How Common Are Nightmares After Trauma
Among the general public, about 5% of people complain of nightmares. Those who have gone through a trauma, though, are more likely to have distressing nightmares after the event. This is true no matter what type of trauma it is.
Those trauma survivors who get PTSD are even more likely to complain of nightmares. Nightmares are one of the 17 symptoms of PTSD. For example, a study comparing Vietnam Veterans to civilians showed that 52% of combat Veterans with PTSD had nightmares fairly often. Only 3% of the civilians in the study reported that same level of nightmares.
Other research has found even higher rates of nightmares. Of those with PTSD, 71% to 96% may have nightmares. People who have other mental health problems, such as panic disorder, as well as PTSD are more likely to have nightmares than those with PTSD alone.
Not only are trauma survivors more likely to have nightmares, those who do may have them quite often. Some survivors may have nightmares several times a week.
Bad Dreams Trying To Sleep
If you are dealing with nightmares resulting from PTSD you are most definitely not alone. The U.S. Department of Veterans Affairs has done a lot of research on PTSD. Their data shows that, of people who arent dealing with PTSD, only 5% report persistent nightmares.
Compared to the people struggling with PTSD, where anywhere from 70% to 96% are dealing with nightmares, it is obvious the problem is widespread and common.
Every time I close my eyes, I would have a nightmare, said Valerie Ovalle of the U.S. Army. It can have massive impacts on our overall health when one of our ultimate forms of comfort and rest is taken from us.
Similarly, P.K. Philips wrote I saw violent images every time I closed my eyes, after experiencing many different traumas. For her the nightmares were only one part of her struggle other symptoms followed along.
One thing you might experience, or see and read about from others who suffer from PTSD nightmares, is how they stick with you. If you wake up right in the middle of a nightmare the chances are high your brain wont let go of those details quickly.
This can disrupt your entire night of sleep and then affect the next day even. Its a horrible cycle that might seem like its never ending.
But there is help!
What Are Night Terrors
Some people with PTSD experience night terrors, also known as sleep terrors. Night terrors are fairly common in children but not in adults, but trauma can cause them. During a night terror, a person appears to awaken and scream or shout in terror. Most of the time, they are not actually awake.
Night terrors may be accompanied by sleepwalking. They can cause a racing pulse, flushed skin, dilated pupils, sweating, and kicking and thrashing in bed. Someone in a night terror will be difficult to awaken. They may not have any memory of it the next day.
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Treating Ptsd Nightmares And Flashbacks
Treating the nightmares and flashbacks of PTSD is possible, but it can be a slow process . Therapy can help someone end these intrusion symptoms that negatively affect his/her quality of life.
Ideally, treating nightmares and flashbacks is a component of overall PTSD treatment. Some specific treatment approaches for PTSD nightmares and flashbacks include:
- Image Rehearsal Therapy for nightmares involves, during the day, changing the ending of the nightmare and replaying this over and over so that eventually the new dream will replace the PTSD nightmare
- The PTSD medication, Prazosin, for nightmares
- Exposure to traumatic imagery to desensitize ones reaction to flashbacks
- Stress reduction and relaxation techniques
- Orientation techniques to ground someone in the now world during a flashback or after a nightmare
PTSD nightmares and flashbacks take over someones body and emotions and plant him/her in the middle of the trauma world. Understanding PTSD nightmares and flashbacks can help someone stay rooted in the now world.
Research Into The Effectiveness Of Rescripting Dreams Suggests That Posttraumatic Nightmares Are Actually A Range Of Different Phenomena Opening Up The Possibility Of Targeted Treatments
A common symptom of posttraumatic stress is having nightmares, where a person re-experiences their traumatic experience in some way while they sleep.
But, what we are starting to suspect is that not all posttraumatic stress disorder nightmares are the same, and that has important implications for how we go about treating them.
One promising and relatively simple psychological intervention for PTSD nightmares has been to have patients consciously rescript their nightmare in a way that increases their sense of mastery or control, and steers the storyline in a different direction before it reaches the most distressing part.
