March 17, 2023 • 17 mins
They’re frightening and disturbing—and because they disrupt your sleep, they leave you feeling tired during the day. Nightmares are common in adults, but Dr. Saltz has techniques anyone can use to turn bedtime back into a restful experience.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:05):
Bees are challenging times, but you don't have to navigate
them alone. Welcome to How Can I Help? I'm doctor
Gale Saltz. I'm a clinical Associate Professor of Psychiatry at
the New York Presbyterian Hospital, a psychoanalyst, and best selling author,
and I'm here every week to answer your most pressing questions,
(00:26):
hopefully with understanding, insight and advice. A nightmare is a
disturbing dream associated with negative feelings, like anxiety or fear,
that awakens you. I received a question from someone who
was having difficulty with nightmares. Nightmares are common in children,
(00:49):
but actually can happen at any age. Occasional nightmares usually
are nothing to worry about. Nightmares usually begin in children
somewhere between the ages of three and six and tend
to decrease after the age of ten. During the teen
and young adult years, girls appear to have nightmares more
(01:12):
often than boys. Some people continue to have nightmares as adults,
and actually throughout their entire lives. Although nightmares are common,
about one and twenty adults having them twice as many
children have them, but actual nightmare disorder is relatively rare.
(01:36):
Nightmare disorder is when nightmares happen often cause actual distress,
disrupt your ability to sleep and cause problems with your
daytime functioning, or create such a fear of going to
sleep that it becomes a problem. You're more likely to
(01:57):
have a nightmare actually in the second half of your
sleep time, and some nightmares can occur every once in
a long while, or they can happen more frequently, even
several times a night. Usually the episode is brief, but
even brief, they can cause you to wake up and
(02:19):
have difficulty returning to sleep. Typically, a nightmare involves these
features being vivid and real and making it therefore more
upsetting and becoming disturbing. As the dream unfolds. The storyline
is usually related to threats to safety or survival, but
(02:44):
it can have other disturbing themes in it. Often the
dream awakens you. You may feel scared or anxious, angry, sad,
or disgusted as a result of the content in your dream.
Some people wake up feeling sweaty or having a pounding
(03:05):
heartbeat in bed because of the content, and you find
that you can think clearly upon awakening and recall the
details sometimes of your dream, and your dream might cause
you distress that then keeps you from falling back to
sleep easily. But it's only considered a disorder if it's
(03:29):
occurring frequently, if you have major distress or impairment during
the day, like anxiety, persistent fear, or as bedtime approaches
you become really anxious about having another nightmare, if you
find during the day you have problems with concentration or memory,
(03:49):
and that you can't stop thinking about images from your dreams.
People with nightmare disorder experience daytime sleepiness or fatigue or
low energy, and have problems functioning at work or school
or even in social situations. And people may have behavior
problems related to bedtime or a fear of the dark,
(04:14):
like not being able to go to sleep in the
dark or even walk into a dark room. Having a
child with nightmare disorder can cause significant sleep disturbance and
distress for their parents. Sometimes nightmares aren't really a cause
for concern at all. If your child has nightmares, you
might mention it to your pediatrician, but really, at a
(04:38):
well check up, I wouldn't visit a pediatrician unless you
find them occurring very frequently and persisting over time. If
they are routinely affecting your child's sleep, if they are
causing them a fear of going to sleep, and if
they are causing them daytime behavior problems or difficulty functioning now.
(05:01):
A night time disorder is usually referred to as a parasomnia,
which is a sleep disorder that involves undesirable experiences that
occur while you're falling asleep, during sleep, or when you're
waking up. Nightmares specifically usually occur during the stage of
(05:21):
sleep known as rapid eye movement or rem sleep. The
cause is actually not really known, but they are often
triggered by specific factors. A big one is stress or anxiety.
The ordinary stresses of daily life. Having a problem at
(05:43):
home or for children at school can trigger nightmares at night.
A major change in life, like a move where someone
in your life dying, can have the same effect an anxiety.
Just high anxiety in general during the day can produce
a greater risk of nightmares at night. The experience of
(06:06):
a trauma is often associated with more nightmares, like having
an accident, ear an injury, being abused in some way.
