Time to put an end to all the tossing and turning.
Although nightmares are more commonly seen in children, at least half of adults have occasional nightmares. In fact, between 2 and 8 percent of adults frequently suffer from nightmares.
What are Nightmares?
Nightmares are vivid, disturbing dreams that typically awaken you from sleep. They most commonly occur during REM (Rapid Eye Movement) sleep, a time when your brain works hard at processing emotions, memories and cognition. Although we dream in other stages of sleep, most dreaming tends to take place during REM sleep. We also stay in REM sleep longer as the night progresses, leading to more nightmares occurring in the last third of the night.
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Nightmares are different from night terrors. Night terrors tend to occur in the first third of the night and the patient awakens with a scream and look of fear. However, the patient typically has very little to no recollection of the event and what may have provoked it. Nightmares, on the other hand, usually happen in the later part of the night and patients awaken with a vivid recall of the disturbing dream. A good rule of thumb to distinguish between the two events is to see who is more distressed in the morning-the patient or the observer.
Chronic nightmares can wreck havoc on both your nighttime sleep and daytime functioning. Nightmares lead to increased daytime stress and decreased resources to deal with it. They can worsen (or cause) depression and anxiety. As a result, more stress during the day can lead to more nightmares at night. And more nightmares lead to insomnia, lack of sleep and overall sleepiness and fatigue during the day. It can become a vicious cycle.
Why do Nightmares Happen?
There are many reasons nightmares occur. Sometimes, they just happen for no particular reason and the brain almost "learns" out of habit to keep having them. For others, late night snacks can awaken the brain more and cause more nightmares.
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Sleep deprivation, restless leg syndrome (RLS) and sleep apnea can also contribute to nightmares. These problems serve to disrupt proper REM sleep. Consulting with a sleep specialist to rule out any other sleep disorder is paramount.
Some medications can lead to nightmares-in particular, antidepressants, narcotics and some blood pressure medications. Talk with your doctor if you have nightmares and suspect that any of the above medications may be a culprit. Also, withdrawal from some medications and drugs or alcohol can all cause nightmares.
Stress, anxiety, depression and post-traumatic stress disorder (PTSD) are all common nightmare culprits. PTSD in particular can lead to recurrent, frequent nightmares-often related to the trauma that was experienced.
Treatment for Nightmares
First and foremost, rule out anything that might be contributing to your nightmares. Make sure you follow proper sleep hygiene (i.e. keep consistent bed and wake times, get enough sleep nightly, and refrain from alcohol and heavy meals at least three hours before bed). If you are on any medications that might contribute to your nightmares, talk with your doctor about changing your dosage or the prescription altogether. Also talk with your doctor if you suspect you have sleep apnea or RLS since treating these disorders can alleviate nightmares as well.
For those who suffer from nightmares and anxiety, depression or PTSD, it has long been thought that nightmares were a result of the underlying psychological disorder and that treating the "main" disorder would cure the nightmares. However, many recent studies have shown consistently that this simply isn't the case and that sleep problems continue to exist, despite treatment of any other psychological issue. As a result, obtaining a separate, adjunctive treatment for nightmares (in addition to any other psychiatric problems) is recommended.
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If you continue to suffer from nightmares and have tried the above suggestions, consider finding a specialist in Imagery Rehearsal Therapy (IRT). Typically conducted by psychologists who specialize in Behavioral Sleep Medicine, IRT is a promising, effective, simple and short-term treatment targeted at changing the imagery of nightmares.
Finally, a hypertension medication called Prazosin has also been shown to be effective for those who suffer from nightmares that are the result of PTSD. Consider speaking with a sleep specialist if you think this might be a possible treatment approach.
Chronic nightmares are nothing to take lightly. As disturbing and frustrating as nightmares can be, there are promising treatments available. Don't suffer in silence-talk with your doctor or a sleep specialist if you're concerned. You can bet you'll wake up less stressed and more refreshed!
- by Shelby Freedman Harris, Psy.D.
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