CHAPTER EIGHT

NIGHTMARES

While they are a type of dream, owing to the upset that they invoke, nightmares are anything but dreamy. And, unfortunately, they are anything but uncommon. It’s thought that upward of 80 percent of people have experienced a nightmare in their lives, with estimates suggesting that about 5 percent experience them weekly. As discomforting as nightmares are, their frequency does bely something that may give you comfort: as unsettling as they may be, they are a totally normal experience. You’re in good company if you have bad dreams here and there; there is nothing actually wrong with having them, besides the obvious upset that they cause.

That said, for some people, nightmares occur so regularly and with such intensity that they impinge upon their quality of life, as well as their ability to consistently get adequate sleep. In this case, one may be experiencing what’s known as nightmare disorder (also referred to as anxiety dream disorder), a condition codified in the psychological guidebook, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). It’s estimated that about 4 percent of adults, and a greater number of children, have such powerful recurrent nightmares as to have a significant negative impact upon their well-being (whether because of ensuing emotional upset or fear of sleep). Nightmare disorder could arise in conjunction with post-traumatic stress disorder (PTSD), anxiety, depression, or other psychological conditions, or could be an outcome of an acute period of stress. Those who suffer from nightmare disorder are encouraged to seek professional assistance.

One only has to think about our everyday language to further appreciate how nightmares are an experience to which we can all relate. After all, the definition for the word is not limited to upsetting dreams — rather, it’s also used to describe things that occur in our waking life. Whether employed as a noun or an adjective, the term nightmare describes situations or people that pose an unpleasant prospect, are difficult to deal with, or bring us fright.

Defining Nightmares

What, actually, is a nightmare? Well, if you ask medical researchers, you’ll mostly find some overlap in description, but not necessarily full agreement on the nuances of how to categorically define these events. This could be the reason that among the many studies done to understand their prevalence and etiology, inconsistencies remain. Researchers aside, though, there is a general agreement that nightmares are dreams that are so upsetting and frightening that they wake us up out of sleep. Our nightmares may be filled with situations that we perceive to threaten our very survival, whether that’s physically or psychologically; in our dream, we may find ourselves experiencing an assault on our physical security or our self-esteem. Sometimes they are so disconcerting that we can’t seem to shake them, with their residue wafting into all corners of our waking consciousness. Years or decades later, many people still remember their first childhood nightmare.

Nightmare vs. Night Terror

Nightmares are quite different than a phenomenon known as night terrors. The former occur during later episodes of REM sleep, wake you up, and are readily remembered. Meanwhile, night terrors occur during NREM sleep, generally within the first 2 hours of sleep onset, and are experienced more frequently by children than adults. In general, we remember our nightmares and yet hardly ever recall the terrifying oneiric subject matter of night terrors when we awaken. For more on night terrors and children, see here.

However, not every bad dream is a nightmare. Sometimes we have dreams that contain upsetting situations or yield disturbing feelings, but they don’t cause the disquietude that a nightmare can. We may have plenty of bad dreams that are striking, but not stirring enough to awaken us; therefore, we recall some of what occurred, but generally not as much as the nightmares that shake us out of sleep. Nightmares, like most other vivid dreams and those with a detailed narrative structure, generally occur during the REM sleep cycle. As discussed shown here, the length of REM cycles increases as sleep progresses through the night. As such, it seems more common to have a nightmare in the early morning hours rather than soon after you fall asleep.

THE SPIRIT OF THE NIGHTMARE

There are numerous viewpoints on what may inspire nightmares. Before we consider these, though, let’s explore a mythic perspective that wove itself throughout numerous cultures, as it can help us to understand not only how people have grappled with nightmares throughout time but also from where the word itself is derived.

