With the current climate in 2020, such as COVID-19, the fight against racism and racial injustice (i.e. protests), and Black Lives Matter movement, many people are experiencing an increase in trauma-related nightmares, more anxiety, and many other trauma-related symptoms.
Interestingly, a lot of people go through life-threatening events or potentially traumatic experiences in their lives and successfully recover over time; however, an important minority of people do not recover as easily and develop Post Traumatic Stress Disorder (PTSD).
If you are experiencing trauma-related nightmares, this article is for you.
June is PTSD awareness month!
People with PTSD can experience a wide range of symptoms like:
- Frequently having thoughts about the traumatic event(s)
- Feeling like they are reliving the traumatic event(s)
- Being constantly on alert
- Being easily startled
- Having increased negative feelings or
- Avoiding triggers that remind them of what happened
Among the re-experiencing symptoms, nightmares are very common. The rate of nightmares in individuals with PTSD can be as high as 72%, while other research suggests that it can range from 71%-96%. Regardless, it is a very high number.
Many people report that their nightmares include:
- Replaying the traumatic experience(s) exactly as it happened
- Going through similar experiences or situations (it can be directly or symbolically related to the event) or
- Having the emotions they experienced when the incident happened
“PTSD nightmares aren’t always exact replays of the event. Sometimes they replay the emotions you felt during the event, such as fear, helplessness, and sadness.”-Alice Cariv
Impact of nightmares
Trauma-related nightmares generally occur during REM sleep, which is when we tend to have vivid dreams. When you wake up from these nightmares, you may experience fear, anxiety, panic, distress, frustration, or sadness. You can also wake up soaked in sweat and with your heart pounding.
As you may imagine, these nightmares tend to be very distressing. Because they’re so stressful, you may begin to fear going to sleep or attempt to aid your sleep by drinking, using drugs, or using/abusing prescribed medications.
You may also start exhibiting behaviors such as:
- Staying up late
- Leaving the lights or the tv on at night or
- Avoiding sleep as best as you can
Nightmares affect your overall quality of sleep, as it may impact your ability to fall or to stay asleep (which can also contribute to potentially developing other sleep disorders).
Consequently, poor sleep affects all aspects of your life. From your mood (causing irritability and stress) to increased arousal caused by the anxiety. This ends up being a vicious cycle that ends up continuing to affect your sleep and adds to your PTSD symptoms.
The cycle keeps feeding itself because nightmares can be triggered by many factors like stress, sleep deprivation, medications, substance use, and other medical or mental health conditions.
As you can see, nightmares can begin due to trauma and then increase or continue from the side-effects of the nightmares themselves. It can be a complicated phenomenon.
How to work through trauma-related nightmares
Typically, the first step is addressing the cause of the nightmares (in this case, PTSD).
There are evidence-based treatments for trauma or PTSD that are known to be very effective in reducing symptoms (including trauma-related nightmares; learn more about them here). An individual evaluation would be important to address if medication is necessary and to rule out any health risks.
If trauma-related nightmares persist, here are specific evidence-based treatments to address them:
- Imagery Rehearsal Therapy (IRT) and
- Exposure, rescripting, and relaxation therapy (ERRT).
These treatments share some basic aspects like visual imagery (visualizing a scene or activity in your mind) and nightmare rescripting.
Here is an example of how visual imagery and nightmare rescripting work:
- Think about a nightmare that comes up frequently
(Where are you? What is happening? Who is present?)
- What are you feeling? (during the nightmare and when you wake up)
- How would you like to feel instead?
- How would the story need to change to feel this way?
It’s hard to convey the nuances in this technique. A trained therapist can help you further by teaching you the specific strategies to rescript the nightmares properly (to address the last two points).
Skills for managing nightmares
Although individual treatment is very powerful in managing trauma-based nightmares, there are skills that you can try yourself. Such as grounding, and relaxation or breathing exercises.
Grounding and Relaxation skills to try yourself:
Grounding techniques are helpful to distract or temporarily get some distance from the distress caused by nightmares by focusing on the present moment.
First, be sure to completely wake up after having a nightmare. The idea is to help you get oriented in the here and now and to re-establish your sense of safety before you go back to sleep (which you can’t really do if you are drowsy or sleepy).
Tip: it is useful to have a nightlight or a lamp near your bedside to aid you in getting oriented in the present moment
After waking up, begin this grounding technique.
It’s all about your senses. Focus on:
- 5 things you can see
- 4 things you can feel
- 3 things you can hear
- 2 things you can smell
- 1 thing you can taste
If you need a little more help, you can follow a grounding technique with a simple breathing exercise.
Breathing Exercise skill to try yourself:
- Start by sitting or lying down in a comfortable position
- When comfortable, gently close your eyes (or set your gaze to a point in your surrounding)
- Inhale through your nose for 4 counts (1-2-3-4)
- Exhale through your nose for 4 counts (1-2-3-4)
- Repeat at least 3-4 times or as needed
If you or someone you know is experiencing trauma-related nightmares, I hope this article has been helpful.
If you’re interested in getting to know more about improving sleep habits and routines (sleep hygiene tips), check out our downloadable document below for more information.
Learn more about PTSD and the treatments we offer here!
Thank you and sleep well!
Dr. Gabriela Sadurní Rodríguez is a licensed psychologist at The Psychology Group Fort Lauderdale and is an expert in trauma-related issues, depression, anxiety, life transitions/adjustments, and difficulties in interpersonal relationships. Call 954-488-2933 x 8 or email today to discuss how her services can help you.
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Copyright © 2020 Dr. Gabriela Sadurní Rodríguez