We call it imagery rehearsal therapy.
But, after encouraging initial studies on the effectiveness of imagery rehearsal in PTSD, larger and more rigorous studies are yielding more unclear treatment outcomes.
So why would it work for some people and not others?
Recent polysomnography research into posttraumatic nightmares is suggesting that these dreams differ from normal ones in several ways and may actually be a range of phenomena, rather than a single one.
Imagery rehearsal therapy was first introduced by British psychiatrist Isaac Marks 40 years ago, originally as an intervention to help children to overcome repetitive bad dreams.
Since then, research into the use of imagery rehearsal in the treatment of posttraumatic nightmares in adults with PTSD has grown.
So where does this leave us?
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The Impact Of Nightmares On Ptsd
Nightmares are considered a central feature of PTSD. While a generic nightmare may feel extreme and life-threatening, it is usually unrelated to actual events. PTSD nightmares, however, are usually directly related to a previously experienced, traumatic event. For veterans, an example of a PTSD nightmare usually involves the replaying of traumatic events they witnessed or took part in. Similar to civilians who suffer from PTSD, their nightmares could be a replay of the traumatic event, such as physical abuse or violence.
One sleep therapist described whatPTSD nightmares are like based on the experience of their clients. They involved a replay of traumatic and vivid images, such as being knocked over by blown up body parts of a close friend, seeing the face of a person they killed in battle, or seeing the same image over and over again, such as what occurred with many people who witnessed the terrorist attacks of 9/11.
The trauma of reliving these nightmares causes many to dread or fear sleep. The avoidance of sleep in combination with an already inefficient sleep cycle causes many to become irritable and affects family, professional and social life. In one study, the risk of becoming suicidal or having suicidal thoughts was three times more likely in PTSD sufferers. With the addition of nightmares, individuals can be made to feel defeated and hopeless, contributing to the risk for suicidal ideation.
Are There Any Effective Treatments For Posttraumatic Nightmares
Nightmare symptoms often get better with standard Treatment Basics. If nightmares persist, there are treatments that can reduce how often they occur.
One treatment is Imagery Rehearsal Therapy . In IRT, the person who is having nightmares, while awake, changes how the nightmare ends so that it no longer upsets them. Then the person replays over and over in their minds the new dream with the non-scary ending. Research shows that this type of treatment can reduce how often nightmares occur.
Also, treatment for breathing problems that occur during sleep may reduce the nightmares that follow trauma. High levels of sleep-disordered breathing have been seen in trauma survivors. In one study, patients given a treatment to improve their breathing during sleep no longer had violent, scary dreams.
Little research exists on the use of medicines to treat nightmares from trauma. The medicine with the most promise is prazosin. Two studies have found that prazosin reduces nightmare symptoms. More research on prazosin is under way.
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Can Melatonin Cause Nightmares
There’s much less research to suggest how melatonin can affect how often you have nightmares when you take extra melatonin. A 2015 case report first found a possible link between melatonin and episodes of nightmares though taking melatonin itself wasn’t necessarily the source of the nightmares./span>
Coping And Getting Help
Sleep problems are important to address because poor sleep can lead to a number of other problems. A lack of sleep or poor sleep quality can be a factor contributing to stress and mood problems. Poor sleep can also have a negative impact on your physical health.
Pharmacologic interventions are sometimes necessary for the sleep problems that accompany PTSD, however changing sleep habits may also be helpful in improving your ability to fall asleep. Fortunately, there are a number of things you can do to improve your sleep.
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Sleep Problems In Ptsd
People with PTSD may experience a number of different types of sleep problems. Many people with PTSD have difficulties falling asleep as compared to people without PTSD. In fact, one study of Vietnam veterans found that 44% of those with PTSD said that they have trouble falling asleep at night, whereas less than 10% of combat veterans without PTSD said that they have this problem.
People with PTSD may wake up frequently during the night, have difficulty falling back asleep, or may wake up earlier than they intended. Also, even if sleep does occur, it is often not good, restful sleep.
