Dear Alice,

What, if anything, can a person do about their nighttime dreams? I have had nightmares every night for the past few months. I can't remember when I last had a pleasant dream. I don't attribute this to any daytime stresses; I am doing what I want to be doing. But I truly dread going to sleep some nights, because I can count on a nightmare or a very vivid, disturbing dream. I am on no medications and I try to eat a healthy diet. There are many nights where I feel very exhausted, but I do not sleep well. Any insight would be helpful. I am afraid that this will continue for years.

Dear Reader,

Nightmares, those frighteningly vivid dreams that can shock us awake in the wee hours, are very common and quite normal. Having nightmares every night for months is more unusual, though. It can be an issue when you can’t catch much needed zzzzz’s and fear the moment your head hits the pillow. The exact reasons why nightmares occur is unknown, but that doesn’t mean there’s nothing you can do about them. Here are a few questions that can help you hone in on what might be triggering nightmares and will help give you some ideas on how to make persistent nightmares stop.

  • Stress. Has anything changed in your life in the past few months; such as quitting smoking, a move, or the death of a loved one? While ordinary stresses of daily life can trigger nightmares, major changes can have the same effect. Do you relax before bedtime or is it go-go-go until you hit the sack? Try some relaxation techniques beforehand, such as taking a warm bath, meditating, or practicing deep breathing. Do you get any exercise? Physical exercise, meditation, and yoga all have a sleep-improving component, according to many practitioners of these stress reduction strategies.
  • Bedtime snacks. Do you eat dinner and/or have a glass or more of something alcoholic to unwind just before bed? Even if you’re eating a mostly health diet, some people experience a boost in metabolism and brain activity that leads to nightmares from eating close to bed. Alcohol (and illegal drugs) can trigger nightmares, too. Try eating earlier or cutting down on alcohol before bed.
  • Illness. Being sick can sometimes lead to nightmares, especially if an illness involves a fever, and nightmares have been associated with colds, respiratory infections or other breathing difficulties. You mentioned that you are not on any medications, and indeed some drugs, such as antidepressants, benzodiazepines (sedatives like Valium and Librium), and beta-blockers (used to lower blood pressure and regulate an erratic heart rate)can lead to nightmares.
  • Scary stories. Have you been reading a scary book or watching movies or television shows just before bed? Consider the content of what you consume just before bed and opt for something less scary.
  • Trauma.Traumatic events, like an accident and especially those that involve torture and imprisonment, are common nightmare triggers for people. Has anything significant happened to you that might qualify as trauma? Are the nightmares different every time or is there a recurring episode, person, or theme to them? A frequently used technique for people who have nightmares as a result of post-traumatic stress disorder (PTSD) is image rehearsal therapy. This technique involves ‘rewriting’ or changing the ending to your remembered nightmare when you are awake so that it is no longer threatening.
  • Medication. You mentioned that you are not currently taking any medication. Does this include over the counter medications? While more likely with some prescription medications, it’s possible for sleep and dreams to be impacted by non-prescription substances.

Nightmares occur during REM (rapid eye movement) sleep in the middle and latter parts of the nightly sleep cycle. They can usually be remembered in detail. Nightmares should be distinguished from night terrors, a parasomnia in which you are likely to sit up, scream, talk, thrash and kick. There is also REM sleep behavior disorder, which is more common in older adults and involves the acting out of dreams.

Even though nightmares and night terrors don't appear to cause any long-term dangers, they can affect sleep-quality and mood. In your case, don't be too quick to rule out everyday stressors like classes, work, partners and family, child-rearing responsibilities, etc. It's important to remember that stress can result from activities and emotions that we consider positive. Given that, here are a couple of questions to ponder: are you getting any time to yourself? Do you have a support network of friends or relatives with whom you can share concerns and vent possible frustrations? Since stressful events are associated with nightmares in adults, you might try to reduce possible unconscious anxiety associated with, well, life. Discussing your thoughts with others – particularly with others in similar roles – and writing about them in a journal may be ways to avoid taking tension to bed with you.

Since nightmares are often caused by mental disturbances, sleep deprivation, or have no identifiable cause, professional counseling is another option if your nightmares persist. You might also mention them to your health care provider, and give details like how long the nightmares have been occurring, when you began experiencing them, if you’ve had sleep problems in the past, and if anyone else in your family has had sleep problems. Nightmares are rarely related to any other sleeping disorders, but if your sleep continues to be severely disturbed, your health care provider may recommend an overnight sleep study with a sleep specialist to help determine if the nightmares are connected to another sleep disorder. Rest assured, however, that for most people, nightmares eventually subside.

For additional online resources, you can check out the website for the American Sleep Association or the Columbia Health A!Sleep initiative. Hope you get some peaceful, nightmare-free shut-eye soon!

Alice!

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