People who experience a lot of nightmares are people with
post traumatic stress disorder. Another issue actually paradoxically even is
sleep deprivation. Changes in your schedule that cause you to
(06:30):
have irregular sleep and wake times may interrupt or reduce
the amount of sleep that you get and can increase
your risk of having nightmares. And then, of course it's
a vicious cycle because fear of going to sleep from
nightmares causing insomnia also increases nightmares. Some medications can actually
(06:54):
increase the risk of nightmares, very specific antidepressants in blood
pressure medications, medications called beta blockers which are often used
for treating blood pressure issues, and drugs that treat Parkinson's
disease or even to help stop smoking. These are classes
of drugs that can trigger nightmares. Substance abuse and misuse
(07:19):
is known to cause nightmares, but also withdrawal from it
can also trigger nightmares, and disorders like depression. Even heart
disease or cancer can often bring on nightmares. Other sleep
disorders can also be associated with nightmares. And last, but
(07:42):
definitely not least, and quite pertinent to you parents out
there who are concerned about a child with nightmares, Scary
books and movies for some people, especially before bed, is
often associated with nightmares. And even though I just said
that's for the children out there, it's often for the
adults who also are struggling with nightmares. Nightmares are more
(08:08):
common when family members have a history of nightmares or
other types of sleep parasomnias like talking during your sleep
or walking during your sleep. Now having regular nightmares besides
causing daytime sleepiness because you're not able to get back
to sleep as easily, can also affect daytime activities like
(08:31):
driving and concentrating. It can also cause problems with your
mood like depression or anxiety because the dreams are bothering
you so much, And it can also cause a resistance
to going to bed since you're concerned about having another
bad dream. These are important things to pay attention to
(08:53):
which may be clues that this nightmare issue is growing
and becoming an issue for you. There are no real
medical tests to diagnose a nightmare disorder. It's really based
on the clinical judgment that the disturbing dreams are causing
you enough distress or keeping you from getting enough sleep.
(09:15):
So these are things to keep in mind when you
go to a doctor and discuss with them if you're
having a lot of nightmares and what exactly is the
problem that's being caused. So with that right after the break,
we'll get to my listener's question. Welcome back. Let's get
(09:45):
to my listener's question and see how can I help
Dear doctor Souls. My twenty six year old daughter has
been suffering from chronic nightmares at least since her junior
year in college. She says that she recalls having nightmares
prior to that time, but thought it was normal until
one of her friends hold her that regularly experiencing nightmares
(10:08):
is not normal. The subject matter of the nightmares varies
from normal fears such as getting a bad grade, to
scary scenes where she is being chased by someone, but
she doesn't recall having actually gone through being chased by anyone.
She does not recall having any other traumatic event that
could have caused the nightmares. I was initially concerned that
(10:32):
a meningitis vaccine that she had shortly before she told
me about the nightmares could have caused them, but her
doctors have said there's no evidence of that. She first
saw a pediatric psychiatrist who could find no evidence of
trauma and recommended that she have a sleep study. She
had two sleep studies two years apart that showed that
(10:53):
she has a low ramed sleep, possibly because she wakes
up during that sleep phase due to the nightmares. She
has been to a neurologist who prescribed medications, but she
was unable to take them because they caused side effects
such as mourning fatigue that made it difficult for her
to get up in the morning. She then saw an
(11:14):
adult psychiatrist for a year who was unable to help
her find any cause of the nightmares. She is high
functioning despite the nightmares and is in her last semester
of law school. Since she has had multiple physical exams
and blood tests to rule out a physical cause such
as lyme disease. I don't know what else to do
(11:34):
to help her, other than to find another therapist. Are
there any other treatments for chronic nightmares? Nightmares happen to
many adults. Sometimes they are just unpleasant, and sometimes they
can affect sleep, causing awakening with anxiety that makes it
hard to go back to sleep, or fear that makes
(11:55):
it hard to go to sleep. If the nightmares are
there but still feels well rested, can sleep well, isn't
bothered during the day by thoughts of nightmares, then in
truth this may not require treatment. If, however, she is
disturbed by day and it is affecting her ability to
(12:15):
get a good night's sleep, then treatment would be warranted.
Given she has had a work up ruling out a
medical cause, she actually might consider finding a specialist who
does what's called imagery rehearsal therapy. This is usually a
behavioral sleep specialist, as the type of doctor that you
(12:37):
would be looking for. They are often found at a
hospital which has a sleep center. This form of therapy
does not ask patients to review past traumas, nor even
really past traumatic nightmares. Instead, it is a technique of
taking the dream or a piece of the dream and
(12:59):
essentially changing it, rewriting it, imagining visually this new rewrite
to create a different dream in your conscious waking life,
a dream that is not scary or terrible like the
nightmare was. This therapy helps the brain to unlearn the
(13:21):
pattern of chronic nightmare. There are no side effects, and
it is a tool the patient can reuse anytime nightmares
may crop back up. This may be a treatment worth
seeking out for your daughter. I hope that was helpful.
