By day, Lisa (last name withheld) in Charleston, South Carolina, has it all together: a strong marriage, beautiful children, a thriving career. At night, however, the beauty disappears and something more sinister takes over. Lisa has suffered from chronic, unpredictable nightmares for decades. “Sometimes I take several a night. Sometimes I go two or three weeks without [one],” she explains in an email interview.
Lisa isn't visited by the second coming of Freddy Krueger or anything like that, but the content of these terrible dreams is still quite shocking. In a recurring nightmare, she is driving too fast at a famous Atlanta highway intersection known as “Spaghetti Junction” and runs off the shoulder, falling to her death. “It crosses my mind that I know I'm doing this and that everyone will be very disappointed in me,” she says.
Another example is her hunting a demon at her mother-in-law's house. “I have to work hard to climb and reach the devil, who is at the bottom of the house, but with each dream I get closer,” she remembers. “The most recent one, I was looking through a knot in the wooden door and he was looking at me, eye to eye. It was horrible."
Everyone has occasional nightmares. Approximately 5% of the general population have at least one nightmare per week, says clinical psychologist and sleep expert Dr. Michael Breus in an email interview. “Nightmares typically happen during REM sleep, in the middle and end of the night,” he explains. “Because of where nightmares tend to occur in the sleep cycle, and because of the intensity of their images and emotions, nightmares will result in some degree of awakening. You may stand up in bed and have trouble going back to sleep, thanks to a nightmare.”
We don't know exactly why nightmares happen, but Breus says it's possible they help the brain "practice, prepare for, and even anticipate difficult or dangerous experiences in waking life." In fact, these issues often need attention during the day, so it's possible that Lisa lives in fear of an accident on the road or needs to talk about things with her mother-in-law. “Of course, it is possible that nightmares, like dreams in general, do not have a primary function – they are a byproduct of other activities in the body,” says Breus. “But most sleep scientists think that dreams and nightmares exist for some purpose.”
One study found that the most common nightmare was falling, followed by dreams of being chased, dying, feeling lost, and feeling trapped.
Content
- Causes of nightmares
- The Link Between Nightmares and Sleep Apnea
- Using Imagery Rehearsal Therapy to Treat Nightmares
Causes of nightmares
Certain circumstances and characteristics make some people more prone to nightmares than others, says Savannah internist and sleep medicine expert Dr. Barry Krakow, author of the upcoming book “Life Saving Sleep,” which delves deep into nightmares and other disorders. of sleep. . People who have been traumatized are certainly at greater risk of having nightmares, he says, giving examples such as war veterans, those who have suffered sexual or criminal assault, or those who have been in a life-threatening accident. People with some degree of sensitivity in their biological makeup are also more likely to have nightmares, which is why they are more common in people who suffer from anxiety or depression, or who use opiates or alcohol excessively.
Folklore often attributes nightmares to excessive consumption of rich foods before bed, but the jury is still out on whether this is true. A 2015 study found a link between eating dairy or spicy foods before bed and having disturbing dreams, but the study authors noted that this could not be conclusively proven because the data was self-reported and there were many other variables. to be considered. consider. (For example, some of the participants binged, practiced intermittent fasting, and/or may have had undiagnosed reactions to certain foods.)
However, research over the past few decades has shown that people who suffer from sleep disorders are also more likely to have nightmares. Specifically, people with undiagnosed or untreated sleep apnea are at higher risk, Krakow explains.
The Link Between Nightmares and Sleep Apnea
People with sleep apnea stop and start breathing hundreds of times during the night. Although it is widely associated with snoring, a person does not need to snore to have sleep apnea. People with sleep apnea are often very tired during the day, even when they supposedly slept through the night. Other symptoms of sleep apnea are shortness of breath during sleep, dry mouth or headache in the morning, trouble sleeping, irritability, and attention problems.
According to Krakow, the many misconceptions surrounding sleep apnea make it difficult to diagnose a person. “Many children have sleep apnea and are not diagnosed until they are 50 years old,” he says. This is important because, in addition to nightmares, sleep apnea is associated with a higher risk of diabetes, brain dysfunction, heart disease, and so on. “There are so many deaths caused over time by oxygen not reaching the brain,” he explains.
Currently, his practice helps treat mental health patients with sleep disorders. “Many of them have undiagnosed sleep apnea,” he says, noting that he has seen thousands of patients at his center with nightmares. “The vast majority report reduced sleep apnea with use of a CPAP machine, which then appeared to reduce nightmares.” Formally known as continuous positive airway pressure (CPAP) therapy, this is a standard treatment for people with obstructive sleep apnea.
The problem is that many mental health professionals, who people typically turn to for help with nightmares, are not aware of the link to sleep apnea. “Some people undergo psychotherapy for years due to PTSD and the nightmares do not go away”, laments Dr.
Using Imagery Rehearsal Therapy to Treat Nightmares
Even those who suffer from nightmares and do not have sleep apnea have another option. In 2001, Krakow and his team published a groundbreaking study in JAMA. The study pioneered “imagery rehearsal therapy,” or IRT, which the team describes as a brief treatment that reduces chronic nightmares, improves overall sleep quality, and reduces PTSD symptoms. The problem is that even though the treatment is endorsed by the American Sleep Academy and has been studied by dozens of groups around the world, many health professionals don't know about it.
Here's how it works: "You teach someone to imagine a new version of their dream in their mind while they're awake, and that has a very powerful impact on their dreams," says Krakow, noting that it only takes a few weeks to see clear reductions. in nightmares. “By portraying new images, they appear to be activating an imaging system that sets in motion the process of diminishing disturbing dreams.”
The study showed dramatic results: “Post-traumatic stress symptoms decreased by at least 1 clinical severity level in 65% of the treatment group, compared with symptoms that worsened or did not change in 69% of the controls,” the authors of the study wrote. study . Krakow notes that IRT is “as powerful as someone taking medication for PTSD.”
For many, it's not even technically necessary to visit a professional to practice IRT, although some people may be better off. “It's very simple and very effective, but sometimes it would be better to do the technique with a therapist,” he says.
Now that's cool
People who suffer from nightmares and want to try IRT can download an audio workbook from Dr. Krakow called “Turning Nightmares into Dreams.” With around three hours of audio lessons and a 100-page workbook, it's a convenient and cost-effective way to learn the technique.
