Recurring nightmares can create a nightmarish existence for sufferers, even during waking hours.
Up to 50% of children aged 3-6 years experience sleep-disturbing nightmares, and up to 80% of young children have frightening dreams. Between 2% and 8% of adults also complain of recurring nightmares that disturb their sleep and diminish their day-to-day functioning.
Could there really be a simple way to stop the scary dreams? Image Rehearsal Therapy (IR) may be the answer.
What Are Nightmares?
Nightmares are clear and horrifying dreams that startle the dreamer awake. Usually, the dreamer can report a vivid, often bizarre plot upon awakening. Typically, the nightmares take place during the REM (rapid eye movement) stage of sleep, the deep periods of sleep when most dreaming occurs.
As the night progresses, and people cycle through the stages of sleep, their periods of REM sleep become progressively longer. Therefore, many report experiencing nightmares during the early morning hours.
The DSM-V, the manual disseminated by the American Psychological Association, details a variety of sleep disorders. Among them is Nightmare Disorder, which is described as repeated awakening from sleep with detailed memories of terrifying dreams. Usually, the nightmare involves a serious threat to security, self-esteem or survival. Examples are physical threats such as being chased, or psychological threats such as being bullied. Children often report seeing images such as ghosts, monsters or ferocious animals.
The Nightmare Disorder sufferer is usually immediately alert upon awakening, which occurs during the second half of the sleep period. In order to qualify as a disorder, the experience of dreaming leads to impairment in daily functioning or clinically significant distress.
Nightmare Disorder is different than night terrors, which usually occur during the first half of the sleep period, and create the feeling of terror without relatedness to a specific dream.
Causes of Nightmare Disorder can be difficult to determine. Psychological triggers, such as depression or anxiety, can cause nightmares, as can mental impairment, delirium and organic brain disorder. Nightmares are also one of the features of Post-traumatic Stress Disorder (PTSD); those nightmares often are a recreation of the original trauma.
Drugs, Alcohol and Dreams
The treatment for recurring nightmares might be as simple as changing a medication. Certain blood pressure medications, such as centrally-acting antihypertensives, have been linked to increased nightmares. Some antidepressants, such as SSRI’s, tricyclic antidepressants and MAOI’s can also lead to nightmares. Common names for such antidepressants are Paxil, Lexapro, and Nardil. Some treatments for Parkinson’s Disease, such as Levodopa and Selegiline may cause nightmares as well.
People experiencing recurring nightmares should also steer clear of short-acting barbiturates, such as Phenobarbitol. Another culprit can be alcohol withdrawal, or withdrawal from benzodiazepine use. During the withdrawal period, stages of REM sleep lengthen, increasing the probability of nightmare occurrence.
Chase Your Nightmares Away
What can you do about this terrifying phenomenon? For a child, frequent reassurance and a relaxing bedtime routine (such as a warm bath followed by storytelling) might reduce the chance of nightmares. Speaking about the nightmare with the child, and discussing how the scary scenario could end differently, might also help put the child in control and change the course of his or her dreams.
For adults, image rehearsal therapy (IRT), a treatment developed in the 1990’s, has been proven to deliver relief to at least 70% of nightmare sufferers. IRT uses imagery to teach people how to control their dreams, even as they sleep.
The IRT process is quite simple. There are three steps to gaining control over one’s nightmares: Writing down a description of a nightmare, imagining a way in which the nightmare could be changed for the positive, and reserving a few minutes every day to imagine a mental picture of the improved version of the nightmare.
For example, someone with recurrent nightmares about drowning in the ocean could instead picture herself standing at the seashore with the waves gently coursing over her feet. She would practice picturing the seashore image for a few minutes a day. Eventually, the picture of the seashore will present itself during her dreams, replacing the frightening ocean drowning image.
The rationale behind IRT is that nightmares are a learned behavior, or habit. Nightmares become frequent because they’ve been repeated too many times. According to learning theory, you can change negative habits through the regular practice of positive habits.
Stop Recurring Nightmares With Practice and Understanding
Through daily exercises of the brain during waking hours, positive dreams can become habitual. As a result, during sleep, the brain will behave in the way it’s become habituated to act: dreaming dreams with happy endings.