Post Traumatic Stress Disorder (PTSD) sufferers experience nightmares much more frequently than the general population (52-96% compared to 3% ). Generally, nightmares are thought to be a normal reaction to stress, and some clinicians believe they aid people in working through traumatic events – but what can you do when they get out of control and are affecting your quality of life?
During sleep, we pass through five stages: 1, 2, 3, 4 and REM (rapid eye movement) sleep. These stages progress cyclically from 1 through REM then begin again with stage 1. A complete sleep cycle takes an average of 90 to 110 minutes. During these cycles, we typically spend more than two hours each night dreaming. Despite dreams being studied for years, scientists do not know much about how or why we dream as it’s an area of neuroscience and psychology that’s notoriously difficult to study. Psychologist Sigmund Freud believed dreaming was a “safety valve” for unconscious desires, but when researchers began researching sleep and REM more fully in 1953, they discovered that dreams almost always occur during the REM part of sleep.
Most people experience 3 to 5 intervals of REM sleep each night and because these periods become progressively longer during the night, you may find you experience nightmares most often in the early morning hours. During REM sleep, your brain waves exhibit activity fairly similar to when you’re awake, and your brain is consuming as much if not more energy than when you’re awake.
So why do PTSD sufferers have more nightmares than most?
First is rumination, or going over things again and again in your mind. Rumination keeps the pain of those negative experiences fresh.
The second process is catastrophizing, in which you imagine the worst possible outcome from a negative experience.’
Both rumination and catastrophizing are common symptoms of PTSD (particularly from hypervigilance), and these factors alone are likely to increase the likelihood of a PTSD sufferer having nightmares.
Further studies have shown too that adults with personality traits like distrustfulness, alienation, and emotional estrangement or a negative self attitude (all common in those with PTSD) are associated with higher incidence of nightmares.
So how do I stop having nightmares?
Controlling nightmares remains largely unresearched, although there are few different trains of thought when it comes to managing them. The main issue with nightmares is being woken up during them, which means you’re likely to remember them, and have all the negative experiences of fear surrounding them. As such, these tips will help you stay asleep for a more nourishing, and deeper sleep, which should reduce your likelihood of having, and then recalling nightmares.
Temperatures that are too cold or too hot can lead to a less restful sleep and more awakenings (meaning more remembered dreams). Try to ensure that you have opened/closed your windows as necessary, or perhaps invest in a lighter duvet or pyjamas if you get too warm in the night – temperatures around 15-21°C are considered best.
Pain can also lead to more awakenings in the night, and so you’re more likely to remember any nightmares you’re having. PTSD often causes joint pain as your muscles can be very tense. If you feel that it’s pain that’s waking you up in the night, it may be worth speaking to your GP about this. Furthermore, be aware of pain relievers as some may contain caffeine (also likely to affect your sleep).
Scent A German study released the scent of rotten eggs or roses into the rooms of sleepers after they entered REM sleep. After they awoke, the people smelling roses reported more positive dream content than those smelling rotten eggs who reported more negative content. Investing in a lavender infused pillow could help you stay asleep through the night.
Eating and drinking too close to your bedtime can cause indigestion, and it may also influence your metabolism disturbing your sleep. Junk food or spicy meals are thought to be the worst culprits for affecting sleep. Try to eat your evening meal at least 3-4 hours before you go to sleep, or even try a cup of herbal tea to help you drift off.
Light “Humans are designed to sleep in the dark: when the sun comes up, the light receptors in the retina at the back of the eye tell us it’s time to wake up by inhibiting the release of melatonin, the hormone that makes us sleepy.” states Dr. Guy Meadows from The Sleep School. Therefore a flickering TV light, or any other light sources around you as you fall or are asleep stops the melatonin being released and your sleep will be affected. It’s best to remove or turn off light sources like TVs, DVD players, and alarm clocks, and consider blackout blinds or a sleep mask. It’s thought too that the ‘blue’ light from electronics like TVs and tablets affect our circadian rhythms and so our sleep, so it’s best to turn them off at least 30 minutes before bed, and even invest in a ‘red’ light app such as Twilight.
