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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Create A Safe Sleeping Space
Your sleep space goes beyond your physical bedroom to include your mind. Start by ensuring the physical space you sleep in is comfortable and promotes relaxation. Then, work to set your mind to a calming station, as you would a radio. A great way to get your mind in a peaceful and happy place is to practice meditation for 10-30 min before sleep.
Theres Life Beyond The Nightmares And Trauma
Sleep apnea may have taken away your sleep, nightmares may have hounded you, and your traumatic memories may have devastated you.
However, its not the end. Theres a light at the end of the tunnel as long as you get the help you need. In time, no matter how long it takes, youll find a sense of wellbeing again. With the information above, you may be able to move forward and discover ways to heal
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What Causes Nightmares In Adults
Nightmares in adults are often spontaneous. But they can also be caused by a variety of factors and underlying disorders.
Some people have nightmares after having a late-night snack, which can increase metabolism and signal the brain to be more active. A number of medications also are known to contribute to nightmare frequency. Drugs that act on chemicals in the brain, such as antidepressants and narcotics, are often associated with nightmares. Non-psychological medications, including some blood pressure medications, can also cause nightmares in adults.
Withdrawal from medications and substances, including alcohol and tranquilizers, may trigger nightmares. If you notice a difference in your nightmare frequency after a change in medication, talk with your doctor.
Sleep deprivation may contribute to adult nightmares, which themselves often cause people to lose additional sleep. Though it’s possible, it has not been confirmed whether this cycle could lead to nightmare disorder.
There can be a number of psychological triggers that cause nightmares in adults. For example, anxiety and depression can cause adult nightmares. Post-traumatic stress disorder also commonly causes people to experience chronic, recurrent nightmares.
Follow A Sleeping Schedule
Another good tip for PTSD and sleep is a consistent sleeping routine. When you go to bed and wake up at the same time throughout the week, it can significantly maintain your internal clock and prevent waking up when you have nightmares. Dont forget to do something relaxing before bedtime, like meditation or reading a book, in order to ensure a night of better sleep.
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Some Relevant Faqs About Ptsd Nightmares:
1. Are bad dreams a sign of PTSD?
Believe it or not, bad dreams are one of the symptoms and sign of PTSD. Some of the patients experience traumatic events and flashbacks of the trauma experienced before.
2. Do PTSD nightmares ever go away?
Yes. As many other mental disorders could be treated, PTSD could also be treated with trauma-focused therapy. With the passage of time, PTSD nightmares simply move away.
3. Can PTSD change your personality?
If PTSD has reached an intense level, it can bring changes in a persons individuality, emotional, and social life.
4. Is it possible to have PTSD without nightmares?
Yes. PTSD comes with different symptoms and sometimes PTSD stresses a person or creates negative mood swings without showing nightmares.
In the end, we would like to say that dont hesitate, ask for help. You start to improve as soon as a positive thought, and a positive voice comes from within. We may not be able to change the past and trauma associated with it, but the future is in our hands. So rise today, rise now!
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Try Imagery Rehearsal Treatment
This treatment is designed as a cognitive-behavioral treatment in which patients get to rewrite their nightmares. Working with a therapist, you can rehearse the dream and rewrite the ending to be less threatening and traumatizing. This method is one that has proved to reduce both the intensity of reoccurring nightmares as well as the frequency.
Sleep Hygiene After Trauma
In addition to seeking professional support when coping with the effects of trauma, it may be helpful to consider strategies to support healthy sleep hygiene.
- Remember that symptoms may be normal: Immediately after having a traumatic experience, its normal to have difficulty sleeping. Be gentle on yourself and remember that your body is attempting to process and cope with the event.
- Maintain your usual sleep routine: Sleep and routine go hand in hand. After trauma it may be tempting to withdraw or change our normal daily activities. Try to keep to your usual sleep routine to give your body the best chance for a restful night.
- Relax before bed: Instead of trying to pressure yourself into falling asleep, focus on finding ways to calm your mind and body before bed. Turn off electronics and try some relaxation methods that may help you fall asleep.
- If you cant sleep, dont stay in bed: Staying in bed when you cant sleep can create an unhelpful association between the bed and sleeplessness. If you find yourself lying awake for more than 20 minutes, try getting out of bed and doing something relaxing, like reading a book or listening to gentle music.
