Tag Archives: sleeping difficulty

Why Am I Having Nightmares?

Image from Dreams.co.uk.

What causes nightmares, anyway?

Nightmares tend to crop up when we’re stressed, anxious, depressed, on certain medications, or when our sleep is being consistently interrupted (hello, parents of a newborn!). Occasional nightmares are normal, but consistent nightmares can be indicative of a larger problem.

The most common mental health disorder associated with nightmares is Post Traumatic Stress Disorder (PTSD), whether it be from traumatic life events or military service. (In fact, frequent nightmares have become a criteria used to diagnose PTSD.)

What’s happening in your brain?

To understand nightmares, we need to look into human sleep patterns, especially REM sleep. A Harvard neurobiology article describes  REM sleep in layman’s terms: when you’re deeply asleep you have rapid eye movement (REM), irregular heartbeat, and your breathing rate increases.

REM sleep signals begin with the pons, which is an area at the base of the brain. The pons shuts off neurons in the spinal cord to suspend movement, all the while sending signals to the thalamus, which then boomerangs them to the cerebral cortex because that’s where the brain learns and organizes information.

REM sleep isn’t continuous–it’s a cycle that repeats through the night, only making up 20 percent of your total slumber–but it is in REM sleep that nearly all vivid dreaming takes place.

When do nightmares become a problem?

The occasional nightmare is normal, but here are some symptoms that may be indicative of a nightmare disorder:

  • Frequency (having nightmares several times a week)
  • Anxiety or persistent fear to go to sleep
  • Problems with concentration or memory
  • Daytime fatigue or sleepiness
  • Problems functioning in social situations
  • Persistent fear of the dark

What can I do about recurring nightmares?

Name your fear. Identifying and managing the biggest stresses in your life can go a long way toward your peace of mind. Ask yourself: what are your biggest worries? What can you do about them right now? Are you willing to make those changes to address the problem?

Evaluate your lifestyle. What you take into your body can affect your quality of sleep. The National Sleep Foundation discourages drinking, smoking, or eating large meals late in the day. They also caution against ingesting large sources of caffeine as it acts as a stimulant for your brain. The highest sources of caffeine are in energy drinks, coffee, chocolate, diet drugs, soft drinks, non-herbal teas and some pain relievers, such as Excedrine.

Rewrite the ending. The Harvard neurobiology article describes a treatment called image rehearsal therapy (IRT). It’s a cognitive therapy where individuals with recurring nightmares write it out, then give it a positive ending. They rehearse this rewritten version before going to sleep.

See an APRN, doctor or specialist. If you believe you are having medication-induced nightmares, you may need the dosage adjusted. If you have persistent nightmares or sleep terrors, you may need to have a sleep study done to identify a problem.

If you think your nightmares are linked to anxiety, depression or past trauma, counseling can be helpful in identifying and managing those fears. Please let me know if I can help you.

Satu Woodland is owner and clinician of Mental Health Solutions, an integrative mental health practice located at Bown Crossing in Boise, Idaho. If you would like to discuss the information in this blog further with her, please call 208-918-0958. She sees adolescents and adults. Information in this blog is not intended as medical advice. Please consult your health care provider about decisions regarding your health.

Insomnia: Who should I see for help?

When I see patients in my office I would say that 75% have as a major complaint of insomnia or having difficulty going to sleep and/or staying asleep. Many times the problem has been going on for years. How does one know who to see about their insomnia? The general practitioner? The Sleep Specialist? The Mental Health Specialist?

Questions to ask yourself: How long have you had this problem? If it’s only been a few days or weeks then I would say it would be ok to see your general practitioner or mental health practitioner. Both have the knowledge to help you get to sleep. If you say all your life or since I put on a lot of weight, that is work for the specialist. There could be a mental health disorder or a physical structural disorder that is causing a disorder called “Sleep Apnea.” This is a condition where a person stops breathing in the middle of the night sometimes thousands of times resulting in a restless or inadequate sleep. A major symptom of this is if a person snores loudly and a sleep partner observes the person actually stopping breathing for seconds at a time. Another major symptom is extreme fatigue during the day.

In the mental health category, if a person has been experiencing anxiety or depression and he/she is having trouble sleeping then a mental health evaluation may be appropriate.

Major Depression, General Anxiety Disorder, PTSD and Bipolar Disorder are all conditions that interfere with sleep. These are treated in different ways. In my practice I teach my patients “Sleep Hygiene.” This is a program to help the body cue itself that it is time for sleep. We often lose that cue with bad habits and lack of routine over time.

What kind of medications are the best for insomnia? I always start with the mildest remedies that are not addictive. Melatonin and antihistamines top my list. Second tier would include medications in the antidepressant class such as Trazadone. One does not
have to be depressed to use Trazadone. It is very effective. Third tier would be other antidepressants and mood stabilizers according to what are the diagnoses. I totally avoid the Benzodiazepine class. Benzodiazepines are only meant for the occasional sleep problem. If one has issues with addictions of any kind, or has it in their family, then I would recommend avoiding this class altogether.  The problem is Benzos can cause addictions but also can cause Depression when used long-term.