Ptsd Nightmares: Is There An Effective Treatment
“We recommend starting with one of the behavioral treatments when a patient has access to a qualified therapist and is willing to commit to that therapy.”
The scientific community has made major strides in recent years to untangle PTSD, a mental health condition that can trigger flashbacks to a traumatic event or cause one to feel distant and angry. Advancements have been made to understand the reasons behind PTSD, where the condition takes hold in the brain, and which therapies work best.
But uncertainty exists in how to best treat nightmares, a hallmark symptom of PTSD. Research results on therapies for PTSD patients who are experiencing nightmares have been inconsistent. That shortcoming applies to Veterans, active-duty service members, and civilians, all of whom have been diagnosed with the disorder.
Dr. Ali El-Solh is a pulmonologist and sleep specialist at the VA Western New York Healthcare System in Buffalo.
Dr. Ali El-Solh, a pulmonologist and sleep specialist at the VA Western New York Healthcare System in Buffalo, is hoping to improve the lives of Veterans with PTSD who are battling nightmares. He authored a review that explores why nightmares are a characteristic of PTSD, examines the health risks linked to PTSD and nightmares, elaborates on psychological and drug treatments for these nightmares, and identifies future research needs.
Why is it important to highlight the connection between PTSD and nightmares?
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VA RESEARCH
Beat Nightmares And Get Back To Restful Nights
You’re being chased by someone or something. Whatever it is, it always seems to be just behind you. You run and run, your whole body on fire with fear, and you can’t shake your pursuer. You jump into the air, and suddenly you’re free-falling. Your teeth start rattling and falling out. Then, somehow you’re on stage, under a spotlight, and you realize you’re not wearing pants, and everyone in the audience is staring at you.
Hopefully, you haven’t experienced any of those events in real life. But I bet you’ve gone through at least one of these common themes in the snooze world and woken up in a cold sweat with your heart pounding.
What are nightmares, and who has them more often?
Nightmares can be a mystery. Around the world, folklore tales have attributed nightmares to be demons, the souls of dead people who were wronged in life, and malicious spirits. Although we still haven’t fully solved the mystery of why nightmares exist and how they come about, we do know that they’re intense mental activity that happens mostly during rapid eye movement sleep. Most commonly, we experience nightmares as very vivid dreams that are terrifying or distressing. And, naturally, they can disrupt our sleep and affect our mood.
Whether you have Nightmare Disorder, PTSD, or just experience more nightmares than you’d like, there are things you can do to decrease nightmares and regain a good relationship with sleep.
What Causes Ptsd Nightmares
Nightmares that result from PTSD are different than;typical nightmares. This is because PTSD symptoms all occur as a result of a specific traumatic event in a person’s life. While nightmares that aren’t related to PTSD can be about anything, PTSD nightmares almost always include some aspect of the specific traumatic event that caused the disorder to develop.
Because I experienced multiple traumatic events over the course of my childhood, my PTSD nightmares are a little more complex. Even so, the things I dream about night after night all relate to my past in some way.;
Stress is also a common cause of nightmares. It’s normal to have bad dreams when you have a big exam or important project looming at school or work. Because stress is also a core symptom of PTSD, it’s natural that people with PTSD would experience more nightmares than those without.;
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Ptsd And Night Terrors
Approximately 96% of people with PTSD experience terrifying nightmares that are so vivid that they seem real. Unlike bad dreams, night terrors have physical manifestations such as thrashing, flailing, screaming, and even sleepwalking. Night terrors should be addressed early on because they can put you in serious danger. Sleeping beside someone who suffers from PTSD-induced night terrors can also cause emotional distress.
Night terrors come in episodes, and in a sleep terror episode, you may:
- Start with a scream
- Turn aggressive when restrained
- Have no memory of the night terror episode
Any of the above behaviors are not normal and should not be shrugged off as if it were just a nightmare. Night terrors is considered a serious condition.
Summing Up: Ptsd Nightmares
PTSD nightmares can be scary, but they dont have to be a regular, nightly feature. With many forms of therapy available, it is possible to welcome sleep instead of avoiding it. Much of the research done on nightmares is directly related to PTSD and the results show much promise.;
Current therapies and medications to keep in mind when considering treatment for PTSD include:
- Prazosin: A medication that decreases CNS output
- Image Rehearsal Therapy: A form of therapy that rewrites the original story of trauma to include a positive ending
- EMDR Therapy: A form of therapy that helps to lessen arousal associated with traumatic memories
If you or someone you know struggles with PTSD nightmares and uses alcohol or other substances to cope, know you are not alone. Contact The Recovery Village today to speak to a representative and discuss a treatment plan appropriate for you.