Experiencing trauma can increase the risk of a multitude of mental and physical health issues, including suicide. If you or someone you know is in crisis, the National Suicide Prevention Lifeline provides 24/7, free and confidential support.
National Suicide Prevention Lifeline
Tip : Take Care Of Yourself
Letting your family members PTSD dominate your life while ignoring your own needs is a surefire recipe for burnout and may even lead to secondary traumatization. You can develop your own trauma symptoms from listening to trauma stories or being exposed to disturbing symptoms like flashbacks. The more depleted and overwhelmed you feel, the greater the risk is that youll become traumatized.
In order to have the strength to be there for your loved one over the long haul and lower your risk for secondary traumatization, you have to nurture and care for yourself.
Take care of your physical needs: get enough sleep, exercise regularly, eat properly, and look after any medical issues.
Cultivate your own support system. Lean on other family members, trusted friends, your own therapist or support group, or your faith community. Talking about your feelings and what youre going through can be very cathartic.
Make time for your own life. Dont give up friends, hobbies, or activities that make you happy. Its important to have things in your life that you look forward to.
Spread the responsibility. Ask other family members and friends for assistance so you can take a break. You may also want to seek out respite services in your community.
Set boundaries. Be realistic about what youre capable of giving. Know your limits, communicate them to your family member and others involved, and stick to them.
Support for people taking care of veterans
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.
Speak With A Psychotherapist
Getting help from a trained professional can be a game-changer. But finding the right psychotherapist can be difficult. I had to fire the first psychotherapist I saw. After one appointment I left the office feeling more scared than before I had entered. Avoid going to free services because they often dont attract the best psychotherapists.
I found the best person to help me by getting admitted to the hospital and being referred to the hospitals sexual assault unit. The psychotherapist in that division was hired by the hospital. Her role involved going to court with survivors, helping survivors through their trauma, using CBT therapy and various other techniques to help survivors deal with their trauma.
At the time, I couldnt afford a psychotherapist, I was a student and I had just gotten fired from my job. So I was able to fill out a form that allowed me to see her for free. But she did have a fee for other patients. Keep in mind that Canada does have free healthcare. However, they may be affordable services if you dont have the budget to get professional help for your PTSD nightmares.
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Content And Characteristics Of Nightmares Comorbid With Ptsd
Posttraumatic nightmares typically involve themes and sensory input related to a specific traumatic event. Harb and colleagues studied a sample of 48 combat-exposed Vietnam veterans to find a relationship between dream content and treatment outcomes of image rehearsal therapy , an intervention that promotes mastery over recurrent nightmares by rehearsing modified versions of the disturbing nightmare . Reports of olfactory experiences during original nightmares predicted a smaller reduction in sleep disturbances, possibly due to the link between odor perception and emotional memory. Harb and colleagues reasoned that experiencing smells may indicate intensity of a nightmare because of the rudimentary nature of the brain systems responsible for olfactory processing . If that is the case, nightmare characteristics such as sensory experiences may inform patient prognosis.
How To Work Through Trauma
Typically, the first step is addressing the cause of the nightmares .
There are evidence-based treatments for trauma or PTSD that are known to be very effective in reducing symptoms . An individual evaluation would be important to address if medication is necessary and to rule out any health risks.
If trauma-related nightmares persist, here are specific evidence-based treatments to address them:
- Imagery Rehearsal Therapy and
- Exposure, rescripting, and relaxation therapy .
These treatments share some basic aspects like visual imagery and nightmare rescripting.
Here is an example of how visual imagery and nightmare rescripting work:
- Think about a nightmare that comes up frequently
- What are you feeling?
- How would you like to feel instead?
- How would the story need to change to feel this way?
Its hard to convey the nuances in this technique. A trained therapist can help you further by teaching you the specific strategies to rescript the nightmares properly .
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Common External Ptsd Triggers
- Sights, sounds, or smells associated with the trauma.
- People, locations, or things that recall the trauma.
- Significant dates or times, such as anniversaries or a specific time of day.
- Nature .
- Conversations or media coverage about trauma or negative news events.
- Situations that feel confining .
- Relationship, family, school, work, or money pressures or arguments.