Habits Keeping a regular evening relaxation routine, bedtime and waketime throughout the week is a key part of supporting your internal clock. You may find that including yoga and meditation in your evening routine is also helpful. Furthermore, as tempting as it may be, sleeping in at the weekend is likely to reset your sleep cycles, and so can affect your week day sleeping.
Bad habits Caffeine, alcohol and nicotine can all affect sleep in different ways, and are best avoided in the hours before bedtime. Sources of caffeine include coffee, chocolate, soft drinks, non-herbal teas and even some pain relievers.
Image Rehearsal Therapy (IRT) is a type of CBT that involves recalling your nightmare and then writing out a new, more positive version of it. You then go over this new scenario daily to displace the original nightmare theme. IRT is a well-researched type of therapy, and is highly recommended for PTSD-related nightmares.
Talking Some psychologists believe that talking about your nightmares can put them into perspective (key to reducing the inevitable anxiety following nightmares). This might take the form of talking out dreams with a therapist or discussing them with a partner or friend.
Writing In the same way talking can help reduce nightmares, writing can also be a help. Some recommend that if you wake up anxious from a nightmare and can’t get back to sleep right away, to get out of bed and write the dream down, and even change its course (Image Rehearsal Therapy).
Progressive Muscle Relaxation is a process (similar to yoga nidra and some mindfulness meditations) where you gradually tense and relax different groups of muscles all over your body to reduce stress and tension. This is ideal to do just before you drift off to sleep.
Fear It perhaps goes without saying but avoid watching or reading things that scare you, or are related to your PTSD triggers before you go to bed.
Video Games A study found that the male PTSD sufferers who played video games frequently had less threatening dreams and were less passive in their dreams. Speculation is that the process of desensitization, fighting and winning associated with video gaming can carry over to your subconscious, and so your nightmares/dreams too. Subsequent studies have found however, that video games are not as effective for females in reducing nightmares.
Exercising daily often helps people sleep deeply, but for maximum benefit, work out about 5 to 6 hours before going to bed.
Smoking Due to nicotine withdrawal, smokers tend to sleep very lightly and often wake up in the early morning – which could be during your REM sleep, and resulting in waking up during a nightmare. Where possible, it goes without saying that giving up smoking would be the best course of action here.
Sleep until the sun rises It’s not always possible, but if you can, wake up with the sun, or use very bright lights in the morning. Sunlight helps the body’s internal clock reset itself daily and so an hour of morning sunlight can assist normal sleeping patterns to develop.
Sleep Deprivation Unfortunately, nightmares can be a vicious cycle as insomnia and fatigue also increase the chances of frequent nightmares. Using the tips above should hopefully break this cycle, and allow you to gradually reduce the nightmares you experience.
Regardless of the sleepless nights, PTSD can make you incredibly tired. To find out why, you can read more in our article ‘Why does PTSD make you so tired?’
If you struggle to get to sleep, or back to sleep if you wake up, we’re written an article about a technique to fall to sleep in under 1 minute.
If you have any tips to help reduce nightmares from PTSD, or to sleep more soundly, please do comment below.
SOURCES: Huffington Post, Psychology Today, Boots, Sleepdex, Psychology Today, Sandman N, Valli K, Kronholm E, Revonsuo A, Laatikainen T, Paunio T. Nightmares: risk factors among the finnish general adult population. SLEEP 2015;38(4):507–514., Kales, Anthony; Soldatos, Constantin R.; Caldwell, Alex B.; Charney, Dennis S.; Kales, Joyce D.; Markel, David; Cadieux, Roger, Nightmares: Clinical characteristics and personality patterns. The American Journal of Psychiatry, Vol 137(10), Oct 1980, 1197-1201., The Lad Bible.
IMAGE: Eye by hans van den berg