Of course, nightmares are also very common among people with PTSD. Nightmares are considered one of the re-experiencing symptoms of PTSD. Among people with PTSD, nightmares may be about the traumatic event a person experienced or they may be about some other upsetting or threatening event.
Finally, because of these sleep problems, people with PTSD often develop fears about going to sleep. They may experience worries or thoughts about their traumatic event as soon as they go to bed. They may also fear acting out their nightmares while asleep or impulsively upon being woken up from a nightmare, leading them to sleep alone away from their partners.
What Are The Health Effects Of Nightmares In Adults
Nightmares become much more than bad dreams when they have a significant effect on your health and well-being. Among people who experience nightmares, those who are anxious or depressed are more likely to be distressed about the experience and suffer even more psychological ill effects. Although the relationship is not understood, nightmares have been associated with suicide. Because nightmares may have a significant impact on your quality of life, it’s important to consult a medical professional if you experience them regularly.
Sleep deprivation, which can be caused by nightmares, can cause a host of medical conditions, including heart disease, depression, and obesity.
If nightmares in adults are a symptom of untreated sleep apnea or post-traumatic stress disorder, the underlying disorders can also have significant negative effects on physical and mental health.
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Eye Movement Desensitization And Reprocessing
EMDR therapeutic approach is guided by the Adaptive Information Processing Model whereby nightmares are viewed as manifestations of disturbing events that have not been adequately processed but encoded and stored in a state-specific dysfunctional form. EMDR therapy elicits the recall of these distressing images while activating one type of bilateral sensory input such as hand tapping or side to side eye movement. By overloading the working memory, emotional reactivity is dampened and imagery becomes less vivid. It is speculated that this technique produces emotional and physiologic alterations resulting in a relaxing response including respiratory synchronization, reduction in heart rate, and reduction in galvanic response.
The Connection Between Ptsd Sleep And The Brain
Researchers have found evidence that multiple overlapping brain regions are implicated in both PTSD and sleep problems, most notably the hippocampus, the amygdala, the anterior cingulate cortex, and the insular cortex. These brain regions are likely responsible for causing the patient to revisit the traumatic event in flashbacks and nightmares, as well as for maintaining a state of hyperarousal.
Studies have found that individuals with PTSD have a faster heart rate while sleeping, indicating an enhanced fight-or-flight response that maintains the body in a permanent state of hypervigilance. Unsurprisingly, hallmarks of disturbed sleep in PTSD sufferers include more stage one light sleep, less restorative slow-wave sleep, and fragmented REM sleep.
Another significant connection between sleep and PTSD may lie in the way the brain processes fear-inducing memories. During a traumatic event, the brain learns to associate a certain stimulus with a negative response. Long after the traumatic event, this association may be so strong that the person suffers a violent reaction every time they are presented with a similar stimulus.
Sleep loss may also cause daytime sleepiness and interfere with coping strategies, leaving people anxious and hypersensitive to triggers. The good news is that improving sleep seems to have corresponding effects on PTSD.
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How Does Ptsd Affect Sleep
Individuals with PTSD frequently have trouble falling asleep and awaken easily, often waking up many times throughout the night. Many people with PTSD also have nightmares. These issues result in disrupted, non-refreshing sleep.
Those with chronic pain, substance abuse, traumatic brain injury, depression, or other medical problems face an additional barrier to getting quality sleep. Certain sleep medications also interfere with REM sleep, which is the sleep stage during which we dream and an important sleep stage for dealing with traumatic memories.
The most common sleep problems in PTSD can be summed up in three categories:
Treating PTSD-related sleep problems, as well as co-existing disorders such as depression, is an important part of resolving overall PTSD symptoms.
