What are nightmares?

 

Nightmares are dreams that result in the experience of intense fear, distress, or anxiety upon awakening. Some people experience other negative feelings during nightmares, like disgust, guilt, or frustration.

 

The content of a nightmare typically involves the person dreaming of being harmed or in danger, or of harming or endangering others. The nightmares of Veterans and active duty military who have PTSD will often involve aspects of the traumatic events they have experienced during deployment.

 

People who have nightmares will wake up from them and typically be able to recall the content of the nightmare. After waking from a nightmare people will often feel negative feelings and physiological arousal (e.g., rapid heart rate), which may cause them to be unable to go back to sleep. Some people have multiple nightmares a night or within a week. This often results in a fear of going to sleep or falling back asleep. Thus, some people who experience recurring nightmares also experience insomnia.

 

What causes nightmares?

 

Anxiety and stress seem to be the common causes of nightmares. They can also be caused by:

 

• Traumatic or major life changing events, like combat or other deployment-related experiences
• Stressful life events, like transitioning to civilian life or losing a close relationship
• Certain medications or recreational drugs
• Alcohol withdrawal
• Severe fever

 

Nightmares and PTSD

 

Nightmares are one of the most frequently reported and chronic symptoms in PTSD. Specifically, nightmares are part of a category of PTSD symptoms that involve reliving the traumatic experience. Recent estimates indicate 50-70% of patients diagnosed with PTSD report frequent nightmares although estimates are higher (90%) in some studies of Veterans. Sometimes, the occurence of nightmares as well as other sleep problems, like insomnia, occur before other symptoms of PTSD.

 

Patients who have already been treated for PTSD will often continue to experience nightmares and other sleep problems. Separate treatment for these sleep disturbances may be required.

 

What treatments are available for nightmares?

 

Behavioral treatment is usually the first line of treatment for nightmares. The most commonly used treatment is Imagery Rehearsal Therapy (IRT). The focus of this behavioral treatment is on learning to rescript or rewrite nightmares into less disturbing or less distressing narratives. Visualization sessions are then used to rehearse the non-distressing imagery during the day so that it reduces one’s repetitive, negative nighttime imagery.

 

There are also medications that are available. One of these medications, Prazosin HCl (Minipress), is an antihypertensize medication that may be effective in reducing nightmares for some people. As with any medication, they come with certain side effects that may be aversive and a decision regarding their use should be made in conjunction with your physician.  

 

Beneficial effects of medication may not last as long as those associated with behavioral treatments, especially if the medication is discontinued.

 

More information about nightmares

 

National Center for PTSD (VA)

This website is provided  by the Department of Veterans Affairs and provides information for both veterans and the general public. There is a separate section specifically for nightmares.