The Future

Nightmare disorder makes waking life hellish too

For those who suffer chronic nightmares, relief can be difficult to find.
The Future

Nightmare disorder makes waking life hellish too

For those who suffer chronic nightmares, relief can be difficult to find.

The other night, while positioned in a forced recline, I watched as a stranger’s hairy hand dragged a straight razor blade down both my shins. Later that week, I discovered a previously unknown section of the house I’ve owned and lived in the past two years; in it, black mold and bloody splatters decorated the walls. Both mornings, I woke from those nightmares sweat-drenched and exhausted.

Dr. Michael Nadorff, Director of the Sleep, Suicide and Aging Laboratory at Mississippi State University, says about one nightmare a month is standard for adults. People who suffer nightmare disorders, like me, experience highly visual and often downright disturbing dreams as frequently as every night. Some people afflicted with the disorder are so troubled by their nightmares they’re often afraid to fall asleep. There is some documented correlation between nightmares and risk of suicide.

“They do make it harder to want to fall asleep,” Mina, a 27-year-old health care professional, told me over email (some of the names in this piece have been changed). “The really bad ones that are extremely vivid leave an echo that kind of hangs over me the whole day, affecting my mood and concentration. I have a really good memory, so I’ll end up replaying parts of my dream throughout the day. Sometimes I dread going to sleep. It’s certainly made me call my mom more often.”

The Mayo Clinic defines nightmare disorder as “when nightmares happen often, cause distress, disrupt sleep, cause problems with daytime functioning, or create fear of going to sleep.” It’s a rare affliction, affecting four to five percent of adults. Being female or a person living with low monthly family income are factors significantly associated with nightmare frequency. Perhaps the biggest factor in developing nightmare disorder, though, is anxiety.

“The really bad ones that are extremely vivid leave an echo that kind of hangs over me the whole day.”

If you have experienced an uptick in unsettling dreams over the last year or two, you’re probably not alone. It’s certainly not unusual to hear people describe our new political reality as “a waking nightmare.” A recent study found 59 percent of Americans reported feeling anxious because of the 2016 presidential election results; in 2016 The Washington Post found talk and massage therapists were reporting a surge in “Trump anxiety” among their clientele.

However, a true sense of how far-reaching nightmare disorder may be is tricky, as sufferers often only realize they have the disorder while seeking treatment for something else. Nadorff had some theories as to why. “One [reason] was a lot of people didn't even realize treatment is available — it's something a doctor can help with,” he said. “Another was a lot of people didn’t know their nightmares were abnormal. We don't talk about our nightmares often. I've had people say, ‘I have nightmares every night — but doesn't everybody?’ I was like, ‘Well, no. They don’t.’ How do you know what’s normal if you don't have something to compare it to?”

And what we do have to compare experiences to — by way of research in nightmares specifically — is incredibly limited.

People can mistake nightmare disorder for night terrors, which result in the sufferer being startled awake and left extremely disoriented, or sleep paralysis, the super-spooky plane between awake and asleep during which some patients report seeing terrifying figures or scenes but they are unable to move their bodies. “Sleep paralysis is where the body is struggling to get out of REM sleep so the brain wakes up before it’s turned off the paralysis which our bodies naturally do to keep us acting out our dreams,” Nardorff said. “And having that every now and again is considered quite normal.”

“Nightmare disorders” are not officially recognized in the most recent International Classification of Sleep Disorders; instead, it’s regarded as “an REM-Related Parasomnia.” (Parasomnia is a loose term to describe anything abnormal a person could experience during sleep — including sleepwalking, sleep aggression, and sleep sex. Basically, everything besides sleep apnea.) The oversight is a major roadblock for anyone seeking immediate relief from a chronic condition that can make it difficult to lead a full life.

In my teens, when I shared my macabre and vivid dreams, adults applauded my rich imagination. Into college, however, I was more often met with blank or concerned stares. An old roommate turned me on to sage smudging, an appreciated act of kindness even though I’m not sure it did much help; one previous boyfriend quickly dumped me, saying my head was so dark it scared him. After that, I rarely shared the malignant details of my unconscious brain.

I wasn’t officially diagnosed at the high end of the general anxiety-disorder spectrum (one theorized cause of ND) until last summer, when I was 29. Soon after, I started exploring selective serotonin reuptake inhibitors (SSRIs); though a stint using Lexapro in my pharmaceutical cocktail certainly upped the ante in my nightly horror shows, I was already accustomed to the exaggerated levels of stress and violence in my dream world. As it turns out, many antidepressants affect REM sleep. Specifically, both SSRIs and serotonin-norepinephrine reuptake inhibitors (SNRIs), can “prolong REM sleep latency and reduce the amount of REM sleep,” according to the 2013 Sleep Medicine Reviews study. Still, it wasn’t till a few months ago, while chatting with fellow medicated anxious people, I learned that my grueling, regular nightmares weren’t typical dream fare among my peers.

