know, but you're coming out of 10, you're swinging, you're shouting. that's the difference between just being regularly startled or caught off guard and this exaggerated reflex.

Cinnamon: So then I can create that. It's not exaggerated because I'm at a 10 for no reason. But when I have that reaction, then I can startle other people because they were not expecting me to scream bloody murder. when I lived in Columbus, I remember, I was walking into a building and somebody who didn't know this about me, hid behind the door and jumped out and, scream to scare me.

And it was all in good fun. And, I actually got down on my stomach, I literally hit the ground. And as I was getting back up, of course, that person was mortified. that was not what they were expecting as a response. But as I was getting up and brushing myself off and trying to, Oh, you're fine.

You didn't do anything wrong. Like it's not your fault. there was a Vietnam vet, across the parking lot. And he just looked at me and it was like in that moment, he's like, I get you, I know what that was, and the significance of that for it to be like, I see your spots. I have those spots too.

Maybe not for the same reason, but I know what just happened to you and I'm empathizing and I'm feeling compassionate towards you because I know how your heart feels right now. I know how your brain feels.

Erin: Mm hm, yeah. Mm, yeah.

Cinnamon: All right, let's get to difficulty concentrating.

Erin: What's that? Just kidding. Huh? Ha ha

Cinnamon: Oh, that was clever. 

Erin: Mm hm. 

Cinnamon: clever. You got me. I think about difficulty concentrating, I think more about that dysregulation. of our concentration and our focus. sometimes it can be literal, like I can't concentrate, I read the same page over and over, I'm still not comprehending the material and I feel frustrated.

Other times it can look like hyper concentration, where six hours have gone by while I've been playing Wordle. and didn't even know it. that zoning out and not being present and not being able to comprehend what is happening or stay on task or complete the task or easily distractible like, The old example of someone cleaning their house and moving from room to room and never actually completing anything Because after they fold the laundry next They're organizing the sock drawer and then they're throwing away the spare socks and then they're taking the trash out and on and on so concentrating.

And again, it can be easily justified, right? Well, this is boring. I'm tired. I'm not interested. they have a droning on voice, whatever it is. So paying attention to when we're noticing that we're justifying, or I would even go as far as saying like being defensive when something is being pointed out to us, or we are, noticing something within ourselves.

And when it's with what we can be doing internally is minimizing, and we'll talk about this when we,get down there, but this is, a good way to roll into the last one, which is, sleep disturbance or difficulty. With sleep. Because we can give all kinds of excuses.

Erin: we can definitely, before we get into difficulty sleeping, I also want to point out that the difficulty concentrating might look as simple as zoning out. Because that's feedback that we hear from spouses often like they're just not there. I'm talking to them. I'm talking they're not present 

Yeah, I'm I'm telling my spouse something important and they're just off in la la land and that can be an example, too

Cinnamon: Or I'm like, Erin, Erin, Erin! 

And you're like, what?!

Erin: Yep.

Cinnamon: You know, which I just interrupted you from zoning out. So that's irritating on your part, right?

Erin: Yeah The other thing we hear too is that folks will be like I will read a page nine times and not even remember what I read for me, I just know that I don't comprehend well just by reading because I go into other thoughts and things I have to do. So what I do for myself is I will listen to the audio recording and follow along.

In a book at the same time, because then it kind of shuts down any other distraction. Like I'm already choosing several different senses to focus. And I've learned that about myself and it's okay. It doesn't mean there's something wrong with me, but that's how I can. Concentrate and comprehend what I'm doing.

Cinnamon: Successfully.

Erin: Right. If I want to have any success, that's what I gotta do. So anyways, okay. 

Cinnamon: I love that. I love that idea of using those two senses to kind of create barriers from distractions. Where it's both auditory and visual.

Erin: hmm. 

Cinnamon: Brilliant. 

Erin: chance. Only fighting chance. But that's okay. Then, yeah. So, sorry to interrupt. I wanted to point that out. But,

Cinnamon: No, those are good pointers. Outers.

Erin: Pointer Outers. 

Cinnamon: pointer outers. Are you the pointer outer that pointed out or are the things that you pointed out the pointer outers? 

