What are PTSD nightmares?
Post-traumatic stress disorder (PTSD) is an anxiety disorder that can develop following exceptionally stressful, distressing, or frightening events such as warfare or abuse. PTSD patients can experience intrusive thoughts, anxiety, nightmares, and flashbacks of past events that were of a traumatic nature. It is estimated that 71-96% of individuals diagnosed with PTSD may have nightmares. Another important revelation, is that the prevalence of nightmares in individuals with PTSD, appears to be higher among individuals with a parallel panic disorder or anxiety.
PTSD nightmares have been said to cause individuals to re-experience the trauma or similar events. These can occur multiple times per week and can cause a significant level of distress. It also contributes to poor sleep quality for the individual and in many cases, the others in the household. These post-trauma nightmares, over time, have come to be linked to cases of insomnia, depression, anxiety, cardiovascular risk factors, alcohol abuse, suicidal ideations, and suicide attempts.
Research and investigation have provided some recourse for PTSD nightmares. Some common treatments include:
- Cognitive Behavioural Therapy (CBT): This allows the patient to train their mind to replace negative thoughts with more rational and less distressing thoughts.
- Exposure Therapy and Rescripting Therapy: This teaches the patient to have less fear of the memories by re-exploring them. It seeks to provide means by which the patient can alter the connotations associated with these memories; attempting to diminish the impact of these distressing thoughts.
- Medications: There is also some scope to use relevant medications such as SSRIs or prazosin. These, however, are known to cause side-effects and are generally not as effective in the long-term as therapy.
Study of PTSD nightmare recurrence and triggers
A recent study by Youngren, Hamilton and Preacher (June 2020) investigated the recurrence of post-trauma nightmares in female college students, who had previously complained of nightmares relating to past sexual trauma. This involved 146 observations of 27 participants. The participants performed initial assessments and were to keep pre- and post-sleep diaries for 6 days. These were intended to measure nightmare triggers, post-trauma nightmare occurrence and sleep quality.
The study uncovered that both pre-sleep cognitive arousal (worrying or ruminating prior to going to bed) and sleep latency (the time it takes for someone to fall asleep) predicted post-trauma nightmare occurrence. Pre-sleep cognitive arousal also appeared to influence sleep latency and, in turn, post-trauma nightmare occurrence.
Youngren referred to this critical pre-sleep thought process as “priming the mind” for the dream content to relate to the trauma. Hence, the period prior to falling asleep appears to be critical to reduce nightmare occurrence. Future treatments should focus on teaching PTSD patients to manage this period effectively, to avoid distressing thoughts and to have healthy sleep habits and routines.
Westley A. Youngren, Nancy A. Hamilton, Kris j. Preacher. Assessing Triggers of Posttrauma Nightmares. Journal of Traumatic Stress, 2020.
- Featured image:
Monrad-Aas, C-H. Nightmares and how to avoid them. Sleep Cycle, 2020. Accessible at: https://www.sleepcycle.com/sleep-disorders/nightmares-and-how-to-avoid-them/
Edited by Malavika Ramanand