PTSD: Conquering Nightmares

People with post-traumatic stress disorder (PTSD) struggle with nightmares.  The dreams can be so terrifying they’re often afraid to sleep.

If this sounds familiar, here are seven nightmare-busting methods to help you conquer bad dreams.

(1) Write About the Nightmares

A great way to take on nightmares is to to write about them.  Symptoms can get worse before they get better, but this method has been shown to be comparable to individual therapy.  Grab a notebook (or prepare your laptop) and process the nightmare on paper.

• First, document the dream in great detail from beginning to end.  What happened first?  What happened after that?  Who was there?  What did they do?  Don’t forget to describe visions, sounds, smells, and other sensations.  How did you feel?  What were you thinking?  How did you react in the dream?
• Once you’re finished recording the events of the nightmare itself, write about how the dream affects you now.  How do you feel?  What are you thinking?  How does it influence your behaviors?  Vent and complain as much as you need.
• Next, over the course of a month, repeat this process again and again until the nightmare’s power begins to subside.  As mentioned, you might feel the anxiety intensify before it backs off, but once you’re over that obstacle, improvement is usually long-lasting.

Sometimes processing an issue on paper helps change perspective, lending an “ah-ha!” moment that causes everything to click into place.  That’s a special experience, but don’t be disheartened if that doesn’t happen to you.  The goal here is exposure.  The more time you spend examining this dream, the smaller and less threatening it becomes.

Working through this stuff on your own can be tough or frightening.  If you’re having problems doing this alone — the emotion is too intense, or you’re not improving no matter how much time you invest in writing — please reach out for help!

(2) Rewrite the Narrative.

Instead of revisiting the nightmare until it stops bothering you, consider changing the story.  As before, take time to document the dream, but this time change the way it ends.

What outcome feels right to you?  Is it benevolence you seek, where a kind hand pulls you to safety?  Is it power to protect yourself against an aggressor?  How about reconciliation between an enemy and you, where your enemy speaks warm words, where you forgive them and forgive yourself?  Is it the ability to relieve another’s suffering?  Or your own?  Is it kissing someone goodbye and knowing their next destination is a safe one?  If you need special weapons, abilities, or plain old magic to triumph in your nightmare, give yourself just that!  Remember, this isn’t about revenge.  This is about finding peace.

Once you’ve created an alternative ending, think about that outcome as you fall asleep every night. Over time, the new narrative will slip into the nightmare and change the story line at a fundamental level.  The dream becomes just that: A dream.

(3) Talk About the Nightmares. 

Share your dreams with someone you trust, ideally a friend who understands what you’re experiencing.  Use that person as a sounding board.  Your friend doesn’t need to have any great insights.  All that’s required is that they listen and be present.  The more you talk about your nightmares, the less powerful they become.  Sometimes the anxiety worsens before it improves, but once you’re over that hump, the improvement is typically long-lasting.

(4) Cognitive Behavioral Therapy (CBT). 

CBT is a type of talk-therapy.  It’s usually done with a therapist.  This type of therapy is based on the notion that thought and behaviors influence mood.  What you think and what you do affect how you feel, including nightmares.

CBT for PTSD focuses on relaxation (retraining the body to relax when there’s no real danger), rewriting problem thoughts (like not feeling guilty for something you had no control over, or recognizing that the future isn’t as bleak as it seems), and on changing thoughts and behaviors that trigger PTSD symptoms.  Nightmares are a symptom of PTSD.  Sometimes CBT also includes exposure.

While this method is best done with the assistance of a psychotherapist, there are various CBT self-help workbooks available for PTSD.  To learn more about the cognitive prong of CBT, check out this article on cognitive therapy.

(5) Eye Movement Desensitization and Reprocessing (EMDR).

EMDR is a type of individual therapy that uses eye movements to help reprocess distressing memories and beliefs.  The theory is that the brain and thoughts can be rewired by specific movements of the eyes.  It’s surprisingly effective.  As the symptoms of PTSD improve, so do the nightmares.  EMDR must be done with a therapist trained in the method.

(6) Medication

Doctors prescribe Prazosin to help with PTSD-related nightmares. Prazosin is a blood pressure medication that soothes the fight-or-flight response, which seems to diminish bad dreams.  It’s use for nightmares is off-label, meaning it’s not FDA-approved for this purpose.  (The medication is cheap and available in generic, so there aren’t any drug companies motivated to pursue the expensive process of getting FDA approval.)

This medication was initially found to be helpful for combat-related nightmares, but in practice it’s now used for non-combat trauma too.  It occasionally lowers blood pressure, which can cause dizziness and falls.  For more information, talk to your health care provider.

(7) A Final Message: Sleep, PTSD, Other Stuff, and Conclusion

This list isn’t all-inclusive.

Another way to conquer nightmares is by circumventing them completely and confronting insomnia instead.  Educate yourself about insomnia and learn sleep hygiene to get a good night’s rest.  If you can’t sleep no matter what you do, talk to your family doctor or psychiatrist about medications.

A second approach is to treat the cause of the nightmares: the PTSD itself.  Talk to your psychotherapist about the interventions list above, as well as couple or family therapy, support groups, self-care, and self-help.  Consider looking into ways to deal with PTSD triggers.  If your symptoms are debilitating, please reach out for help.

Many providers also recommend mindfulness and meditation for nightmares, and there’s a role for progressive muscle relaxation to help with anxiety/insomnia.  Other options include cognitive processing therapy, Seeking Safety, Dialectical Behavioral Therapy (to a degree), and psychodynamic psychotherapy.

There’s more.  There’s always more.  Above all, just don’t give up!