Mmm conundrum moving on both hands and both so difficulty sleeping or sleep disturbance this actually is It has a lot in it, So when we say difficulty sleeping, that kind of conjures up some ideas.

 But when we talk about sleep disturbance, that may feel like a little bit more of a, actual umbrella where we're not only addressing the quality of your sleep, like, are you feeling rested come morning? But how difficult is it for you to fall asleep? how difficult is it for you to stay asleep?

are you waking up so frequently? that you're not getting into deep or REM sleep, if you are, while you're there, are you having nightmares or night terrors or, sleep paralysis?

Is that you, like, saying, I do, or is that you're saying, I have a

Erin: no. No, no, no. Neither. What I, I was given like a raise the roof. 

Cinnamon: Oh, oh, shout out. 

Erin: because it's interesting sometimes I'll be talking to folks and they'll say, well, no, I don't have nightmares. And then we'll start talking about their sleep patterns and I'm like, well, of course you don't have nightmares because you're not actually getting into that space of sleep, the REM where the dreams occur.

And so your sleep is so broken up that you aren't having nightmares, which is a good and bad thing. It's kind of like that tells me you're not getting enough sleep. it's like, yay. You're not having nightmares, but boo, you're not getting enough sleep, you know, and what we know about the processing of the brain is like, that's where the REM sleep is also where 

Our brain is hard at work, processing events and, memories, taking it from short term storage to long term storage. So, that whole not getting enough sleep. plays many, many parts. That's why I was raising the roof. 

Cinnamon: oh, got it. I like that throwback to the period of time where it was cool to raise the roof. like you're talking about it in terms of chicken and egg with, I'm not having nightmares, yay, because I'm not dropping into REM sleep. I think I see a lot of the opposite too, where I was having nightmares, And my solution is to avoid deep sleep or REM sleep.

So I wake up frequently because now I'm anxious about having, 

uh, and as I'm talking about chicken and egg, I'm pecking at you. that's a visual needed, but we're trying to use a coping strategy or figure out how to problem solve by creating a secondary problem.  Now we're not getting good enough sleep.

 the other thing that I think is a little bit concerning about this one in particular again is that justification. How many times when we do assessments, Erin, and people say to this question, Well, yeah, I sleep like shit, but so does everybody else. And I'm like, luckily we are only assessing you right now, right?

Like, they do it in comparison rather than, It's their normal versus them comparing their normal to the outside world's typical. And so they're like, yeah, there's a lot of people that have it way worse here at work when it comes to sleep than I do. And I'm like, not our measuring stick.

Erin: our measuring stick is what is actually a healthy level of sleep. To be productive, to be healthy, to thrive, not hey, old George Jones in the bunk next to me, he wakes up every 30 minutes, so I feel like I'm getting better sleep than him. No, that's not what we're

Cinnamon: Right. I'm sleeping ever, I'm sleeping for a full two hours at a time. and I love that old George Jones was where you went. There's, there's some subliminal things you might want to take to your therapist. When I think of an old fire guy waking up in the middle of the night, it's gonna look like George Jones.

Erin: why that name, I don't know. Just came up,

Cinnamon: I mean, he's, he was not bad looking. I mean, I guess you'd have to ask Tammy about his personality though. Uh, why not? If you didn't, 

Erin: dude, I didn't even, okay, I didn't even,

Cinnamon: don't even  know who George Jones is 

Erin: Yes I know who George Jones is, but I wasn't thinking that.

Cinnamon: subliminal. 

Erin: This ages, you more than me, by the way.

Cinnamon: Thank you. Thanks. Uh, you know what? Watch it cause we might get a D I V O R C E as Tammy Wynette would say.

Erin: Okay. 

Cinnamon: Oh, all right.  right.

Erin: Anything else about sleep? 

Cinnamon: the one thing that I want to say is I like to use what we call the organ clock. or the body clock from traditional Chinese medicine that lays out. and I believe it's on our resource page on the practice website, but it tells you what's happening in your body. in these two hour increments on the 24 hour clock, and there's a lot of really important things that are happening in the wee hours of the night slash morning when we're supposed to be asleep, that can't happen if we are not asleep.