- Funerals, hospitals, or medical treatment.
Treating Flashbacks Nightmares And Intrusive Memories
If you have stabilized your sympathetic nervous system and reduced your daily Hyper-arousal symptoms but still suffer from Intrusive Symptoms like flashbacks, nightmares and intrusive memories, you might want to consider Exposure Therapy . The goal here is to disconnect your triggers from your traumatic memory and integrate a revised memory back into your normal memory flow.
There are many different ways to accomplish this goal, but they all contain the following steps:
1) Let Go of negative emotions and pain
2) Explore the trauma in detail
3) Reexamine your feelings, both emotional and physical, how have they changed?
4) Reexamine your beliefs about the memory
5) Repeat the process until the memory no longer triggers you
This is ahighly repetitive process, like peeling skin off an onion one layer at a time. The first time you approach the memory, you probably wont be able to let go of feelings or explore the memory in detail. But as you repeat the process, it should get easier each time. If not, you could be triggering into a flashback and may need to choose a slightly different approach.
Ways to Let Go:
1) Share with others and accept support.
2) Cry, scream, curse
3) Use art, music, poetry, theater, or dance to express yourself
4) Visualize draining the feelings and pain into an object, another person, or pet.
9) Massage and body work
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How Imagery Rehearsal Therapy Works
In IRT, your therapist first provides you with background information on sleep and nightmares to “set the scene” for learning to manage them. Then, working with your therapist, you:
- Create detailed, nonfrightening endings for nightmares you’ve had repeatedly
- Write down and rehearse the nightmares with the new endings
- Learn how to monitor your nightmares so you know how well your IRT treatment is working
Often a person with PTSD has already thought about whether it might help to reimagine and “defuse” nightmares so they’re less frightening. That can help make starting IRT feel more comfortable and hopeful, but it isn’t necessary for the technique to be successful.
Nightmares Night Terrors And Ptsd/c
Hi everyone, I have been posting and talking about my night terrors/nightmares recently and I have been asked about the difference between the two and what the relationship is between these and PTSD and C-PTSD.
I was going to write a response on the Facebook page and I felt that it would be a better idea to make this available to everyone by creating a blog post about these common symptoms that childhood trauma survivors and any trauma survivors endure.
How To Deal With Ptsd Nightmares
Posttraumatic stress disorder nightmares make life tiring. When you live with PTSD nightmares plus anxiety, depression, hypervigilance, and flashbacks , it’s no wonder around 70-91% of people with PTSD have trouble sleeping at night.1
Everybody experiences PTSD on a different scale. In my case, I have the most trouble managing my PTSD at night. Insomnia, difficulty staying asleep, and nightmares have been my reality since I first started showing symptoms of PTSD at age 16.
Over time, I’ve learned to manage my PTSD symptoms as best I can. I take antidepressants for anxiety and depression, use sleeping pills for insomnia, and practice breathing exercises to stay calm during the day.
My PTSD nightmares, however, have stuck with me. They’re the one symptom of PTSD I can’t seem to figure out. No amount of medication or therapy has been able to erase what my mind sees when I fall asleep.
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Prazosin is an alpha adrenergic receptor antagonist . It acts to reduce the level of activating neurochemicals in the brain and, via this action, is thought to damp down neurological pathways that are overstimulated in people with PTSD.
Whilst clinically, psychiatrists have been using Prazosin for the treatment of PTSD-related nightmares for years, the fact remains that we still need more evidence from controlled trials to support its efficacy. A small randomized controlled trial of Prazosin for sleep and PTSD has recently made a much-needed contribution to that evidence base.
In a 15-week trial involving 67 active duty soldiers with PTSD, the drug was titrated up based on the participant nightmare response over 6 weeks. Prazosin was found to be effective in improving trauma-related nightmares and sleep quality and, in turn, associated with reduced PTSD symptoms and an improvement in global functioning.
This is encouraging and increases the enthusiasm with which I will recommend this treatment to my patients with PTSD.
Still, the profound effect nightmares have on the quality of life of those living with PTSD highlights that more needs to be done to expand the array of options available to clinicians, like me, to help these patients.
Copyright: Shaili Jain, MD. For more information, please see PLOS Blogs.
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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!