Most of us have had the experience of deeply distressing nightmares that wake us up. But for those suffering symptoms of nightmare disorder, the experience can be terrifying, let alone the idea of falling asleep in the first place. Untreated, nightmare disorder can have a significant, dastardly impact on our ability to just function normally, day to day. It’s not just about having a restless night’s sleep and struggling to get out of bed the next morning laden with fatigue. If you suffer nightmare disorder, you often experience greater frequency of your nightmares either across different nights or as a sequence of disturbing dreams in the same night. Fear and anxiety often wreak havoc on you emotionally, mentally and physically when trying to fall asleep, during and between your
sleep cycles and also upon waking. You’re terrified of sleeping! If you’re tired of experiencing no change even though you’ve reduced your alcohol intake, started exercising and have been going to bed earlier, there is help at hand. Yes, physical changes you make can be extremely helpful (e.g. modifying your diet and eating plan, listening more to positive, inspiring audio books, music and podcasts, doing yoga) but you may be missing some key psychological strategies that can really help to kick your symptoms to the kerb.
How to know if I have nightmare disorder?
The International Classification of Sleep Disorders III provides minimum criteria to determine if individuals suffer from nightmare disorder described below: a) Dreams are recurrent, clearly recalled and involve vividly feeling threats to survival, safety or physical integrity which often jolt you to awaken; b) Upon wakening, you rapidly feel highly alert and become quickly oriented; c) The nightmare itself or the sleep disturbance caused when awakening from it, causes clinically significant distress or impairment in social, occupational, or other important areas of functioning as indicated by experiencing at least one of the following:
Mood disturbance - emotions upon waking persist after the nightmare
The emotions aren’t vivid and distressing only during your nightmare. Even as you awaken they remain very real, are highly intense and usually contain intense levels of anger, fear, terror and/or sadness. In fact the mood you experience can persist for awhile after you awake from the nightmare and the feeling is difficult to shake.
Dream recall is vivid
Many people find it difficult to recall their dreams upon waking even with making a concerted effort to do so. With nightmare disorder, dream recall is quick and vivid and there is little to no confusion about the details of the dream.
Falling asleep again is challenging
You can often suffer physical symptoms upon waking. Breathlessness, sweatiness and tightness in the chest can heighten your attention to remain awake. Being unable to calm yourself physically and mentally makes falling asleep again not only difficult, but awfully frightening. There also can remain the fear of re-entering the nightmare you’ve jolted awake from or re-experiencing the dream again.
You develop avoidant behaviors
Bedtime anxiety can become a common feature. A fear of the darkness associated with sleep time can also develop.
Social, interpersonal and occupational function starts to subside
Your ability to concentrate and focus at work or be fully present during social interactions starts to drop. You might also start to feel silly and ashamed that you can’t ‘get over’ a silly nightmare.
Daytime sleepiness, fatigue and low energy
Your energy levels and fatigue can suffer from not getting enough of the right quality sleep, having incomplete sleep cycles and not getting enough cycles in the first place. During the day you wake up groggy and feel like you’re dragging your feet to concentrate, focus and get anything done.
Other symptoms
In addition to the above, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) explains that a diagnosis of nightmare disorder is not catalyzed by the effect of medication nor drugs and also is not attributed to the presence of another mental disorder (e.g. post-traumatic stress disorder). The DSM-V also indicates how severe a diagnosis might be pending the different time periods of experiencing the symptoms. To gain an accurate diagnosis, work with a qualified, registered mental health professional. Explore your medical history, your previous and current use of drugs and medication, your previous sleep disturbances as well as presence of any similar sleep disturbance in your family and the experience of traumatic events and/or relationships. Whilst there doesn’t yet exist a stand-alone diagnostic tool for nightmare disorder, there can be valuable clues in exploring these potential influences as well.
The Scary Truth About Untreated Nightmare Disorder
According to the American Academy of Sleep Medicine, 4 % of the population suffer from nightmare disorder.((Journal of Clinical Sleep Medicine:
Position Paper for the Treatment of Nightmare Disorder in Adults: An American Academy of Sleep Medicine Position Paper)) Untreated, prolonged effects can lead to the development of anxiety and depressive disorders. For those who might already be suffering symptoms of these, it can worsen them. Whilst development of different types of insomnia, breathing problems such as asthma and snoring have been linked to nightmare disorder, one of the most alarming links is the likelihood of the disorder to suicidality. Studies have not only discovered relationships between nightmares and the presence of suicidal thoughts (ideation) but also suicide attempts. For many, time is not on their side. Having suffered long enough, medication can be a quick and instant way to dampen and numb the symptoms and provide temporarily relief. However, there are some incredibly effective psychological treatments that have not only helped restore an astonishing quality of slumber to sufferers but opened their gateway to rebuilding a remarkable quality of life.
5 Top Treatments to Turn Your Sleep Experience Around
If you don’t feel you have time on your side, you may wish to consult with a medical professional to explore medication that could provide instant relief. Medication or not, the guidance of suitably trained and qualified mental health professionals can help you learn incredible strategies that will accelerate you back to experiencing a far better quality of life. Let’s look at some of the top recommended strategies below.