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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.
Management Of Nightmare Disorder In Adults
Erin D. Callen, PharmD, BCPSProfessor of Health-System Pharmacy
Tiffany L. Kessler, PharmD, BCPSAssociate Professor of Pharmacy Practice
Krista G. Brooks, PharmDAssociate Professor of Pharmacy Practice
Tom W. Davis, MDAssociate Professor of Pharmaceutical SciencesSouthwestern Oklahoma State University College of PharmacyWeatherford, Oklahoma
US Pharm. 2018;43:21-25.
ABSTRACT: Occasional nightmares are fairly common, but nightmare disorder occurs in 2% to 6% of adults. Recurrent nightmares may be idiopathic, but they are often related to posttraumatic stress disorder , underlying psychiatric disorders, or medication use. The American Academy of Sleep Medicines 2018 position paper provides guidance on nonpharmacologic and pharmacologic treatment. Behavioral intervention with imagery-rehearsal therapy is currently the only treatment strategy recommended for all patients with recurrent nightmares. Prazosin may be used to treat both PTSD-associated and idiopathic nightmare disorder. Antidepressants, anxiolytics, anticonvulsants, antipsychotics, and other agents have been studied, with mixed results.
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Ptsd Nightmares: A Neural Gateway To Hell
May 27, 2017
bettysbattleground.com
Elizabeth Brico;shares her personal experience, and expertise on PTSD Nightmares. Elizabeth Brico is a freelance writer from the Pacific Northwest whose work often focuses on trauma, mental illness, and addiction.
Her blog,;Bettys Battleground, was recently ranked on Feedspots list of top 75 PTSD blogs. She is also a regular contributor to the;trauma blog on;HealthyPlace. Her work has appeared in;Politico Magazine,;Talk Poverty,;Tonic/VICE,;The Fix,;Ozy,;Vox, and;Racked, among others.;;In her free time, she can usually be found reading, writing, or watching speculative fiction. You can find her full portfolioalongside some fiction and other ramblingson her author site,;eb-writes.com. Check out her;blog;and;;pages on Facebook, or find her on;,;, and;.
Imagine The Worst Nightmare Youve Ever Had
Can you remember it? Can you remember how it made you feel; your thoughts when you woke up? Probably a mixture of lingering fear; your grogginess may have made your imagination wild; the shadows in your room may have borne;a vague threat. But you probably also felt relief when you woke up. You were glad that the dream was over, and as the sleepiness wore off, you were probably happy to be awake again.
I pulled that description from my memory. From the time before I was traumatized. I remember what nightmares were like before I developed PTSD. They werent fun; I have a vivid imagination and it can definitely run wild with a fearful scenario, but back then, before PTSD, the word nightmare was synonymous with bad dream.
PTSD nightmares are far worse than bad dreams. If dreaming takes us to;an alternate dimension, then PTSD turns the brains of trauma survivors;into gateways to Hell.
The biggest difference between a trauma nightmare and a normal nightmare is that trauma nightmares feel real.
I mean;really;real.
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You Are Unable To Process Your Traumatic Memories Effectively
In the aftermath of your traumatic experiences, your mind and body developed a magnified, dysfunctional version of the fight or flight response. Unlike those who are able to experience trauma and put it into workable personal contexts, your C-PTSD keeps you stuck. And your nightmares not only keep you reliving the experience but impede your ability to soothe and solve the emotional problems created by your past.
Complex PTSD nightmares mean that your mind is still interpreting and responding to the trauma intensely. They mean that your body is unable to unload trauma-related sensations. Youre not yet equipped to incorporate or contextualize the trauma and release it. With that said, your nighttime drama is really the drama of trauma-related memories that dont fade or integrate into your life.
Beressal Vanderkolk, the best selling author of the Body Keeps Score wrote, “…some aspects of traumatic events appear to get fixed in the mind, unaltered by the passage of time or by the intervention of subsequent experience. For example, in our own studies on post traumatic nightmares, subjects claimed that they saw the same traumatic scenes over and over again without modification over a fifteen year period.”;
Sleep Tips For Partners Of People With Ptsd
While most efforts are focused on how to help someone with PTSD sleep, the partners of people with PTSD may also find it difficult to sleep soundly. For those with a partner who wakes up multiple times during the night, it may help to invest in a mattress that muffles sound and movement.
Nightmares and night terrors can be frightening and may cause your partner to lash out violently. Though you want to be there for your partner, you may find it necessary to sleep in a separate, nearby bedroom from time to time so you can get the restful sleep you need.
