11/14/2012 9:31:00 AM Dr. K for Nov. 14, 2012 Cause of nightmares and sleep terrors remains a mystery
DEAR DOCTOR K: I've been having terrible nightmares, and I don't know what to do.
DEAR READER: Almost everyone can remember having nightmares now and then. Just as we don't really know why we sleep, we don't really understand nightmares, or why some people are more prone to have them.
Nightmares and two related phenomena -- sleep terrors and sleep-related panic attacks -- can make sleep more stressful than restful:
Nightmares can be a side effect of certain medications. These include antidepressants, narcotics and barbiturates. Talk to your doctor to see if any medication you're taking might be contributing to your problem.
Nightmares can also occur if you stop taking certain drugs, such as benzodiazepines. Alcoholics who stop drinking often experience dream disturbances and nightmares.
If you experience frequent nightmares that aren't linked to medication use, counseling may help. The most common approach is a type of behavioral therapy known as desensitization. In this therapy, you will be asked to recall the details of your nightmare and use relaxation techniques to overcome your fear. The therapist may guide you through typical dream sequences. For example, the therapist can help you imagine confronting or driving off a pursuer.
Psychoanalytic therapy, on the other hand, may focus on identifying and resolving past and present emotional issues that may be playing themselves out in your nightmares. I'm a skeptic when it comes to the value of psychoanalysis in treating nightmares. I'm not aware of solid research that demonstrates it is more helpful in reducing them than behavioral therapy.
-- During a sleep terror, the sleeper may let out a bloodcurdling scream, sit bolt upright, and attempt to fight or flee. The person may seem confused and agitated. After the spell is over, he or she is likely to go right back to sleep. Later, he or she may not remember what happened.
When my sister was in college, she had a roommate who, every few nights, in the middle of the night, suddenly sat upright in bed shouting, "Oh, oh, oh, my God!" Then she promptly lay down and fell asleep. She had no memory of this the next morning. A little uncontrollable, stereotyped spark had been ignited in her brain.
In any event, if you consistently remember your nightmares, you're probably not suffering from sleep terrors.
Medications such as benzodiazepines are sometimes prescribed for sleep terrors. Hypnosis or a relaxation technique known as guided imagery may also help.
-- If you have sleep-related panic attacks, you may awaken suddenly because of episodes of intense panic. You may experience a racing heartbeat, sweating, trembling, breathlessness, or the feeling that something terrible is about to happen -- like you are about to die. Anti-anxiety drugs are often useful for such panic attacks.
The cause of these sleep disorders is a mystery. They might seem like a trivial mystery, but I don't think so. What brought on the sleep terrors in my sister's roommate? Why was it always the same five words: "Oh, oh, oh, my God!"? I wish we knew. I think if we did, we'd understand a lot more about how the brain works.
(Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.)