1. Image Rehearsal Therapy (IRT)
Image rehearsal is a great technique applied whilst you are awake. You write down your dream but change the theme, story line, ending, or any part of the dream to be a far more positive one. In rewriting the dream scenario, you build in all the sensations, thoughts and emotions you want to experience instead. You are working to displace the distressing experiences you originally had with your newly orchestrated dream. This technique works by challenging the traumatic theme of your original nightmare by injecting a cognitive shift. You choose and design the shift. By then rehearsing this scenario for just 10 – 20 minutes a day, you can be on your way to greatly reducing your symptoms and enjoying a slumber journey to paradise as opposed to the Amityville Horror House.
2. Eye Movement Desensitization Reprocessing (EMDR)
EMDR combines elements from a number of different therapies. It has become a primary treatment for those suffering from nightmares connected with having experienced either a single traumatic event or multiple events over time. Using an eight-step approach a therapist manually induces processing of disturbing memories and experiences by stimulating neural mechanisms similar to those activated during rapid eye movement (REM) sleep.((Healthy Sleep:
REM)) During sessions, therapists direct clients to switch their eye movements to swing back and forth, left to right either following the therapists fingers (or some other object) whilst recalling the disturbed memory. Tones directed through headphones alternately into each ear might be used in similar fashion, or alternate physical taps to each hand. Clients identify and process the disturbed memory and past experience, current triggers and also positive experiences to develop a helpful adaptive response to the traumatic experience. Even though EMDR is a highly effective treatment, there are pre-requisites for engaging this method and this process should only be applied by well-trained professionals who are licensed and qualified to administer it. However, when you experience the benefits, not just your sleep but your quality life can turn around in a massive way!
3. Graded Exposure Therapy
Graded exposure therapy is also known as systematic desensitization. Once again it is best advised to undertake the first steps of this process with a qualified, trained professional. With this method, you build resilience to the distressing parts of the nightmare through gradually exposing yourself to recalling the experience of it. Re-experiencing the memory of the traumatic parts of the dream are identified and organized into a hierarchy of what is least distressing to what is most distressing. Working with parts you feel you can handle, you gradually expose yourself to the different parts of the nightmare memory and re-ignite the stressful emotions, thoughts and sensations one by one at a pace you can handle. As you experience and learn that you are not in danger, your resilience builds and your fear of experiencing the nightmare again gradually drops. Research has shown graded-exposure therapy to be helpful in reducing the frequency of nightmares but more effective when used in combination with progressive deep muscle relaxation (PDMR).
4. Progressive Deep Muscle Relaxation
Whilst research has shown that PDMR has been effective in reducing the frequency of nightmares, the technique has a wide range of uses in managing types of anxiety. In itself, it is an incredible mental health and physical self-care strategy everyone can benefit from, nightmare disorder or not. Working sequentially through the muscle groups in your body – from head to toe or in the reverse direction – you deliberately tense your muscles for a few seconds, then let the tension go and concentrate on how relaxed you feel for longer. By deliberately telling your body to relax and increasing focus on how calm and relaxed you physically feel, you send messages to your brain to relax. Working through the muscle groups sequentially helps to pacify those of us who can get particularly wound up. There are plenty of electronic apps you can access for free on your android phone or download to your iPod (e.g. Calm, Relax Lite). Guided PDMR (i.e. with instructions) is extremely helpful to start with. You surrender to the voice guiding you how and when to tense and relax each muscle group. By creating a deeply relaxed state just before falling sleep, you increase the potential for you to have a more pleasurable sleep experience. By getting started with PDMR straight away you not only have a tool to help you alleviate your nightmare symptoms, but a great relaxation technique to help you combat the challenges life throws at you. Just be sure to consult a medical professional beforehand if you are recovering from an injury or could be at risk some other way. If so, whatever muscle groups could be affected, simply skip those and go on to the next ones.
5. Exposure, Relaxation and Re-scripting Therapy (ERRT)
ERRT is a combination of different steps targeting the anxiety symptoms that exist with the experience of nightmare disorder. If you’re not yet familiar with them, you’ll undertake an introduction to sleep hygiene practices. Clearing out electronic devices from your bedroom, reducing your exposure to blue light from electronic tablets, television and android phones at least 1 ½ hours prior to wanting to fall asleep…..they all help to reduce symptoms of anxiety that can escalate your experiencing nightmares. Looking at bedding and undertaking relaxing activities at night before bed time all contribute to creating blissful sleep opportunities. Once you have your bedroom and pre-sleep activities sorted, you then apply the PDMR strategies which direct your focus on sensations of feeling completely relaxed. You are telling and preparing your mind and body to wind down and prepare for calm, serene sleep. Looking at problem-solving, rescripting (similar to IRT) and coping strategies when you might awaken are all reviewed so you have an all round plan to (i) prepare your mind and body for sleep, (ii) help catalyze a far better dreaming experience and (iii) also have a plan of what to do when you awake suddenly.
The bottom line
Today might have been a wake-up call and you might have thought medication might be the only solution. You have been suffering and letting those symptoms rob you of your ability to rest, restore and regenerate your mind and body long enough. If you have not been aware until now of the techniques and strategies above, make the decision today to get acquainted and consider undertaking an assessment with a mental health professional. You might just turn the tables to discover a whole new lease on life!
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