Coping skills & self-soothing · Medications · Mood and anxiety · PTSD · Trauma

PTSD: conquering nightmares

At last, sleepPeople with post-traumatic stress disorder (PTSD) often suffer from debilitating nightmares.  The dreams can be so terrifying the person is afraid to sleep.

If this sounds familiar, here are six nightmare-busting methods that might help you conquer those bad dreams.

(1) Talk about the nightmares. 

Share your dreams with someone you trust, ideally a therapist or friend who understands what you’re experiencing.  Use that person as a sounding board. The more you talk about your nightmares, the less powerful they become.  Sometimes the anxiety worsens before it improves, but once you’re over that hump, the improvement is typically long-lasting.

(2) Write about the nightmares

If you don’t feel comfortable talking to anyone, consider processing the nightmare on paper.  Get out a notebook (or prepare your laptop), and start writing.

  • First, document the dream in great detail from beginning to end.  What happened first?  What happened after that?  Who was there?  What did they do?  Don’t forget to describe visions, sounds, smells, and other sensations.  How did you feel?  What were you thinking?  How did you react in the dream?
  • Once you’re finished recording the events of the nightmare itself, write about how the dream affects you now.  How do you feel?  What are you thinking?  How does it affect your behaviors?  Vent and complain as much as you need.
  • Next, over the course of the week, repeat this process again and again until the nightmare’s power over you begins to subside.  Note you’ll likely feel the anxiety intensify before it backs off, but once you’re over that obstacle, improvement is (again) usually long-lasting.

Sometimes processing an issue on paper helps change perspective, lending an “ah-ha!” moment that causes everything to click into place.  That’s a special experience, but don’t be disheartened if that doesn’t happen to you.  The goal here is exposure.  The more time you spend examining this dream, the smaller and less threatening it becomes.

Some studies suggest that writing about trauma and nightmares is as effective as talking to someone about it, though working through this stuff on your own can be tough or even frightening.  If you’re having problems doing this alone — the emotion is too intense, or you’re not improving no matter how much time you invest in writing — please reach out for help!

(3) Rewrite the narrative.

Instead of revisiting the nightmare until it stops bothering you, consider changing the story.  As before, take time to document the dream, but this time change the way it ends.

What outcome feels right to you?  Is it benevolence you seek, where a kind hand pulls you to safety?  Is it power to protect yourself against an aggressor?  How about reconciliation between an enemy and you, where your enemy speaks warm words, where you forgive them and forgive yourself?  Is it the ability to relieve another’s suffering?  Or your own?  Is it kissing someone goodbye and knowing their next destination is a safe one?  If you need special weapons, abilities, or plain old magic to triumph in your nightmare, give yourself what you need!  Just remember, this isn’t about revenge.  This is about finding peace.

Once you’ve created an alternative ending, think about that outcome as you fall asleep every night. Over time, the new narrative will infiltrate the nightmare and change the story line at a fundamental level.  The dream becomes just that: a dream.

(4) Cognitive behavioral therapy (CBT). 

CBT is a type of talk-therapy based on the notion that thought and behaviors influence mood.  What you think and what you do affect how you feel.

CBT for PTSD focuses on relaxation (retraining the body to relax when there’s no danger around), rewriting problem thoughts (like not feeling guilty for something you had no control over, or recognizing that the future isn’t as bleak as it seems), and exposure (confronting the trauma and nightmare until they’re not bothersome anymore).   CBT also hones in on changing thoughts and behaviors that trigger PTSD symptoms.  Nightmares are a symptom of PTSD.

While this method is best done with the assistance of a psychotherapist, there are various CBT self-help workbooks available for PTSD.  To learn more about the cognitive prong of CBT, check out this article on cognitive therapy.

(5) Eye Movement Desensitization and Reprocessing (EMDR).

EMDR is a type of talk-therapy that uses eye movements to help reprocess distressing memories and beliefs.  The theory is that the brain and thoughts can be rewired by specific movements of the eyes.  It’s surprisingly effective.  As the symptoms of PTSD improve, so do the nightmares.  EMDR must be done with a therapist trained in the method.

(6) Medication

Doctors prescribe Prazosin to help with PTSD-related nightmares. Prazosin is a blood pressure medication that soothes the fight-or-flight response, which seems to diminish bad dreams.  It’s use for nightmares is off-label, meaning it’s not FDA-approved for this purpose.  (The medication is cheap and available in generic, so there aren’t any drug companies motivated to pursue the expensive process of getting FDA approval.)

This medication was initially found to be helpful for combat-related nightmares, but in practice it’s now used for non-combat trauma too.  It occasionally lowers blood pressure, which can cause dizziness and falls.  For more information, talk to your health care provider.

A final message: sleep, PTSD, and other stuff

Walking asleepAnother way to conquer nightmares is by circumventing them completely and confronting insomnia instead.  Educate yourself about insomnia and learn sleep hygiene to get a good night’s rest.  If you can’t sleep no matter what you do, talk to your psychiatrist about medications.

A second approach is to treat the cause of the nightmares: the PTSD itself.  Talk to your psychotherapist about CBT, EMDR, couple or family therapy, support groups, self-care, and self-help.  Consider looking into ways to deal with PTSD triggers.  If your symptoms are debilitating, touch bases with your psychiatrist about medications.

This list isn’t all-inclusive.  Some providers suggest mindfulness and meditation for nightmares, and there’s a role for progressive muscle relaxation for anxiety/insomnia.  Although CBT and EMDR are the main therapies used for PTSD, there are many other types of therapy counselors use that are very effective at helping people overcome the illness, including cognitive processing therapy, Seeking Safety, Dialectical Behavioral Therapy (to a degree), and psychodynamic psychotherapy.

Thanks for reading, and may you have pleasant dreams!


 

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