Unfortunately, most of the data on these types of occurrences are anecdotal. For example beta-blockers have been known to cause nightmares in a fair number of patients using them for cardiac issues or controlling hypertension, but I am unaware of a definitive explanation for how this operates in the mind-body. There are many OTC sleep aids on the market. The only obvious connection to nightmares might be related to actually promoting more REM sleep. The more REM someone experiences, then the more dreaming occurs. In many individuals the longer they dream, there may be the tendency for the dreams to turn unpleasant. Last, it is well-known that some opiates trigger bouts of nightmares, and I would add I got my start in nightmare treatment research when discussing the problem in a patient who was using codeine. When she stopped the codeine the nightmares went away. With opiates, one working theory is they decrease respiratory drive, and it's now increasingly common to see sleep breathing problems in opiate users, thus the respiratory compromise itself, regardless of any other impact of the drug, could lead to panicky feelings while asleep, which then trigger a nightmare.
Is it common for people who suffer from chronic nightmares to have suffered from night terrors as children and sleep walking/ acting out dreams?
Are nightmares also more common in people who have sleep apnea?
In my experience doctors often believe that nightmares stem from mental health issues. I have questioned that reasoning for my 20 year old son who suffered from night terrors as a child, and continues to have problems with extreme nightmares, sleep walking and sometimes acting out his dreams.
I also ask if there is a connection between nightmares and OSA because when my son was diagnosed with OSA and started using CPAP, his nightmares and sleep walking improved a huge amount; yet they are still problematic.
Kristy, your last reply didn't make it in this thread because i had turned off comments, but it came to my inbox. if you contact me at info@barrykrakowmd.com, then i can respond to you.
Regarding the persistence of nightmares after using PAP, there are still good options to consider, chief of which is Imagery Rehearsal Therapy, which our group pioneered starting in 1988 up the present. My wife and I created a workbook audio series called Turning Nightmares into Dreams (TNID) that many nightmare sufferers have used, sometimes with the assistance of a therapist. TNID is available on the website www.barrykrakowmd.com. There is also the drug Prazosin that seems to work in some individuals. There's also recent research on the use of lucid dreaming. And, last, finding a competent dream therapist can provide considerable benefits far beyond just decreasing disturbing dreams and nightmares.
Thank you! We have your audio series, it looks amazing! It’s been pretty challenging to find a therapist in rural Colorado who is interested in working thru your program with my son, but I think we finally found someone:)
Thank you so much for all the tremendous work and research you have done, you are truly a pioneer!
More research is showing that among children and adults, sleep breathing disorders are linked to their difficulties with night or sleep terrors. Even some acting out or parasomnia behavior can be caused by OSA/UARS. That said, acting out dreams can be a dangerous condition, and it usually requires evaluation and treatment at a sleep center to look for other disorders besides sleep breathing issues
Kristy, thanks for all the good questions. Absolutely are we seeing a decrease in bad dreams in those using PAP therapy, but we've seen more benefits when they use bilevel devices like ABPAP or ASV, although others have reported decreases with CPAP. We have been persuaded for more than 25 years that most chronic nightmare patients also suffer co-morbid OSA or UARS, which raises the interesting question of which one came first, and did one cause the other. No good answers yet on these questions, other than to say it's fantastic that patients and therapists are now seeing that PAP will decrease not only nightmares but also PTSD. I'll continue with the other questions on the next Reply
Thank you Dr. Krakow! My son has told me many time that he has had horrible nightmares since infancy and he believes the nightmares themselves created significant trauma which leads to a horrible cycle (as you said which came first the chicken or the egg?)
I also find your comment about your success with using a BiLevel device interesting. Do you know why you have seem to have success with nightmares and bilevel machines?
My son has had 5 sleep studies, even with his sleep apnea being technically considered “treated” (with APAP and supplemental O2) the PSGs have all still showed tremendous numbers of awakenings. We live in a small town, but during my son’s last sleep study the traveling tech told us that even though our hospital doesn’t test for it she thought my son was still having what she believed were UARS events. It seems that people are diagnosed with either OSA or UARS, can someone have both? If sleep is still disrupted when the OSA is technically treated is it worth looking into UARS to see if bilevel therapy is a better option?
I have a second question Dr. Krakow, can you shed any light on why certain sleep remedies natural and prescription can increase your chances of having nightmares?
Great question, Ms. Z. The evidence is overwhelming that the vast majority of those who are traumatized and experience nightmares will see their nightmares decrease if not disappear in the first few months, often as early as one month. Researchers have been puzzled by this phenomenon and still don't have a clearcut answer. Pragmatically, the most likely explanation is that the brain has its own mechanism for promoting recovery and strengthening mental health. This brain system is probably related to our REM sleep., which many have called our "therapist-in-residence" while we sleep. In sum, whatever this healing system is, it seems to work on many people to dissolve their bad dreams soon after trauma. Unfortunately, there's still a substantial number of trauma survivors who suffer nightmares and PTSD, and these problems can persist for years and decades. The great news is there are many treatment options to decrease or eradicate chronic nightmares.
Good evening Dr. Krakow, I have a question about how to handle trauma and nightmares. Can you explain why some trauma survivors have to deal with nightmares for many years and other trauma survivors may only deal with them for a few months or less.