Mina also didn’t recognize her nightly brain films as abnormal until her mid-twenties. “The realization kind of came in two ways: one, I started having these hyper-realistic dreams about immediate family members dying and two, when I talked to friends I discovered that most people my age didn’t get nightmares,” she said. “Or if they did, it was just the average loose teeth variety.” Although she has experienced nightmares her whole life, she said they have increased in the past five years. “They usually happen several times a week, and are often about my mom dying, and how my dad, brother, and I would cope with her death,” Mina said. “The weird thing is, I don’t think my life is any more stressful now than it’s been before. I haven’t lost anyone, and I don’t have PTSD from a traumatic event. It just… keeps happening.”

Research suggests post-traumatic stress disorder is more common among those afflicted with ND. “Trauma,” however remains a subjective term; an experience that causes one person lifetime repercussions can leave another emotionally unscathed. “There are some documented PTSD diagnoses of people [who experienced] 9/11, not in New York City, but just watching it on TV,” Nadorff said. Interestingly, Nadorff added that while PTSD can be a contributing factor to ND, the reverse is also possible. “So nightmares aren't just a symptom,” he says, “it's actually a risk factor for developing PTSD.”

Additional causes of ND include the aforementioned clinical anxiety as well as vague events like stressors. Of course, people who marathon American Horror Story or are otherwise regularly exposed to violence are more likely to have disturbing dreams; after all, dreams are often just regurgitations of our boring-ass days — which is why we may dream about building an Excel spreadsheet or washing dishes.

Psychiatric causes, like schizophrenia and borderline personality disorder are often involved. Some blame drug and alcohol use for exacerbating ND. However Katie, 33, said she didn’t even notice the intensity of her frequent nightmares until getting sober more than a decade ago. “When I was drinking, I didn’t really remember my dreams, though I do remember frequently have nightmares in high school and as a kid,” she said. “Whether or not those were normal kid nightmares or something more chronic, I don’t know. Similarly, it could be that I had this when I was drinking and just didn’t remember my nightmares or it’s something I developed in sobriety.” For every 10 dreams Katie has, nine are “full-blown nightmares.”

Complicating things even further, many of the conditions that predispose people to ND — from generalized anxiety to post-traumatic stress disorder — remain stigmatized to a degree that can dissuade sufferers from seeking help. For those willing to open up, there are still major obstacles in access. “I’ve never been able to afford seeking real psychological help, but for about four years I’ve had off-and-on stints of very vivid, alarmingly realistic dreams that have often left me exhausted and, if they last long enough, questioning the reality and/or accuracy of my own memories,” McKenna, who is in her early 20s, said. “The little professional help I’ve been able to get has ascertained that the nightmares are typically a result of ignoring repressed feelings and thoughts that my subconscious is forced to deal with when I'm asleep.”

Even though nightmare disorder can profoundly disturb a sufferer’s life and relationships (who wants to be woken up by someone screaming or thrashing a few nights a week? Seriously, tell me and I’ll date them), and we are in the golden age of pharmaceuticals, there are few treatment options available. The ones that are available would fit more readily in the self-help section of an airport bookstore.

Who wants to be woken up by someone screaming or thrashing a few nights a week? Seriously, tell me and I’ll date them.

Lauri Loewenberg, dream expert and author of Dream on It: Unlock Your Dreams, Change Your Life, coaches people on how to manage their dreams from within them, a process called lucid dreaming.

Lucid dreaming, she writes, is especially helpful for ending recurring dreams that make a person re-live a specific trauma. Loewenburg suggests with repeat nightmares to “write out the dream exactly as you can remember in as much detail as you can remember it, but then when it gets to the end or the point where it gets the scariest, change it."

Nadorff compared lucid dreaming to imagery rehearsal therapy, a treatment he exalts. “Usually I see about 75 to 80 percent success rate with it, so we've done very well with that treatment,” he said. Some doctors prescribe Prazosin, a blood thinning medication, to war vets to temper PTSD-fueled nightmares — though recent studies suggest the drug isn’t all that helpful after all.

Katie has tried lucid dreaming, but remains skeptical of the practice. “When the nightmare feels as real and complex and nuanced as real life is, it’s nearly impossible to convince yourself it’s not true,” she said.

Still, most of the limited resources online recommend drastic lifestyle changes to combat nighttime demons, include completely cutting caffeine and alcohol from one’s diet. Others urge developing militant sleep hygiene practices, or completely avoiding any entertainment in the horror or true crime genres. Seems a bit unfair that the way to combat overly vivid dreams is by making your waking life as dull as possible.

It’s unlikely anyone will receive funding for the research necessary to find an effective cure in the near future. Our society tends to still think of nightmares as a childhood problem; one to be set aside once our student loan debt is nightmare enough. In the meantime, ND-afflicted populations continue to trial-and-error new treatments. Given the current political climate that simultaneously shames and exacerbates mental illness, it seems reasonable to assume that population may be growing. There’s plenty of data on the rise in factors — like “post-election stress disorder,” a phenomenon especially affecting women — that can contribute to developing the disorder.

Nadorff stresses the importance of good sleep hygiene — which includes avoiding screens, exercise, and eating right before bed — as integral to passing through the normal stages of REM sleep, which means you’re less likely to remember your nightmares.

“As long as you don't wake up [during it],” he told me, ”you'll never know you had it.”

Beca Grimm is a freelance journalist who writes about culture, sex, and cannabis.