Nightmares: Their Lingering Effects On Our Sleep And Mind

Nightmares are vividly realistic, disturbing dreams that can rattle you awake from a deep sleep. They can leave you feeling anxious, tense, queasy, upset, or not like yourself. They can also affect your mood and daytime activities. Research has shown that nearly all participants in a 444-person trial exhibited effects from their dreams on their daytime moods.

Nightmares can be caused by a variety of factors, including late-night snacks, certain medications, sleep deprivation, and psychological triggers such as anxiety and depression. They can also be a symptom of underlying sleep disorders or conditions like post-traumatic stress disorder (PTSD).

If you're experiencing frequent nightmares that are disrupting your sleep and affecting your daily life, it's important to seek help from a medical professional. Treatment options such as psychotherapy and medications can help reduce the frequency and impact of nightmares. Additionally, behavioural changes, relaxation techniques, and improving sleep hygiene can also help lessen the occurrence and effects of nightmares.

Nightmares can cause stress and anxiety, impacting your day and sleep

Nightmares can have a significant impact on a person's sleep and their day. They can cause stress and anxiety, leaving people feeling tense, anxious, upset, and not like their usual selves. This can make it challenging to get on with your day and affect your mood and daytime activities.

When you have a nightmare, stress hormones are released while you sleep, and these are still present when you wake up. This can cause a range of physiological and psychological after-effects, such as an increased heart rate, heart rate variability, changes in breathing, and skin temperature. These changes often accompany the body's fight-or-flight response during stressful real-life events.

Research has shown that the day after people experience nightmares, their cortisol awakening response is elevated, and their mood is decreased compared to days after they had neutral dreams. Introverted people or those with thin emotional boundaries tend to experience the effects of dreams on their daytime moods more frequently.

Nightmares can also cause sleep deprivation, which can lead to further issues. When people wake up from a nightmare, they may feel anxious, making it hard to relax and get back to sleep. This can lead to sleep avoidance and less time allocated to sleep, which can provoke a REM sleep rebound with even more intense dreams and nightmares. This can result in a pattern of disturbed sleep that can culminate in insomnia.

Insufficient sleep connected to nightmares can cause excessive daytime sleepiness, mood changes, and worsened cognitive function, negatively impacting a person's daytime activities and quality of life. Nightmares can also exacerbate mental health conditions, and insufficient sleep can worsen the symptoms of conditions like depression and anxiety.

If nightmares are causing significant distress and regularly interrupting your sleep, it's important to address the issue and make changes to reduce their occurrence. This may involve seeking professional help, especially if the nightmares are frequent, intensely distressing, or significantly impacting your day-to-day life.

Nightmares can be caused by medication, drugs, or withdrawal

Nightmares can be distressing, but they are a normal part of childhood and adulthood. They can be caused by various factors, including medication, drugs, or withdrawal.

Medication

Some medications can cause nightmares as a side effect. These include:

• Antidepressants, such as Prozac, which change serotonin levels
• Beta-blockers, such as Metoprolol, which block the release of melatonin
• Sleep aids, such as Ambien and melatonin supplements
• Cholesterol drugs, such as statins
• Blood pressure drugs, such as Lisinopril
• Antibiotics and antivirals, such as Ciprofloxacin
• Alzheimer's medications, such as Donepezil
• Dopaminergic medications, such as Carbidopa/levodopa

Drugs

Illicit substances or street drugs can also cause nightmares. These include:

• Alcohol
• Illegal street drugs
• Over-the-counter sleep aids and medicines

Withdrawal

Withdrawal from certain medications can also lead to nightmares. This is because some medications suppress REM sleep, so when a person stops taking them, there is a short-term rebound effect of more REM sleep accompanied by more nightmares. Additionally, a 2020 study found that withdrawal from psychotropic drugs that affect sleep quality and REM sleep can also increase the likelihood of nightmares.

Nightmares are more common in those with mental health disorders

Nightmares are indeed more common in people with mental health disorders. Research has shown that nightmares are more frequently reported by people with mental health disorders like post-traumatic stress disorder (PTSD), anxiety disorders, and other mental health conditions. In fact, up to 70% of people with PTSD, major depression, and other mental health diagnoses experience chronic nightmares.

People with PTSD often have frequent and intense nightmares in which they relive traumatic events, worsening their symptoms. A study found that 80% of people experiencing PTSD have frequent nightmares. Another study that analyzed data from the National Vietnam Veterans Readjustment Study found that regular nightmares were reported by 52% of combat veterans but only by 3% of civilian participants.

Not only are nightmares more common in those with PTSD, but they also occur more frequently, sometimes several times a week. These nightmares often involve elements similar to the trauma that caused the PTSD, with about half of those who have nightmares after a traumatic event reliving the trauma in their dreams.

In addition to PTSD, nightmares are also prevalent in people with anxiety disorders and depression. A study found that half of those diagnosed with a psychotic disorder screened positive for nightmare disorder, and over a third of those with mood disorders experience nightmares.

The link between nightmares and mental health disorders may be due to several factors. One factor is stress and anxiety, as sad, traumatic, or worrisome situations can induce stress and fear, triggering nightmares. Additionally, certain medications and sleep deprivation can also contribute to an increased risk of nightmares.

Treating nightmares can be beneficial for improving mental health. Psychological therapy, such as image rehearsal therapy (IRT), and medications can help reduce nightmares and promote better sleep and overall health. IRT involves recalling and rewriting nightmares to give them a positive ending, which has been found to reduce nightmare frequency and distress.

Nightmares can be caused by sleep disorders like sleep apnea

Nightmares can have a significant impact on a person's sleep and can cause excessive daytime sleepiness, mood changes, and worsened cognitive function. They can also exacerbate mental health conditions, and insufficient sleep can give rise to more pronounced symptoms of conditions like depression and anxiety.

The blood oxygen drop that occurs during an apnea causes the brain to go into high alert and trigger responses in your sleep that may be unsettling. Dreams during sleep apnea are often very specific, such as dreams of drowning or suffocating, as the brain reacts psychologically to the physical event of sleep apnea.

Research has shown that people with sleep-breathing disorders are more likely to have unusual dreams, which can be related to symptoms of their sleep apnea, like depression and increased anxiety. These dreams have been shown to decrease with the use of treatments like a CPAP device or oral appliance.

Nightmares can be treated with therapy and medication

Therapy

Image Rehearsal Therapy (IRT) is a form of cognitive behavioural therapy (CBT) that is the most frequently recommended therapy for severe nightmares. During IRT, a patient recounts their most common recurring nightmare with a therapist and together they discuss the possible stressors or traumas feeding the dream. They then brainstorm an alternative ending, which the patient rehearses for 10 to 20 minutes each day while awake. The idea is that the nightmare will change in their sleep. IRT can be done in-person, over the phone, or online.

Other types of therapy used to treat nightmares include:

• Lucid Dreaming Therapy
• Exposure and Desensitisation Therapies, including self-exposure therapy and systematic desensitisation
• Hypnosis
• Progressive deep muscle relaxation
• Cognitive-Behavioural Therapy for Insomnia (CBT-I)

Medication

Several types of prescription medications may be used to treat nightmare disorder. These include anti-anxiety, antidepressant, or antipsychotic drugs. Medication benefits some patients but can also come with side effects. It is important to talk with a doctor who can describe the potential benefits and downsides of prescription drugs for nightmare disorder.

Frequently asked questions