Diagnostic Criteria For Nightmare Disorder
The third edition of the International classification of sleep disorders has recently redefined nightmares as repeated occurrences of extended, extremely dysphoric, and well-remembered dreams that usually involve threats to survival, security, or physical integrity . Contrary to several other parasomnias, the sleeper rapidly regains alertness and orientation upon awakening from a nightmare. Nightmare disorder is characterized by dysphoric dreams that perturb sleep consolidation and daytime functioning. While nightmares are developmentally common in young children, traumatic events and pharmacological agents are the most commonly identified precipitating factors in adults.
Nightmares are one of the re-experiencing symptoms of PTSD , and affect as many as 50 % of trauma-exposed adults. There is early evidence to suggest that men are more likely to experience nightmares as a symptom of PTSD than women. Males deployed in support of Operation Enduring Freedom or Operation Iraqi Freedom are more likely to experience nightmares, numbing, and hyper-vigilance than their female counterparts who experience more concentration problems and distress with reminders . Whether or not the same pattern holds in the civilian population or with nightmares without comorbid PTSD has yet be determined.
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Treatments For Night Terrors
The most important treatment for night terrors is addressing the underlying condition. For someone with PTSD, this means regular therapy, trauma-focused therapy, and in some cases medications. Because PTSD is so serious, and symptoms like night terrors can be so disruptive, a residential mental health facility is often a good idea. It gives the individual the chance to benefit from intensive treatment, round-the-clock safety, and the ability to focus on their wellness.
Successful treatment of PTSD should reduce and ultimately eliminate night terrors. In the meantime, strategies such as managing stress, meditation, good sleep hygiene, and anticipatory waking can help. Anticipatory waking means setting an alarm to wake up about 15 minutes before the terrors usually begin.
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How Can You Reduce Nightmares From Ptsd
Post Traumatic Stress Disorder sufferers experience nightmares much more frequently than the general population . Generally, nightmares are thought to be a normal reaction to stress, and some clinicians believe they aid people in working through traumatic events but what can you do when they get out of control and are affecting your quality of life?
During sleep, we pass through five stages: 1, 2, 3, 4 and REM sleep. These stages progress cyclically from 1 through REM then begin again with stage 1. A complete sleep cycle takes an average of 90 to 110 minutes. During these cycles, we typically spend more than two hours each night dreaming. Despite dreams being studied for years, scientists do not know much about how or why we dream as its an area of neuroscience and psychology thats notoriously difficult to study. Psychologist Sigmund Freud believed dreaming was a safety valve for unconscious desires, but when researchers began researching sleep and REM more fully in 1953, they discovered that dreams almost always occur during the REM part of sleep.
Most people experience 3 to 5 intervals of REM sleep each night and because these periods become progressively longer during the night, you may find you experience nightmares most often in the early morning hours. During REM sleep, your brain waves exhibit activity fairly similar to when youre awake, and your brain is consuming as much if not more energy than when youre awake.
So how do I stop having nightmares?
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Pharmacological Treatments Of Nightmares
Alpha-1 Noradrenergic Antagonists
Although the etiology and pathophysiology of nightmares remain unknown, heightened noradrenergic tone during sleep and especially rapid-eye movement sleep has been proposed as a potential mechanisms underlying nightmares in the context of PTSD .
Prazosin is an alpha-1 noradrenergic antagonist that crosses the blood brain barrier, and that may reduce nightmares and sleep disturbances that characterize PTSD . Based on the extensive review of open trials and placebo-controlled studies conducted in military veterans and civilians with nightmares PTSD, the American Academy of Sleep Medicine recommended prazosin as an evidence-based treatment of nightmares, especially in the context of PTSD see also: for recent reviews.
Ahmadpanah and colleagues conducted an eight-week randomized clinical trial to compare prazosin and hydroxyzine to a placebo condition on measures of nightmares, sleep quality, and PTSD symptom severity in sample of 100 adult civilians. Hydroxyzine is a histaminergic receptor blocker that has anxiolytic and sedative properties and may be effective in the treatment of anxiety disorders . Both active treatments were associated with improvements in nightmares, overall sleep quality, and PTSD symptomatology, and the magnitude of improvements was slightly greater for the prazosin group.
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