Mare is an old English word that denotes a creature that torments or drains the vitality of sleepers. Hence, nightmares reflect the visitation of these evil spirits in the night, during the time of slumber. Mare — also known as mara, mart, mahrt, moroi, or alp — has appeared in numerous cultural legends, including those of Germany, Croatia, and Russia, as well as Scandinavian and Slavic countries. While each spirit has its own associated myth, in general, a mare would enter into a bedroom in the evening, sit upon a sleeper’s chest, and usher in bad dreams.

Legend had it that there were ways to protect against these mythical spirits and the nightmares that they catalyzed. One such strategy included preventing them from entering the room by tightly closing the doors and windows, while also obstructing all the keyholes. To initiate a detour so that they wouldn’t find their way to the dreamer, shoes were left by the bedside with their toes facing the door, in the hopes that the mares would reroute themselves through the holes in which the laces were threaded. Other nightmare-prevention action plans included positioning a broom in the bedroom upside down and placing either a bundle of hay or a sharp object in one’s bed. Some people would also resort to this more radical mare-dispelling custom: after urinating in a clean bottle and leaving it in the Sun for three days, they would take it to a stream and throw it backward over their head into the water. Customs that seem more aligned to strategies we may employ today to ward off disturbing dreams include sleeping in a different position and saying a prayer.

Why Do We Have Nightmares?

Mares aside, much research and inquiry has focused upon nightmares, investigating how and why they may arise, and how to address them. For some, the etiology of a nightmare may be psychological, while for others, it’s a physiological factor that brings them on. What follows are a variety of perspectives on what may underlie the phenomenon.

NIGHTMARES HELP WITH EMOTIONAL PROCESSING

Many feel that through our dreams, we have the opportunity to process daytime experiences and feelings, especially those that we may not have had the inclination to digest and absorb when they occurred. Given that our lives may contain situations that are unsettling, inspire fright, feel threatening, or catalyze a host of other disconcerting emotions, it would make sense that our dreams may sometimes be upsetting, enough so to shake us up and wake us up. Nightmares may also clue us in to the unresolved psychological conflicts that we carry within.

As it turns out, those who are more sensitive, emotionally reactive, and have thinner personal boundaries are more apt to have nightmares. And of course, when we are going through acute periods of situational anxiety, stress, or grief, we may find ourselves having nightmares more frequently as we work through all the feelings in which we are swirling.

Some believe that going through the emotions stirred by an occasional nightmare can be healing, as this may give us an opportunity for processing and expression, rather than avoidance or repression. For those who believe in the prescient potential of dreams, a nightmare could also serve to alert us to an upcoming challenge. And for those who ascribe to the Threat Simulation Theory, a nightmare may be a playscape through which we rehearse actions that we can use in waking life to counter fight-or-flight situations that engender threats to our security.

NIGHTMARES CONNECT US TO THE SHADOW

Nightmares not only wake us up out of sleep, but they can also awaken us to what we may be hiding from our conscious minds. From the perspective of Carl Jung and those who practice Jungian psychology, to understand nightmares — and the route to healing that they may be revealing — we need to understand something called the shadow. The shadow is the part of ourselves that we keep in the dark, the aspects of our personality that we may deem inappropriate, hard to accept, or with which we don’t readily identify. It embodies our repressed thoughts and feelings, those that we’ve disowned, likely due to societal conditioning. Within our shadow may reside emotions that mirror fear, shame, guilt, desire, jealousy, and unworthiness. These feelings may seem so Herculean to carry that we tamp them down and hide them away.

From a Jungian perspective, this then may constitute some of the underpinnings of nightmares: the shadow, crying out to be seen and heard, finds its outlet through dreams. And as it does, it awakens us as it rattles the cage of our emotional equipoise. The dark or gray tone inherent in nightmares reflects the shadow’s overtures. In trying to get our attention, it may show up as our being chased, whether by frightening animals, demons, people, or the like. Or it may just appear emblazoned in anything that we find triggering and that blatantly catalyzes fear. And yet, by embracing these shadow elements, we encounter healing and the process of individuation that Jung so prized. Jungians assert that this can allow us to move toward holism, marrying the light and dark aspects of ourselves, weaving all the pieces of our psyche into more of a seamless tapestry. And while this perspective may not necessarily fully take away the sting that we feel when awakening from a nightmare, if we look at disturbing dreams from this orientation, we may be able to more fully appreciate the treasures of insights and healing that they offer.

