Managing disturbing dreams and nightmares

We can have all sorts of dreams, sometimes really nice ones that we don’t want to end but this section aims to consider in some more detail dreams that we find disturbing and times when we experience nightmares.

For the purposes of this summary dreams are something that you remember in the morning when you wake up. Nightmares, on the other hand, wake you up during the night and can often make it difficult, if not impossible, for you to return to sleep.

After a traumatic event it is not unusual to experience disturbing dreams and nightmares, it is often the way in which our brain processes, sorts out and comes to terms with the events that have happened. Quite often the dreams and nightmares will then reduce both in terms of how frequently they take place and in terms of how distressing they seem. This is a good sign that you are moving forward that the events are seen as being in the past and that recovery is taking place.

Sometimes, though, it can seem as if the dreams and nightmares have taken on a life of their own and continue long after the event. The dreams and nightmares may remain exact replays of the difficult event or they may change so that the themes remain the same but the story is different. In these cases, the dreams and nightmares are no longer serving a helpful purpose. They can seem like a cracked record repeating themselves again and again. When they do this they can cause a significant loss of sleep, can contribute to high levels of distress and understandably make going to bed seem upsetting and something to be avoided. When this happens there is increasing evidence that the dreams and nightmares need tackling directly, not as a symptom of another problem but as a problem in their own right. They won’t just go away.

Many people think that because these disturbing dreams and nightmares happen automatically there is little that they can do to gain control over them. However, more recent developments in theory and in approaches to treatment suggest that it is reasonable to be upbeat and positive about managing these difficult experiences. You can change your disturbing dreams and nightmares It might be useful to remember that one of the most important jobs that our brain is designed to do is to keep us safe. In the presence of danger or threat, very quickly, our brain will do its job of getting us ready to attack to run or to freeze. This is, of course very helpful when we are faced with real danger or threat. What is important to remember though is that our brain will get us ready to attack to run or to freeze when we remember events that were scary and even when we imagine or make up scary situations.

So for example, if we are remembering a difficult experience we will often experience a range of bodily changes which would be very helpful if we needed to run or attack at this moment but which can feel uncomfortable and distressing if we are sat in a chair or lying in bed. There are now a number of ways in which it is possible to try and gain some control over our disturbing dreams and nightmares.

Take for example a situation where a person replays whilst they are asleep the disturbing events that took place and that they wake up at the worst point (or the step before the worst point) in the story. When this happens the processing of the story stops. One potentially helpful approach is to try and spend time going through the whole story, not just up to the worst point, but also what also happened after up to a point where you were safe. It can be useful to write out the whole story and read it a number of times a day, including just before going to sleep.

Have a look at the example below.

Josie was attacked one evening by a stranger who held her up against a wall and started to strangle her. She remembers the feel of his hands around her throat and the smell of his breath. She has this nightmare three or four times a week and always wakes up at this point, sweating, feeling panicky and shouting out. However, what happened on the night of the event was that as she started to feel his fingers around her throat two men arrived and dragged her attacker off. He ran away and the two men stayed with Josie whilst she called a friend and was able to return home safely.

Josie found it helpful to write down a clear summary of what had happened on the night, not just to the point when her attacker’s hands were around her throat, but the sequence of events that led to her being safe. Initially, the first half of the story, up until she felt her attacker’s hands around her throat was much longer than the second half of the story, the arrival of the men who dragged him off, the arrival of her friend and her return home, but with practice she was able to remember more of what had happened in the second half.

She read this summary to herself every day and went through it each night before going to sleep. It helped to remind her that, whilst this was a very scary and frightening event, she did in fact survive and made it to a place of safety. Reading the story every day for a few weeks was helpful in also reminding Josie that this was an event in the past.

Slowly Josie started to notice some changes. She still had nightmares three or four times a week but they weren’t as distressing and she could get back to sleep more easily (a change in intensity). Then she started to notice that she didn’t have the nightmares as frequently (a change in intensity and frequency) and that whole weeks could go by without the nightmare occurring.

In this example going through the whole story time and time again helped Josie to realize that whilst she had been involved in a dreadful experience, she had come through it, she had survived and was now safe.

There are other ways in which it is possible to deal with nightmares, one particularly helpful approach is called Imagery Rehearsal Therapy (IRT). This approach is based on the idea that the images you experience in a nightmare no longer fulfill any useful purpose and that it might be helpful to deal with these images directly.

Whilst there can be differences in the way in which this therapy is provided, there are generally a number of steps involved.

Step 1

The first step is to start by looking at the disturbing dream or nightmare directly, getting it out of the shadows so to speak. Talking it through clearly and writing it down is often a good start.

For some people this can almost immediately help to reduce the 'power' of the nightmare, helping them to remember that this is an event from the past and that they are now safe. This will also help to clarify the ways in which this disturbing dream or nightmare, even if it is a replay of an event that has happened it is no longer helpful, how it has taken on a life of its own and why it needs to be tackled directly.

Step 2

The second step then involves imagining an alternative ending for the nightmare, this will become clearer in the examples below.

Step 3

The third step involves rehearsing the new version of the nightmare in your imagination each day and at night just before falling to sleep.

Example

Arthur had had many wartime experiences involving danger and feeling trapped but his regular nightmare was not something that had ever specifically happened to him. Two or three times a week he would wake up sweating and in significant distress as he imagined himself being chased through a jungle and coming to a cliff edge from which there seemed to be no escape.

After some thought, Arthur came up with a new ending for this nightmare. As he reached the cliff edge he realised that he had a parachute on and was able to jump off the cliff and glide down to safety Arthur wrote out this story and, like Josie, read it to himself on a regular basis, in particular before he went to sleep.

Over a period of weeks, he too noticed a reduction first in the intensity of the distress and then the frequency of the nightmares. Over time the nightmare faded away completely.

When the nightmare is a fantasy or an imagined situation the more fantastic and sometimes humorous the ending the better! See the example below.

Example

James had been involved in a range of threatening situations as a result of his work. He had a regular nightmare that he was being shot at and he would wake at the point when he could see the bullet spinning just in front of his eyes. This had never happened.

James discussed the idea of a fantasy ending to this imagined nightmare with a friend and they came up with the idea that he would catch the bullet in his teeth and spit it back at the person who fired the gun.

It worked for him and again over a few weeks the frequency and the levels of distress created by this nightmare reduced significantly.

The overall message here is that with help it is possible to make changes to disturbing dreams and nightmares and as sleep quality improves, so does mood, concentration and activity levels.