(13:43):
If the nightmares are associated with an underlying medical condition,
like a medication or substance abuse, treatment is aimed at
the underlying problem. If a mental health condition such as
high stress or anxiety seems to be contributing to the nightmare,
then learning stress reduction techniques and counseling or therapy with
(14:05):
a mental health professional can help. Often use with people
who have nightmares as a result of post traumatic stress
disorder is something called imagery rehearsal therapy, which involves changing
the ending to your remembered nightmare while awake so that
it's no longer threatening you. Then rehearse the new ending
(14:28):
in your mind. This approach can reduce the frequency of nightmares.
Imagery rehearsal therapy or IRT, is an evidence based, non
drug approach to nightmare treatment that was developed by doctor
Barry Krakow. In IRT, patients do not discuss the experience
(14:51):
that spurred the nightmares or even the content of their dreams. Instead,
they focus on changing the imagery. Patients are taught ways
to rewrite the dream, even only a scene of the dream,
and then to practice reimagining the new dream during the daytime.
(15:13):
The experience of nightmares is actually unique to each person
and is impacted by many factors, life circumstances, different coping styles,
and even different biological predispositions, but research is shown that
IRT is effective with a wide range of patients, from
(15:35):
those who suffer from distressing dreams on a regular basis
to those who have nightmares related to PTSD. Treatment generally
includes education on the many factors that can cause nightmares
and lead to nightmares, becoming a learned behavior, and developing
healthy and effective sleep behaviors, performing something called imagery rescripting
(16:02):
of dreams through imagery practice, and learning skills for calming
the mind and managing stress. And clinical studies have shown
that IRT is effective for the treatment of nightmares. Some
patients report improve daytime mood and functioning as a result
(16:23):
of their successful treatment of nightmare disorder, and although each
person situation is unique, on average, three to four sessions
are required for many people to begin seeing real improvement
in nightmare frequency and distress, and then follow up recommendations
(16:43):
are made to make sure the results are maintained. Do
you have a problem I can help with? If so,
email me yet How can I help? At senecawomen dot com.
All centers remain anonymous and listen every Friday too. How
can I help with me? Doctor Gaiale Salts
Bees are challenging times, but you don't have to navigate
them alone. Welcome to How Can I Help? I'm doctor
Gale Saltz. I'm a clinical Associate Professor of Psychiatry at
the New York Presbyterian Hospital, a psychoanalyst, and best selling author,
and I'm here every week to answer your most pressing questions,
(00:26):
hopefully with understanding, insight and advice. A nightmare is a
disturbing dream associated with negative feelings, like anxiety or fear,
that awakens you. I received a question from someone who
was having difficulty with nightmares. Nightmares are common in children,
(00:49):
but actually can happen at any age. Occasional nightmares usually
are nothing to worry about. Nightmares usually begin in children
somewhere between the ages of three and six and tend
to decrease after the age of ten. During the teen
and young adult years, girls appear to have nightmares more
(01:12):
often than boys. Some people continue to have nightmares as adults,
and actually throughout their entire lives. Although nightmares are common,
about one and twenty adults having them twice as many
children have them, but actual nightmare disorder is relatively rare.
(01:36):
Nightmare disorder is when nightmares happen often cause actual distress,
disrupt your ability to sleep and cause problems with your
daytime functioning, or create such a fear of going to
sleep that it becomes a problem. You're more likely to
(01:57):
have a nightmare actually in the second half of your
sleep time, and some nightmares can occur every once in
a long while, or they can happen more frequently, even
several times a night. Usually the episode is brief, but
even brief, they can cause you to wake up and
(02:19):
have difficulty returning to sleep. Typically, a nightmare involves these
features being vivid and real and making it therefore more
upsetting and becoming disturbing. As the dream unfolds. The storyline
is usually related to threats to safety or survival, but
(02:44):
it can have other disturbing themes in it. Often the
dream awakens you. You may feel scared or anxious, angry, sad,
or disgusted as a result of the content in your dream.
Some people wake up feeling sweaty or having a pounding
(03:05):
heartbeat in bed because of the content, and you find
that you can think clearly upon awakening and recall the
details sometimes of your dream, and your dream might cause
you distress that then keeps you from falling back to
sleep easily. But it's only considered a disorder if it's
(03:29):
occurring frequently, if you have major distress or impairment during
the day, like anxiety, persistent fear, or as bedtime approaches
you become really anxious about having another nightmare, if you
find during the day you have problems with concentration or memory,
(03:49):
and that you can't stop thinking about images from your dreams.