It’s important to remember that there is both a collective, as well as a personal, shadow. Given that some of our dreams seem to connect us directly to expressions of an archetypal nature (those that Jung called big dreams), some of our nightmares may be conduits for understanding what it is that we are together avoiding and collectively disowning. As such, some of our nightmares may be less related to personal issues and more connected to what we perceive society as a whole is repressing, whether that be despair, guilt, disempowerment, or some other form of suffering.

NIGHTMARES AS AN EXPRESSION OF EXPERIENCED TRAUMA

Those who have suffered a traumatic event often experience recurrent nightmares, which involve reminders of the episode from a physical and/or emotional perspective. In fact, having nightmares in which a traumatic event is reexperienced is one of the defining diagnostic criteria for PTSD. About 8 million Americans are estimated to suffer from PTSD, and up to 80 percent of sufferers are thought to experience nightmares. As war is one of the traumatic experiences that can cause PTSD, veterans experience it with more prevalence than the general population. Concurrently, veterans are more likely to have nightmares than the general population; in one well-cited study of Vietnam War veterans, 52 percent of soldiers had nightmares, compared to 3 percent of civilians. Other studies on veterans have found that upward of 90 percent suffer from nightmares.

Traumatic nightmares are different than regular ones, often taking a more violent tone. For some, they involve repetitive dreams that feature an exact reenactment of the anguish-filled event, unfolding as it did exactly — or exceptionally close to — as when it was originally experienced. These dreams may appear like a flashback, with daytime memory seeming to intrude upon the sleeping mind. Some traumatic dreams don’t necessarily include the replayed event, but may instead be a canvas for expression of the emotions that were experienced because of it, with symbolic situations expressing terror, fear, and/or survivor guilt. Traumatic dreams are not limited to occurring in REM sleep, like regular nightmares. They may also occur in NREM sleep and be experienced as night terrors. Healing from traumatic events is often reflected in nightmare resolution.

Depression and Nightmares

Not surprisingly, those with depression may have nightmares more frequently. Part of this may be explained by the finding that those with affective disorders oftentimes have challenges sleeping, which can lead to ensuing shifts in sleep architecture that contribute to the greater possibility for nightmares to occur. Not getting adequate sleep can lead to being exhausted during the day, which can impinge upon coping abilities and emotional well-being, which can exacerbate the depression-nightmare-insomnia cycle.

While some who experience PTSD-associated nightmares opt for medication, there are other behavioral approaches that have received widespread attention for their benefit, including Image Rehearsal Therapy (discussed shown here). Lucid dreaming, which we explore in chapter 9, may also hold promise in helping people release the hold that traumatic dreams may have.

PHYSIOLOGICAL CAUSES OF NIGHTMARES

For some people, it may be physiological, rather than solely psychological, factors that give rise to their nightmares.

Medications

Certain medications are associated with the more frequent reporting of nightmares. These include antidepressants belonging to the SSRI (selective serotonin-reuptake inhibitor) category, the withdrawal from which has been associated with increased nightmares by some people. Other medications that may have similar effects include certain beta-blockers, high-blood-pressure medications, and L-dopa, the latter which is commonly used for Parkinson’s disease. If you have frequent nightmares and just started taking a new medication, talk to your doctor or pharmacist to see whether bad dreams are a side effect of your prescription.

Sleep Patterns

Research studies have noted that those who have insomnia may be more likely to have frequent nightmares. Unfortunately, this can become a self-perpetuating cycle, as nightmares can lead to insomnia, owing to fear of going to sleep. This can cause sleep deprivation, which reduces resiliency and increases stress, which can then lead to more nightmares. If you notice an insomnia-nightmare connection, see chapter 2 for tips that may help you sleep better. In addition to bad dreams being more prevalent in those who don’t get adequate sleep, researchers also suggest that long sleepers (those who sleep more than 9 hours a night consistently) also have more nightmares.