And so. the baseline of good mental health, it has to be sleep. So when we talk to a lot of our people that work those 24 hour shifts or work the overnight shift, I want them to know you're kind of starting in the hole. you're already starting in the red and we've got to take additional steps to get you at least back in the black.

 But once people can see that visual of what their body is missing out on if they're not asleep by 11 p. m It does make a difference. that's when your liver is Taking it's turn of getting detoxed and I always think about it like if the body focuses its work on the liver from like one to three a.

m, but bars don't close till two. It's almost like a guarantee the next day we're going to smell like alcohol, right? part of, taking care of ourselves is not necessarily. going to sleep when we feel like it, but working to get to a place where you're comfortable with a starting to wind down at 10, 10 30.

So you can be asleep by 11. especially on the nights that you're not working. so you at least have that little advantage, but sleep is like therapy. It's as restorative. It's as necessary. without it, you're going to land in the red. even if everything else is going right, even if you don't do first responder work, if you don't sleep well, it is going to affect your mental and physical health.

End of story.

Erin: The end. That's right. just to kind of run through real quick, what we discussed today, the symptoms of Criterion E look like irritability or aggression, risky or destructive behaviors, hypervigilance, that heightened startle. Reaction or exaggerated startle reflex the difficulty concentrating and difficulty sleeping

Cinnamon: Yeah. 

Erin: Yep And the next episode that we do over this is going to be the wrap up of this series It's going to be the little bow on it explaining how all of this stuff fits together And what you would need as the qualifying symptoms and the length of time that these symptoms have occurred in order for you to actually have this diagnosis of PTSD.

And we'll talk about that and a difference between acute stress and how that folds in and so on and so forth.

Cinnamon: And I think it's imperative to stress that what we have ran through in these episodes are the ways that post traumatic stress shows up in our lives. It takes a certain number of those to qualify for the diagnosis of PTSD, 

but you can have numerous PTS symptoms and recognize them as such. I mean if you're having nightmares but haven't had a traumatic event, well that's not what I mean, Like you have to meet that criteria a, that first one. And then after that. you can have just slightly not enough to meet the criteria, but still be experiencing post traumatic stress.

Erin: hmm.

Cinnamon: And, this is where stress is the noun, not another adjective, and it can still have a negative effect or impair how you function, even if, you don't meet that, cutoff of this is official and this is not.

To me, what's most important is, are you suffering? Are you not satisfied with the quality of your life because of how these things are showing up? Are other people not comfortable with the quality of your life or your behavior? That they feel like they need to speak up and say I think you need to get some help.

Erin: exactly, And so we're excited to wrap this whole series up next time, it'll be in the next few weeks and get you the bow on top. listen, if you are finding value in the show, we're going to ask that you take some time and rate and specifically a review so we know, are we on the right path?

Let's move forward also so other folks know that this is a tool that you find valuable and maybe they would find Value in it as well So we're gonna ask that you hook us up so we can keep hooking you up and know that we're on the right track 

Cinnamon: I would even encourage using that share episode button if you're gonna go in and give us a rate and a review which we So appreciate you know, we can get feedback, but we're kind of in this little bubble and we're just putting this out into the universe. And so it's, it's kind of important for us to know, are we hitting or missing the mark?

 what would be helpful? but if you are, somebody who is a regular listener or even just discovered us go onto that episode and hit the share episode button and send it to a few friends and be like, I think that you would like this. So, yes, the official stuff, the rate and the review, but also share, share it and spread the word that we're here and we're doing this thing and we're trying to, reach the people who are open and ready to learn more, as well as the people who maybe aren't Completely ready to take that extra step and pick up the phone and make the call to the therapist or maybe don't need that But still benefit from knowing what the hell is happening to them in their body

Erin: Exactly. All right. Well, thanks for continuing to join in and we will see you next time with, our caller hotline. We got a real impactful, powerful caller coming up next episode from a dispatcher who really lays it out and it is a good one.

Cinnamon: you don't want to miss that

Erin: Yeah. So we will see you soon.