People with nightmare disorder experience daytime sleepiness or fatigue or
low energy, and have problems functioning at work or school
or even in social situations. And people may have behavior
problems related to bedtime or a fear of the dark,
(04:14):
like not being able to go to sleep in the
dark or even walk into a dark room. Having a
child with nightmare disorder can cause significant sleep disturbance and
distress for their parents. Sometimes nightmares aren't really a cause
for concern at all. If your child has nightmares, you
might mention it to your pediatrician, but really, at a
(04:38):
well check up, I wouldn't visit a pediatrician unless you
find them occurring very frequently and persisting over time. If
they are routinely affecting your child's sleep, if they are
causing them a fear of going to sleep, and if
they are causing them daytime behavior problems or difficulty functioning now.
(05:01):
A night time disorder is usually referred to as a parasomnia,
which is a sleep disorder that involves undesirable experiences that
occur while you're falling asleep, during sleep, or when you're
waking up. Nightmares specifically usually occur during the stage of
(05:21):
sleep known as rapid eye movement or rem sleep. The
cause is actually not really known, but they are often
triggered by specific factors. A big one is stress or anxiety.
The ordinary stresses of daily life. Having a problem at
(05:43):
home or for children at school can trigger nightmares at night.
A major change in life, like a move where someone
in your life dying, can have the same effect an anxiety.
Just high anxiety in general during the day can produce
a greater risk of nightmares at night. The experience of
(06:06):
a trauma is often associated with more nightmares, like having
an accident, ear an injury, being abused in some way.
People who experience a lot of nightmares are people with
post traumatic stress disorder. Another issue actually paradoxically even is
sleep deprivation. Changes in your schedule that cause you to
(06:30):
have irregular sleep and wake times may interrupt or reduce
the amount of sleep that you get and can increase
your risk of having nightmares. And then, of course it's
a vicious cycle because fear of going to sleep from
nightmares causing insomnia also increases nightmares. Some medications can actually
(06:54):
increase the risk of nightmares, very specific antidepressants in blood
pressure medications, medications called beta blockers which are often used
for treating blood pressure issues, and drugs that treat Parkinson's
disease or even to help stop smoking. These are classes
of drugs that can trigger nightmares. Substance abuse and misuse
(07:19):
is known to cause nightmares, but also withdrawal from it
can also trigger nightmares, and disorders like depression. Even heart
disease or cancer can often bring on nightmares. Other sleep
disorders can also be associated with nightmares. And last, but
(07:42):
definitely not least, and quite pertinent to you parents out
there who are concerned about a child with nightmares, Scary
books and movies for some people, especially before bed, is
often associated with nightmares. And even though I just said
that's for the children out there, it's often for the
adults who also are struggling with nightmares. Nightmares are more
(08:08):
common when family members have a history of nightmares or
other types of sleep parasomnias like talking during your sleep
or walking during your sleep. Now having regular nightmares besides
causing daytime sleepiness because you're not able to get back
to sleep as easily, can also affect daytime activities like
(08:31):
driving and concentrating. It can also cause problems with your
mood like depression or anxiety because the dreams are bothering
you so much, And it can also cause a resistance
to going to bed since you're concerned about having another
bad dream. These are important things to pay attention to
(08:53):
which may be clues that this nightmare issue is growing
and becoming an issue for you. There are no real
medical tests to diagnose a nightmare disorder. It's really based
on the clinical judgment that the disturbing dreams are causing
you enough distress or keeping you from getting enough sleep.
(09:15):
So these are things to keep in mind when you
go to a doctor and discuss with them if you're
having a lot of nightmares and what exactly is the
problem that's being caused. So with that right after the break,
we'll get to my listener's question. Welcome back. Let's get
(09:45):
to my listener's question and see how can I help
Dear doctor Souls. My twenty six year old daughter has
been suffering from chronic nightmares at least since her junior
year in college. She says that she recalls having nightmares
prior to that time, but thought it was normal until
one of her friends hold her that regularly experiencing nightmares
(10:08):
is not normal. The subject matter of the nightmares varies
from normal fears such as getting a bad grade, to
scary scenes where she is being chased by someone, but
she doesn't recall having actually gone through being chased by anyone.
