Dream anxiety attacks, nightmares, devils of the dreamland, whatever you want to call them, they are intense, distressful and anxiety provoking. Interestingly it is not always the content of the nightmare that is frightening; it is the experience of the dream as negative that is distressing. The same pleasant dark shadow in the corner of your room that you saw as your deceased loved-one in last night’s dream could become the grim reaper tonight. Instead of imparting a comforting feeling, the reaper scares your pants, or rather PJs, right off!
Nightmares usually occur in REM (rapid eye movement) sleep, during the longer periods of REM in the latter half of the night and are in a group of sleep phenomena called parasomnias. The stress of nightmares causes our hearts to race and our breathing to pick up pace as the anxiety builds and we burst awake sometimes with an abrupt movement or struggle to scream when the fear gets too great. Upon awakening, people report long, distressing dreams that become more frightening toward the end. Nightmare frequency is highest, 10-50%, between the ages of three and six years when children experience the many stressors of toilet training, dealing with emerging aggression and confusing sexual impulses.
The frequency of childhood nightmares usually decreases significantly within weeks or months of initial onset as children adapt to the stressors. But that’s not the end of the nightmares. They will reappear now and then throughout adult life, waxing and waning along the same frequency as fluctuating stress levels. Adult nightmares usually reflect themes of being pursued or attacked, particularly following trauma (rape, childhood abuse, serious accidents, etc.). There is some evidence that trauma-based nightmares may occur during stage two sleep which explains why they can coincide with violent behaviour in bed. Normally we are in an odd state of paralysis when we dream and have nightmares. REM sleep, the dreaming stage of sleep, has a special protective mechanism. Mother nature realized that if we can move while we dream, then we will act out our dreams and nightmares. As you can imagine, mother nature, and a healthy dose of evolution, removed the genes that would allow us to run out of the cave and fall off the side of our cliffs to escape our nightmare persecutors. The only thing she lets us do now is move our eyes. Thus the name REM sleep.
The REM periods, also known as REMP’s, during which the nightmares occur are longer, lasting at least ten minutes, possibly explaining why they feel so intense. Our eyes also move more during nightmare REMP’s, a measurement called REM density. Although we cannot predict with any accuracy who will have a nightmare on any particular night, there are a few risk factors:
- A high fever from an illness can change the temperature of the brain and cause slight neurochemical changes that influence REM sleep and produce nightmares.
- Some medications suppress REM sleep, especially tricyclic antidepressants like amitriptyline. This drug action is essentially depriving your brain of what it wants. When you stop the medication, your brain makes up for lost time and gets as much REM sleep as possible, a phenomenon called REM rebound. More REM sleep means more dreaming and a greater chance of nightmares.
- Alcohol can work the same way as medications; suppressing REM sleep while it is being regularly consumed and causing REM rebound when it is withdrawn. You don’t have to be an alcoholic for this to happen either, a regular nightcap can have this effect.
- People struggling with mental illnesses like personality disorders and schizophrenia often struggle with nightmares too.
- Anti-parkinsonian medications like L-Dopa and hypertensive medications used to treat high blood pressure, the beta-blockers as they are commonly known, can actually increase REM sleep. Again, more REM sleep results in more dreams and a greater chance of nightmares.
- It seems that being female may also be a risk factor. Women experience more nightmares than men. Estimates range from 2:1 to 4:1. This figure may be a little skewed because women are also more likely to ask for help. Men just sit and suffer.
- Of course there is also stress. The mechanisms here are not well known but some research points to the neurochemical changes in our stressed-out brains as being the culprit and other research points to deep sleep being replaced by REM sleep in the stressed-out person.
Although these are reliable risk factors, for most nightmare sufferers they are not that common. The source of the nightmare is neither a recent stress nor a recent trauma. Sure these may have occurred in the past, but most nightmare sufferers have successfully processed these issues and find that they just can’t shake the recurring nightmares. At this point it is best to think of the nightmare as a pattern that your brain has fallen into and to use the power of your own actions to stop the nightmares. Here’s a few strategies to try:
- First make sure that the 7 risk factors above are not complicating your situation.
- Start a dream journal. Spend 10 minutes every morning writing down your dreams and nightmares.
- Talk about your good dreams (not the bad ones) with friends and family.
- Just before bed every night spend 10 minutes writing down a dream you would like to experience. Start this dream off the same way your nightmare starts, but create a better ending.
- Ask for help from the right person. Be sure to chose someone who has a strong background in behavioural sleep medicine. These practitioners will help you reduce or even stop the nightmares and bad or undesirable dreams quickly and for good.
If you are experiencing nightmares every now and then, maybe once or twice a month, it’s nothing to worry about, it’s normal. But if you are waking up from a nightmare’s grip once a week or more, then it’s time to look into stopping them. At this rate, nightmares can lead to sleep deprivation and problems coping with life and your daily activities.
Thanks to L. Orr, BA, RPSGT, for her help with this article.