How to Cope with Nightmares

If you’ve experienced a nightmare before, you know how terrifying they can be. Waking up with your heart pounding, unable to get the images out of your mind. 

As the pandemic drags on, sleep and dreams have become popular topics and many people are experiencing changes in their typical dreaming habits. Knowing what a nightmare is and how to cope with them can greatly improve your sleep.  

What is a Nightmare?

Many people are noticing an increase in bad or weird dreams during the pandemic. This may be an anxiety dream, which is most often related to stressful events or illness. We tend to remember anxiety dreams, but they don’t wake us up and we forget about them as the day goes on.  

Nightmares are different, however, and fall into two categories: REM (or idiopathic) nightmares or trauma nightmares. REM nightmares are common in childhood and teenage years and many people grow out of them. Trauma nightmares typically start or change after a traumatic event. Trauma nightmares can take place during REM sleep and stage 2 sleep. 

What makes a nightmare different from other types of disturbing dreams is that nightmares are vividly recalled and they wake you up. It is common to wake up during the most frightening part of a nightmare and it’s often difficult to fall back to sleep. Sometimes nightmares are so distressing that you may be afraid to go to sleep at all. Nightmares are particularly common after trauma and often coincide with PTSD. 

The good news is that there are some strategies can help reduce the frequency and severity of nightmares.

Keep a regular sleep-wake schedule

Any sleep difficulty tends to throw off our sleep schedule and circadian rhythm. If you are having regular nightmares, a regular and consistent schedule can help. These are some basics of cognitive behavioral therapy for insomnia (CBT-i) that can help regulate your sleep schedule.

It is essential is to keep a regular wake time, no matter what time you go to sleep. If you awake in the middle of the night, you might be tempted to sleep late the next day, to make up for lost sleep. It’s important not to vary your wake times and if you get less sleep in the short term, that may help with nightmares. 

Also, if you wake up in the middle of the night after a nightmare, get out of bed right away. Find a quiet and relaxing activity to do out of bed until you feel sleepy again. And finally, only get in bed when you’re very sleepy and use your bed only for sleep. 

Practice relaxation before bed

A relaxing meditation or progressive muscle relaxation (PMR) before bed can help relax your brain and your body for restful sleep. This is something you’ve likely heard before but there is significant evidence to support that these practices help.

A cognitive behavioral therapy approach to treating nightmares (ERRT) uses PMR as a part of the protocol. PMR is practiced right before bedtime every night in this treatment and research supports that this is an important step. A 2015 study showed that 50% of individuals practicing ERRT in the study had improvement in the frequency and distress of nightmares.

Meditation before bed can also promote the relaxation response and decrease over-activation of the amygdala. It’s important to practice every night and make relaxation a part of your bedtime routine. 

Re-write the ending

There are two well-known nightmare treatments (ERRT and IRT) that use this technique as a key component and it’s very successful in reducing nightmares. The idea behind these therapies is that nightmares are a learned behavior or habit and we can teach our brain a new story. Rescripting your nightmare works best when you work with a therapist who is trained in IRT or ERRT. 

When working with a therapist, they will have you write out the story of your recurrent nightmare in as much detail as you can. Once you have the story of your nightmare, your therapist will help you to identify the themes that are most distressing to you. And then you come up with a new ending to your nightmare. The alternative story can be fantastical or even humorous. The goal is to make the nightmare less scary and distressing. When you practice reading your new story, the nightmare should feel less threatening. And research shows that this process leads to fewer and less severe nightmares. 

Seek Treatment 

If you are struggling with nightmares, it is important to find a qualified therapist to help. Not all therapy can be effective for nightmares, so make sure to work with someone who has been trained in IRT or ERRT. These evidence-based treatments can help nightmare sufferers to get their life back.

At DC Metro Sleep and Psychotherapy, we are trained in behavioral sleep medicine. This means we treat sleep problems from a behavioral perspective and we are trained to treat nightmares. Feel free to contact us to schedule a free consultation. We’d be happy to answer any question you may have and get you on the path to better sleep. 

Annie Miller is a licensed psychotherapist in private practice in the Washington DC area. Annie specializes in working with insomnia (CBT-i)trauma (EMDR)teen mental healthanxiety disorders, and chronic pain. Interested in learning more about Insomnia Treatment? Check out DC Metro Sleep and Psychotherapy’s Insomnia Treatment Page.

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