Nightmares that relive the trauma are fairly common in PTSD. In fact, one study of veterans showed 88% were experiencing nightmares compared to 5% of the general population. The likelihood of having nightmares is increased if the person also is experiencing depression or anxiety. Although it is thought by many that nightmares are a way the brain processes the traumatic event, it is known that nightmares can increase other PTSD symptoms, such as flashbacks, and can accelerate the progression of PTSD. They also by their nature negatively affect the quality of sleep, and therefore, the overall quality of life.
Researchers have shown 2 things that might increase nightmares in people with PTSD. These are rumination and catastrophizing- both of which are common symptoms of PTSD along with hypervigilance. Rumination is the practice of going over and over the traumatic event in your head and having difficulty not thinking about it constantly. Catastrophizing, on the other hand, is the practice of thinking things through and imagining the worst possible outcome. Several personality traits are related to PTSD nightmares including distrustfulness, alienation, and emotional estrangement- all of which are common symptoms of PTSD.
So, what can be done?
Prevention
There are several things that you can do to decrease the risk of having a nightmare. For instance, establish a night-time routine, decrease your alcohol use, and don’t snack before going to bed. Other suggestions are:
1. Some medications may disrupt your REM sleep which may be causing the nightmares, so review your meds with the prescribing doctor to see if this is a factor in your nightmares.
2. Try using a white noise machine to help you achieve and remain in deeper levels of sleep
3. Avoid reading scary stories or watching scary things on TV before going to bed. Avoid watching or reading the news. Avoid overly tense or suspenseful content as well.
4. Start a practice to reduce stress such as meditation, yoga or even taking a walk.
5. Use a journal to write down and process your feelings. Sometimes it’s helpful to have a journal at your bedside so you can write down whatever is on your mind right before you go to sleep.
Treatment
There are several different things that research has shown to help with PTSD-driven nightmares.
1. CBT- cognitive behavioral therapy can be effective in the treatment of nightmares by focusing on any irrational thoughts that are contributing.
2. Treatment for sleep-related breathing problems which are noted to often accompany PTSD nightmares.
3. Medications including Prazosin or SSRIs including Celexa, Prozac, Paxil, and Zoloft.
4. IRT or Imagery Rehearsal Therapy is a treatment that involves recalling and scripting the nightmare, then changing the ending to avoid the trauma. This new script is then practiced daily to replace the nightmare.
5. EMDR or Eye Movement Desensitization and Reprocessing in which the person is walked through the memory of the traumatic event while performing eye or hand movements.
Coping Strategies
Here I wanted to share some strategies for people to try immediately following a nightmare. The risk though is that while one technique might be helpful for one person, it may increase the symptoms in another. Therefore, if any of these strategies make you feel increased anxiety or discomfort, discontinue immediately and try another one. There are no one-size-fits-all solutions here and you have to do a little trial and error to find what works for you.
1. Take some deep breaths. Deep breathing has been proven to reverse the effects of the “fight or flight” response and so should help you to calm down. This can absolutely be done in addition to any of the other techniques below.
2. Talk to a trusted friend or relative. Sharing a burden will usually help to lighten it because it helps us to not feel so alone and isolated.
3. Wrap a blanket tightly around yourself like a cocoon. This will give you all-over sensory input which can be very relaxing and calming. However, some people might find this type of input to be too restrictive and to actually increase feelings of panic. If that happens to you, remove the blanket immediately and take some deep breaths.
4. Use of weighted blankets will also give you overall sensory input that helps to calm and organize. Weighted blankets can be found for purchase on multiple sites all over the internet. If you don’t want to invest in a weighted blanket, then a heavy quilt would work as well.
5. Use coping, self-soothing statements such as “That’s over now. You’ve survived. You are a survivor”, “You are safe now”, “You’ve handled this before, you can handle this now”, or “I am safe and this will pass”.
6. Cuddle with and stroke your pet. The presence of a beloved animal can be very calming.
7. Make use of aromatherapy. Scents of lavender, sage, or peppermint have been found to be very calming, but experiment and find the scents you like the best as smells can evoke strong memories and can also be a trigger for some people. The oil can be rubbed a few drops at a time between the eyes or on pulse points, or you can use a diffuser to add the scent to the air in your room. Take care not to get the oil into your eye, and dilute the essential oil with a carrier oil like almond, olive or coconut oils.
8. Sit in a rocking chair and rock. There is some evidence that this not only will help calm you but will also help with depression, weight loss, agitation, reduce pain, improve balance, and lessen anxiety!
For More Information
If you would like help coping with your triggers or symptoms of PTSD, please contact me I'd love to hear from you. You can find more information about Trauma Treatment here. And for more information on this topic, check out the links below.
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