It may also be constructive to do exercise together with your partner during the day. In addition to improving sleep, developing healthy routines together can help you bond and help re-establish a sense of security for your partner.
Many caregivers struggle with feelings of guilt and a sense that they are responsible for saving their partner. However, pouring all your energy into helping another person can have a serious effect on your own mental health. Couples therapy, individual therapy, support groups, or a strong network of family and friends may help you manage your own thoughts and feelings to reduce the risk of burnout.
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Not All Ptsd Nightmares Manifest
Not all PTSD nightmares manifest as direct re-experiencing of the epidemiological trauma. Sometimes they just conjure the same feelings. Ive woken screaming from nightmares of being chased by a shadowy phantom down impossible;architectures and never-ending streets. Recently, many of my nightmares have revolved around my ex trying to seduce me, which is probably the most horrifying story line of all.
PTSD erases the line between dream and reality.;There is no difference between the way a PTSD nightmare feels, and the way a real trauma feels. Which means I am re-traumatized by my own brain almost every night.
Treating Ptsd Night Terrors
If you scream and flail in your sleep for a few seconds to a few minutes, its highly likely that you suffer from night terrors. One things for sure, its an undesired occurrence that not only negatively affects you but also the people around you.
While anyone can suffer from night terrors, there are some people who are more prone to developing them. If you have been diagnosed with PTSD, or post-traumatic stress disorder, you are vulnerable to experiencing night terrors.
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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!
How Do Sleep Issues Affect Ptsd Symptoms
Among people who experience a traumatic event, those who suffer significant sleep problems appear to be more likely to develop PTSD in the future. In fact, one of the earliest signs of PTSD is sleep disturbance, which often encompasses nightmares, insomnia, and fragmented rapid eye movement sleep.
Interestingly, sleep problems that precede the traumatic event may also play a role. One study found that people reporting nightmares before going to war were more likely to develop PTSD after coming back.
Once the disorder sets in, the presence of sleep problems appears to exacerbate PTSD symptoms. And even after treating daytime PTSD symptoms, many people find that insomnia still persists.
Sleep problems in PTSD interfere with the brains ability to process memories and emotions, slowing down the recovery process after a traumatic event. Moreover, many people with PTSD use alcohol or other substances to try to sleep better. Far from helping, these counterproductive coping mechanisms actually worsen sleep and can aggravate PTSD symptoms as well.
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Why Do People With Ptsd Have Sleep Problems
- They may be “on alert.” Many people with PTSD may feel they need to be on guard or “on the lookout,” to protect himself or herself from danger. It is difficult to have restful sleep when you feel the need to be always alert. You might have trouble falling asleep, or you might wake up easily in the night if you hear any noise.
- They may worry or have negative thoughts. Your thoughts can make it difficult to fall asleep. People with PTSD often worry about general problems or worry that they are in danger. If you often have trouble getting to sleep, you may start to worry that you won’t be able to fall asleep. These thoughts can keep you awake.
- They may use drugs or alcohol. Some people with PTSD use drugs or alcohol to help them cope with their symptoms. In fact, using too much alcohol can get in the way of restful sleep. Alcohol changes the quality of your sleep and makes it less refreshing. This is true of many drugs as well.
- They may have bad dreams or nightmares. Nightmares are common for people with PTSD. Nightmares can wake you up in the middle of the night, making your sleep less restful. If you have frequent nightmares, you may find it difficult to fall asleep because you are afraid you might have a nightmare.
- They may have medical problems. There are medical problems that are commonly found in people with PTSD, such as chronic pain, stomach problems, and pelvic-area problems in women. These physical problems can make going to sleep difficult.
The Best Advice I Ever Got To Make Ptsd Nightmares Stop
My psychotherapist shared, nightmares are just the brains way of processing information. The trauma arises because youre being forced to deal with it. Your brain is telling you that its time to address the trauma. However, the feelings youre experiencing in the nightmare such as loss of control or fear are just symbols for how you feel in your waking life.
She said, every time you wake up from a nightmare, say out loud to yourself, Im just processing information. Thats the big secret to my PTSD nightmare cure. Its literally the simplest thing to practice. But by expliciting stating why the nightmare is happening, you slowly stop fearing the nightmare. Instead, you begin to logically understand why its happening.
PTSD nightmares are very emotional experiences. But repeating the statement every time you wake up from a nightmare helps balance out the emotion with logic.
Ive literally repeated this mantra after every nightmare for years. Eventually, years later when your PTSD resurfaces again, youll be able to take care of yourself on your own without the help of a psychotherapist. And when you wake up from a nightmare, youll realize youre simply processing information and you wont be scared when you wake up. And so you fall back asleep.;
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