Other Causes

Because it shifts sleep architecture, triggering a greater concentration of REM during later cycles of sleep, heightened alcohol use has been found to be associated with nightmare occurrences in some people. Additionally, alcohol withdrawal has been found to have a similar effect. Some people with untreated sleep apnea have been found to more frequently have nightmares; using a continuous positive airway pressure (CPAP) machine may alleviate the recurrence of disturbing dreams. In some studies, stimulants such as caffeine, cocaine, and amphetamines have been found to be associated with higher occurrence of nightmares.

Phobetor: God of Nightmares

In Greek mythology, Phobetor was the god of nightmares. With his name meaning “fear,” he was the carrier of bad dreams, often appearing as an animal or a monster in oneiric visions. He was one of the sons of Hypnos (the god of sleep) and Pasithea (the goddess of relaxation). Phobetor belonged to the Oneiri, a group of deities who personified dreams, which also included two of his brothers, Morpheus and Phantasos. While Phobetor was the name by which humans knew him, the gods called him Icelos. Many trace the mention of Phobetor to Ovid, in his opus Metamorphoses.

Rescripting the Nightmare: Image Rehearsal Therapy

Image Rehearsal Therapy (IRT) is a behavioral-based approach to treating nightmares that has garnered recognition for its efficacy. Regardless of whether a person’s disturbing dreams stem from a traumatic event, are a corollary of PTSD, accompany a psychological condition such as depression or anxiety, or are just an ordinary idiopathic nightmare, IRT may be of benefit. Developed by Barry Krakow, MD, in the 1990s, IRT was recommended by the American Academy of Sleep Medicine (AASM) as a treatment for both nightmare disorder and PTSD-associated nightmares in its 2018 position paper.

IRT is a form of cognitive behavior therapy, a psychosocial orientation that suggests that psychological conditions stem from faulty or unhelpful ways of thinking, as well as learned patterns of unsupportive behaviors. By addressing these thoughts and behaviors, cognitive behavior therapy has yielded promising results in treating a host of conditions. There are two main components to IRT: redefining the relationship between the dreamer and the nightmare, and a reimagining process in which the dream is rewritten.

DREAMER-NIGHTMARE RELATIONSHIP

This stage involves transforming the dreamer’s association with the nightmare from one of identity to one of behavior. Instead of seeing themselves as a nightmare sufferer, they revise their perspective to see themselves as a person who has nightmares. The difference is not just semantic: there is a sense of empowerment that comes with realizing that having a nightmare is a behavior, which can be recast, rather than an aspect of identity, which is more fixed than mutable.

REIMAGINING THE DREAM

In this stage, what’s first emphasized is the power of imagery, recognizing your capacity to invent stories and create new narratives, and your ability to see them visually in your mind’s eye. From there, you then follow these steps:

Common Nightmares

Numerous studies have been done over the years investigating common nightmare themes. One of the earliest ones dates back to the 1930s, when psychologist Husley Carson questioned over 250 people about the content of their disturbing dreams. Here’s an overview of some of the most common nightmare themes uncovered in these studies:

▪ Physical aggression

▪ Interpersonal conflicts

▪ Failure

▪ Helplessness

▪ Health concerns

▪ Death

▪ Being late

▪ Falling

▪ Being chased

▪ Feeling paralyzed

1 Thinking of a recurrent nightmare you have, you imagine a new story arc that it can take that doesn’t include the upsetting or agonizing aspects. You come up with an alternative scenario, rewriting the dream’s plot, whether it be the outcome or a feature that you find triggering. Some practitioners have you write out both the original and the reimagined dreams, while others only suggest scribing the new dream, so as to avoid further emphasizing your connection to any traumatic elements in the original one.

