Nightmare on Self Street
Nightmares are not an illness in themselves, but frequent nightmares can be debilitating. Importantly, nightmares are signposts to underlying problems and there are ways to alleviate these dark visions of the night.
Nightmares are so common that they have slipped into our descriptive lingo. “The traffic was a nightmare”, “My hair is a nightmare”, and “God, Kevin is a nightmare in meetings!” are just a few examples of the way you have probably used the word to describe some of life’s events. The fact that the word nightmare is so common in our parlance is reflective of how pervasive the phenomenon is in our sleep.
According to the Australian Sleep Foundation, between 10 and 50 per cent of children have nightmares, while between 2.5 and 10 per cent of adults experience them. Nightmares are prolific in both our experience and our language, so it is worth thinking about what they are, where they come from and how to remedy them.
Dark dreaming
Nightmares are an aspect of dreaming and if we want to understand them, we need to begin by considering what we understand dreams to be.
Some hypothesise that dreams are a form of mental catharsis that release the tribulations of daily life. Sigmund Freud believed that dreams represent the fulfilment of unconscious wishes. Carl Jung saw them as a form of psychological compensation that arises when the waking ego becomes too dominant over the unconscious. For Jung, dreams are a way of the psyche guiding the individual back towards a more balanced and integrated self.
The more pragmatically minded suggest that dreams involve recent life events being woven with past memories to create a new memory and make meaning.
Ask a neurocognitive theorist and they will tell you that dreaming is what happens when the brain is activated but disconnected from external stimuli and operating without self-reflection.
We are still searching for one unifying understanding of dreams, and perhaps that will be an eternal search. The content and meaning of your dreams are as individual as your consciousness. Dreams are heavily autobiographical, yet we can find some commonality in the biology that underlies them.
In dream states, your brain’s default network is active. This default network is a system of interconnected brain regions including the thalamus, medial prefrontal cortex and posterior cingulate cortex. This group of regions remains active during otherwise quiet periods in your brain, such as REM (rapid eye movement) sleep. REM sleep occurs in four or five separate chunks during the night and in total makes up about 20 per cent of your sleep time. During REM, your default network is influential and is believed to be the source of dreams. The REM itself is generated by your brain stem, and it is from REM that vividly recalled dreams occur, which brings us to nightmares.
In the late 1700s, Nathan Bailey’s An Universal Etymological English Dictionary (sic) defined a nightmare as (forgive the pronouns) “a disease when a man in his sleep supposes he has a great weight laying upon him”. To our modern understanding, this seems a touch specific. Our current definition is that nightmares are simply dreams that cause a strong and unpleasant emotional response. They are not the same thing as “night terrors”, which are sudden fear-filled reactions that typically occur in non-REM sleep. These “night terrors” are more common in children and because they happen in non-REM sleep, they are often not remembered. Nightmares, however, tend to happen during the period of sleep when REM intervals lengthen. Since dreaming and nightmares occur on the sleep-wake cusp, the images generated during nightmares are often remembered in all of their terrifying originality, leaving a sense of profound disturbance when you wake.
Nightmares are made of this
Nightmares are not a disease, but they can reflect some underlying psychological processes that require some tender loving care.
Bullying
Nightmares are certainly more common in children than adults and researchers from the University of Warwick in the UK have some interesting insight into the cause of those childhood sleep terrors. Their study was long term and involved 6438 children who were enrolled at birth. Between the ages eight and 10, the children were interviewed about their experience of bullying. Then, at age 12, they were given sleep assessments. After adjusting for confounding factors such as IQ, family diversity, any abuse and any psychological problems, it was still found that children who were bullied when they were eight or 10 were much more likely to experience nightmares when they were 12. Those childhood nightmares might be pointing to some earlier experiences that may need to be addressed.
Frustration
In line with the notion that nightmares flow from daytime traumatic experiences, research has also shown that nightmares can be stimulated by frustration with life. Two studies conducted by researchers at the University of Cardiff, UK, involved people keeping records of their dreams or nightmares, as well as a daily diary of life events. It was found that people who did not have their psychological needs met on a day-to-day basis experienced greater levels of frustration and this was associated with an increased incidence of nightmares. Interestingly, people who scored high on frustration were likely to have nightmares that involved falling, failing or being attacked. The nightmare seems to be an attempt by the psyche to process and make sense of challenging experiences.
Anxiety and loneliness
Another factor that has been linked to nightmares is loneliness. People who are lonely are more likely to experience nightmares, according to research published in The Journal of Psychology. Loneliness itself is not the only determining factor, it is the ruminating, worry and anxiety that go with it that are likely to stimulate the nightmare state. Again, there is an element here of nightmares representing your psyche attempting to resolve troubling issues.
Dementia
While nightmares are not a disease, in fact they are your mind trying to achieve a cure, they can be linked to disease. Researchers at England’s University of Birmingham found that middle-aged people (aged 35-64) who experience bad dreams on a weekly basis are four times more likely to experience cognitive decline and twice as likely to be diagnosed with dementia. This is not to say that nightmares cause dementia, but rather that nightmares are a signpost for unresolved psychic issues that may lead to dementia if left unaddressed.
Chemistry
In addition to the psychological dimension of nightmares, there are some definite, not totally unrelated, biochemical causative factors. Alcohol alters the function of the neurotransmitter GABA, leading to less REM sleep during the first part of the night. As alcohol levels drop, your brain attempts to enter REM more frequently to make up for lost REM earlier in the night. This is called “REM pressure” and it is highly associated with nightmares. Benzodiazepine medications also increase REM pressure, as do cocaine and amphetamines.
Some antidepressant medications such as SSRIs and SNRIs alter the actions of the neurotransmitters serotonin and noradrenalin. These neurotransmitters are involved in the brain transitioning out of REM sleep into non-REM. Many of the conventional antidepressant medications do lead to reduced REM time, fragmented sleep and nightmares. Drugs that act on noradrenalin receptors, such as those used to treat high blood pressure, can also be associated with increased reports of nightmares. Some statin drugs, used to lower cholesterol, are also linked with nightmares, especially the statins that can cross the blood-brain barrier.
Nightmare cures
Resolving the anxieties of life and cutting out nightmare-inducing medications are obvious ways to get rid of your ‘mares, but that is easier said than done. There are, however, a few simpler things you can try.
Cut the cheese
Research has shown that lactose intolerance has been associated with gastrointestinal symptoms, poor sleep quality and, you guessed it, nightmares. It is possible that for people with lactose intolerance, having dairy foods such as cheese before bed will lead to digestive discomfort and we know that bodily sensations can affect dreaming.
Image rehearsal therapy
Image rehearsal therapy (IRT) is a form of psychological therapy that attempts to address the underlying issues. It involves a form of visualisation where people who repeatedly experience a given nightmare rewrite the narrative of that nightmare giving it a positive ending. The person then rehearses the rewritten version before bed with the hope of replacing the negative nightmare with a more positive dream. IRT has been found to reduce the frequency of nightmares and ease the associated distress.
The right note
For some people, IRT does not work, but one study published in Current Biology might have a solution. For the study, one group of people tried simple IRT. The other group did the visualisation while a major musical chord was played every 10 seconds. This second group were fitted with a device that detected when they entered REM sleep at night and that musical chord would be played as they slept. The musical chord group had a significantly greater reduction in nightmares and the benefits lasted for three months after the experiment.
While it might seem odd to ask your partner to stay awake watching for you to enter rapid eye movement and then play a chord on their bassoon, some more practical variation of this kind of intervention might be striking the right note in nightmare prevention.