She does not recall having any other traumatic event that
could have caused the nightmares. I was initially concerned that
(10:32):
a meningitis vaccine that she had shortly before she told
me about the nightmares could have caused them, but her
doctors have said there's no evidence of that. She first
saw a pediatric psychiatrist who could find no evidence of
trauma and recommended that she have a sleep study. She
had two sleep studies two years apart that showed that
(10:53):
she has a low ramed sleep, possibly because she wakes
up during that sleep phase due to the nightmares. She
has been to a neurologist who prescribed medications, but she
was unable to take them because they caused side effects
such as mourning fatigue that made it difficult for her
to get up in the morning. She then saw an
(11:14):
adult psychiatrist for a year who was unable to help
her find any cause of the nightmares. She is high
functioning despite the nightmares and is in her last semester
of law school. Since she has had multiple physical exams
and blood tests to rule out a physical cause such
as lyme disease. I don't know what else to do
(11:34):
to help her, other than to find another therapist. Are
there any other treatments for chronic nightmares? Nightmares happen to
many adults. Sometimes they are just unpleasant, and sometimes they
can affect sleep, causing awakening with anxiety that makes it
hard to go back to sleep, or fear that makes
(11:55):
it hard to go to sleep. If the nightmares are
there but still feels well rested, can sleep well, isn't
bothered during the day by thoughts of nightmares, then in
truth this may not require treatment. If, however, she is
disturbed by day and it is affecting her ability to
(12:15):
get a good night's sleep, then treatment would be warranted.
Given she has had a work up ruling out a
medical cause, she actually might consider finding a specialist who
does what's called imagery rehearsal therapy. This is usually a
behavioral sleep specialist, as the type of doctor that you
(12:37):
would be looking for. They are often found at a
hospital which has a sleep center. This form of therapy
does not ask patients to review past traumas, nor even
really past traumatic nightmares. Instead, it is a technique of
taking the dream or a piece of the dream and
(12:59):
essentially changing it, rewriting it, imagining visually this new rewrite
to create a different dream in your conscious waking life,
a dream that is not scary or terrible like the
nightmare was. This therapy helps the brain to unlearn the
(13:21):
pattern of chronic nightmare. There are no side effects, and
it is a tool the patient can reuse anytime nightmares
may crop back up. This may be a treatment worth
seeking out for your daughter. I hope that was helpful.
(13:43):
If the nightmares are associated with an underlying medical condition,
like a medication or substance abuse, treatment is aimed at
the underlying problem. If a mental health condition such as
high stress or anxiety seems to be contributing to the nightmare,
then learning stress reduction techniques and counseling or therapy with
(14:05):
a mental health professional can help. Often use with people
who have nightmares as a result of post traumatic stress
disorder is something called imagery rehearsal therapy, which involves changing
the ending to your remembered nightmare while awake so that
it's no longer threatening you. Then rehearse the new ending
(14:28):
in your mind. This approach can reduce the frequency of nightmares.
Imagery rehearsal therapy or IRT, is an evidence based, non
drug approach to nightmare treatment that was developed by doctor
Barry Krakow. In IRT, patients do not discuss the experience
(14:51):
that spurred the nightmares or even the content of their dreams. Instead,
they focus on changing the imagery. Patients are taught ways
to rewrite the dream, even only a scene of the dream,
and then to practice reimagining the new dream during the daytime.
(15:13):
The experience of nightmares is actually unique to each person
and is impacted by many factors, life circumstances, different coping styles,
and even different biological predispositions, but research is shown that
IRT is effective with a wide range of patients, from
(15:35):
those who suffer from distressing dreams on a regular basis
to those who have nightmares related to PTSD. Treatment generally
includes education on the many factors that can cause nightmares
and lead to nightmares, becoming a learned behavior, and developing
healthy and effective sleep behaviors, performing something called imagery rescripting
(16:02):
of dreams through imagery practice, and learning skills for calming
the mind and managing stress. And clinical studies have shown
that IRT is effective for the treatment of nightmares. Some
patients report improve daytime mood and functioning as a result
(16:23):
of their successful treatment of nightmare disorder, and although each
person situation is unique, on average, three to four sessions
are required for many people to begin seeing real improvement
in nightmare frequency and distress, and then follow up recommendations
(16:43):
are made to make sure the results are maintained. Do
you have a problem I can help with? If so,
email me yet How can I help? At senecawomen dot com.
All centers remain anonymous and listen every Friday too. How
can I help with me? Doctor Gaiale Salts
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