2 Throughout the day, you allocate your attention to your reimagined dream.

3 Before bed, you replay the rewritten dream in your mind, telling yourself in a confident and encouraging way that this is the dream that you will have.

Flower Essences for Nightmares

In chapters 3 and 17, you’ll find flower-essence remedies for inspiring sleep and dreams. Some of the ones featured there may be beneficial for helping to allay nightmares. These include Aspen, Mimulus, and St. John’s Wort.

Doing the practice requires a minimal time commitment (about 15 to 20 minutes per day). And, as simple as it sounds, IRT is quite powerful. Research and clinical experiences have found that nightmare-reduction benefits may occur within weeks, and even after the practice is discontinued, benefits may still be present. IRT can be done with trained practitioners in an individual- or group-counseling setting. For those who may not want or require professional support, self-help resources like Krakow’s Turning Nightmares into Dreams book are also available. A treatment program called Examining Exposure, Relaxation, and Rescription Therapy (EERT) also features a dream reimagining component. First developed by Joanne Davis, PhD, EERT also contains a sleep-hygiene component, as well as teaches relaxation skills, including progressive muscle relaxation.

Self -Compassion as Treatment

Researchers have suggested that those who maintain a negative attitude toward themselves may be more inclined to experience nightmares. Given this, showering ourselves with love and forgiveness may offer yet another benefit to our well-being: being a practice that helps us counter having disturbing dreams. Here are some ways to weave more self-compassion into your life:

▪ Remember that there is no such thing as perfection.

▪ If something feels challenging, tell yourself that you’re doing the best you possibly can.

▪ Every day, undertake one random act of kindness on someone else’s behalf, and one on your own.

▪ Each evening, write in your journal at least one thing for which you are grateful.

▪ If you have a tendency to blame yourself for things that aren’t even your responsibility, try Pine flower essence (see here for more on flower essences).

The Power of Rituals

Rituals give us grounding and have us feel that we can exact action at the behest of an intended outcome. Traditions have held that certain rituals could help to mitigate the impact of bad dreams. In Mesopotamia, they would tell their nightmares to pieces of clay and then throw them in the river to try to dispel the bad dream. The ancient Greeks would share their nightmares with the Sun, believing that its light was a spell-breaker and would cast away the darkness. However, the power of rituals to help counter nightmares may not be solely found in lore of previous times. In fact, recent studies have noted that performing rituals before experiencing a situation anticipated to be stressful can help reduce anxiety. So, if you worry about having a nightmare, doing a pre-sleep ritual may help to calm and center you. This may not only help you to get to sleep more readily, but provide your mind with less anxious fodder that it can translate into a bad dream.

Other Therapies That Take Aim at Nightmare Disorder

In its 2018 position paper, the American Academy of Sleep Medicine shared a variety of treatments that may be beneficial for nightmare disorder. Many of these were behavioral approaches, which is good news for those who want to avoid using pharmaceutical medications. In addition to IRT already discussed, among the other therapies featured were hypnosis, lucid-dreaming therapy, and progressive deep muscle relaxation. Eye movement desensitization and reprocessing (commonly known as EMDR) is also one of the treatments that they gave a nod to when it comes to potentially treating PTSD-associated nightmares.

There are many practices shared throughout the book that can help inspire relaxation, which may have the additional benefit of warding off nightmares. For example, in chapter 2 you can learn about the pacifying potency of meditation, breathwork, progressive muscle relaxation, and autogenic training.

The Power of Intention Setting

Another ritual that may help assuage nightmares is doing a modified version of dream incubation (a technique discussed in chapter 11). Instead of doing this practice with a particular problem-solving aim in mind, you simply focus your intention on having a pleasant dream. Before going to sleep, give a short and sweet instruction to your psyche, something to the extent of “Dream, please provide me with insights of awareness in a gentle way” or “Dream, please be filled with pleasant experiences.” It may seem simple, yet intention setting can be a powerful transformative agent.