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When chronic nightmares create real-world problems

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Chronic nightmares don’t just disrupt sleep, they can also create a vicious cycle of other issues.

A couple of nights ago, I dreamt I had to go and get our dog, Banjo, from pet day care. It wasn’t the most realistic dream because, in real life, we don’t use pet day care and, for reasons that aren’t clear, my dream had transformed him from a small hypoallergenic dog to a pint-sized horse. I had to carry him through the foyer because, in this dream, animals weren’t allowed to walk on the floor.

I know, because the research tells me so, that everyone dreams. But we don’t all remember our dreams, and when we do it’s usually because we’ve woken up from them.

An older man with whom I recently chatted about dreams noted that, as one gets older, there are increasingly more bladder-related opportunities to remember dreams.

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Children sleep about double the amount of older folks and experience more nightmares than any other age group. Ever had a child experience a night terror? Terrifying.

About one in 20 adults experience nightmares to the point where it’s a problem. The diagnostic criteria for nightmare disorder are recurrent episodes of extended, extremely distressing and well-remembered dreams that often involve efforts to avoid personal danger. The nightmares generally occur later in the sleep cycle. On waking from the nightmares, dream recall is instant and clear, with no disorientation or confusion. They are upsetting enough to make it difficult to get back to sleep, and they cannot be explained by the effects of medication or attributed to another mental disorder or medical condition.

Given we’re having a national conversation on the subject, it’s worth noting that people who use cannabis are twice as likely as non-users to have nightmares. Alcohol is unrelated to nightmares, and anyone who is or has been married has fewer of them. I suspect there’s a joke in there somewhere.

Chronic nightmares aren’t just bad because they disturb your sleep, they often make people sleep-avoidant, and that can create a vicious circle of other problems, including depression and anxiety.

Up to 80% of people with post-traumatic stress disorder (PTSD) have nightmares, but regularly experiencing nightmares before a trauma means you’re also more likely to have a strong post-traumatic stress reaction.

If you tick the problem-nightmare box, have you ever told a healthcare professional about it? Odds are the answer is no, and that’s often because people don’t think they are treatable. Why tell someone if you don’t think they can do anything?

Fortunately, nightmares are treatable. For example, prazosin, originally developed to treat blood-pressure problems, has been effectively used to reduce nightmares and improve sleep quality, particularly among people with PTSD.

There’s also evidence that some “talking therapies” are helpful. Cognitive behavioural therapy (CBT) is one of the most common forms of psychological therapy in New Zealand and several versions of it are helpful. For example, image rehearsal involves recalling and writing down the recurring themes in nightmares, then rewriting the script or ending into a happier one. Practising this reframed narrative for 10 to 20 minutes a day “overwrites” the nightmare content.

Another therapy, which you can try at home, is progressive deep-muscle relaxation in which you tense all your muscles, then release the tension one muscle or body part at a time. There aren’t as many studies looking into this as there are for CBT or prazosin, but the ones that have been done look promising, with nightmare frequency and severity being reduced by up to 80%.

This article was first published in the July 6, 2019 issue of the New Zealand Listener.