Unfortunately, most of the data on these types of occurrences are anecdotal. For example beta-blockers have been known to cause nightmares in a fair number of patients using them for cardiac issues or controlling hypertension, but I am unaware of a definitive explanation for how this operates in the mind-body. There are many OTC sleep aids on the market. The only obvious connection to nightmares might be related to actually promoting more REM sleep. The more REM someone experiences, then the more dreaming occurs. In many individuals the longer they dream, there may be the tendency for the dreams to turn unpleasant. Last, it is well-known that some opiates trigger bouts of nightmares, and I would add I got my start in nightmare treatment research when discussing the problem in a patient who was using codeine. When she stopped the codeine the nightmares went away. With opiates, one working theory is they decrease respiratory drive, and it's now increasingly common to see sleep breathing problems in opiate users, thus the respiratory compromise itself, regardless of any other impact of the drug, could lead to panicky feelings while asleep, which then trigger a nightmare.
Is it common for people who suffer from chronic nightmares to have suffered from night terrors as children and sleep walking/ acting out dreams?
Are nightmares also more common in people who have sleep apnea?
In my experience doctors often believe that nightmares stem from mental health issues. I have questioned that reasoning for my 20 year old son who suffered from night terrors as a child, and continues to have problems with extreme nightmares, sleep walking and sometimes acting out his dreams.
I also ask if there is a connection between nightmares and OSA because when my son was diagnosed with OSA and started using CPAP, his nightmares and sleep walking improved a huge amount; yet they are still problematic.
Thank you Dr. Krakow!
Kristy, your last reply didn't make it in this thread because i had turned off comments, but it came to my inbox. if you contact me at info@barrykrakowmd.com, then i can respond to you.
Regarding the persistence of nightmares after using PAP, there are still good options to consider, chief of which is Imagery Rehearsal Therapy, which our group pioneered starting in 1988 up the present. My wife and I created a workbook audio series called Turning Nightmares into Dreams (TNID) that many nightmare sufferers have used, sometimes with the assistance of a therapist. TNID is available on the website www.barrykrakowmd.com. There is also the drug Prazosin that seems to work in some individuals. There's also recent research on the use of lucid dreaming. And, last, finding a competent dream therapist can provide considerable benefits far beyond just decreasing disturbing dreams and nightmares.
Thank you! We have your audio series, it looks amazing! It’s been pretty challenging to find a therapist in rural Colorado who is interested in working thru your program with my son, but I think we finally found someone:)
Thank you so much for all the tremendous work and research you have done, you are truly a pioneer!
More research is showing that among children and adults, sleep breathing disorders are linked to their difficulties with night or sleep terrors. Even some acting out or parasomnia behavior can be caused by OSA/UARS. That said, acting out dreams can be a dangerous condition, and it usually requires evaluation and treatment at a sleep center to look for other disorders besides sleep breathing issues
Kristy, thanks for all the good questions. Absolutely are we seeing a decrease in bad dreams in those using PAP therapy, but we've seen more benefits when they use bilevel devices like ABPAP or ASV, although others have reported decreases with CPAP. We have been persuaded for more than 25 years that most chronic nightmare patients also suffer co-morbid OSA or UARS, which raises the interesting question of which one came first, and did one cause the other. No good answers yet on these questions, other than to say it's fantastic that patients and therapists are now seeing that PAP will decrease not only nightmares but also PTSD. I'll continue with the other questions on the next Reply
Thank you Dr. Krakow! My son has told me many time that he has had horrible nightmares since infancy and he believes the nightmares themselves created significant trauma which leads to a horrible cycle (as you said which came first the chicken or the egg?)
I also find your comment about your success with using a BiLevel device interesting. Do you know why you have seem to have success with nightmares and bilevel machines?
My son has had 5 sleep studies, even with his sleep apnea being technically considered “treated” (with APAP and supplemental O2) the PSGs have all still showed tremendous numbers of awakenings. We live in a small town, but during my son’s last sleep study the traveling tech told us that even though our hospital doesn’t test for it she thought my son was still having what she believed were UARS events. It seems that people are diagnosed with either OSA or UARS, can someone have both? If sleep is still disrupted when the OSA is technically treated is it worth looking into UARS to see if bilevel therapy is a better option?
I have a second question Dr. Krakow, can you shed any light on why certain sleep remedies natural and prescription can increase your chances of having nightmares?
Great question, Ms. Z. The evidence is overwhelming that the vast majority of those who are traumatized and experience nightmares will see their nightmares decrease if not disappear in the first few months, often as early as one month. Researchers have been puzzled by this phenomenon and still don't have a clearcut answer. Pragmatically, the most likely explanation is that the brain has its own mechanism for promoting recovery and strengthening mental health. This brain system is probably related to our REM sleep., which many have called our "therapist-in-residence" while we sleep. In sum, whatever this healing system is, it seems to work on many people to dissolve their bad dreams soon after trauma. Unfortunately, there's still a substantial number of trauma survivors who suffer nightmares and PTSD, and these problems can persist for years and decades. The great news is there are many treatment options to decrease or eradicate chronic nightmares.
Good evening Dr. Krakow, I have a question about how to handle trauma and nightmares. Can you explain why some trauma survivors have to deal with nightmares for many years and other trauma survivors may only deal with them for a few months or less.