Are You Afraid of Sleeping?

Nightmares are a research and clinical area that has always fascinated me. While I have experienced nightmares myself, they have been quite rare in my life. However both a recent article and patient has piqued my curiosity. Nightmares can be defined as a frightening dream that will awaken an individual from REM sleep. Most people, when asked, will recall the content of the dream, in some cases even days after it occurred. If you ask people, almost everyone can recall having had a nightmare, but there are some unfortunate souls who have them with great regularity.

I see some of these patients in my practice, and it is often hard to know what can be done for them.  When is a nightmare just a really bad dream, and when does it cross the line into potentially something else? To try and answer one of these questions a recently published research study in the journal Sleep showed some very interesting results. In a community based population (not just college students, or a psychiatric population –where nightmares are prevalent) researchers at The Chinese University of Hong Kong observed:

• Once a week nightmares were found in 5% of the population
• Women were more likely than men to have nightmares
• In fact 71% of those with nightmares 3 times per week were females
• Those in a lower income bracket were the most likely to have nightmares
• 40-50% of those with some form of insomnia have nightmares

The finding that 5% of people have weekly nightmares was in line with previous studies. Why women have more nightmares than men may be due to the fact that women are better at recalling their dreams than men. Another theory posed by the researchers was that in their population women had a greater tendency for depression, anxiety and other forms of psychopathology. Most importantly those with insomnia appear to have a greater tendency to have nightmares but the next question would be which comes first? The insomnia or the nightmare? I have had several patients come to me with stories of both nightmares and insomnia. These patients will often present in clinic with:

• An inability to fall asleep
  • This can often be due to fear of having a nightmare.
• An inability to stay asleep
  • This can occur when they are woken up in the middle of the night, from a nightmare and do not want to go back to sleep for fear that the nightmare will continue.
• Restless Sleep
  • This is often the accumulation of both of the above situations.

So what are some of the current nightmare treatments available?
Unfortunately this topic is one that does not have a tremendous amount of research available but here is what we have seen:

• Medication: medication has been shown to be both a cause and a treatment of nightmares.

  • While in other cases certain anti-depressant medications (SSRI’s and tricyclics) can reduce the frequency of nightmares by reducing the amount of REM sleep you are getting.

• Talk Therapy: Work has been done where the person having the nightmare will wake up and write down everything that they can remember about the dream.

  1. In as much detail as they can, even with the potential horrible endings (people getting killed, or loved ones getting hurt, or persecuted).

  2. Next they collect these dreams over the course of a week or so and create a script as though it were a play or movie scene.

  3. Finally they CHANGE THE ENDING so that whatever is the horrible consequence is changed so that they become the hero of the dream!

  4. This new version of the dream is then read by the person several times right before they go to bed, to influence their dreaming.

So what can you do if you are having nightmares?

• First, realize that this may be more common than you think.  
• Next speak to your doctor about any medication you are taking and be sure to read the package inserts on any medication to see if vivid dreams or nightmares may be a side effect.
• Consider that a drug interaction (two medications together, or a glass of wine before taking a medication) could be causing the effect. Consider speaking to a psychiatrist or your general practitioner about a medication to help reduce nightmares by reducing your REM sleep
• Consider speaking to a therapist about how to begin the journaling process

Sweet Non-Scary Dreams,
Michael J. Breus, PhD
The Sleep Doctor™
www.thesleepdoctor.com