The other night, I had a nightmare now I don't have them very
often, but this one was a doozy.
I dreamed that I was giving a presentation to a large group of people
and like all good nightmares, right?
Like I was naked.
And while I was struggling to put my pants on the classroom
was suddenly being attacked.
We could hear the gunshots coming down the hall and getting closer to our room.
And then the attackers were at our door pounding and shooting at it.
And that's when I woke up, right.
Heart pounding, hands sweating, and my ears were still ringing.
Like I could feel the physical percussion from the dream in my physical years,
nightmares feel so intense and powerful.
They can make it really hard for people to sleep well.
No, Um, like me, most people have nightmares occasionally, and these
are called idiopathic nightmares.
However, nine out of 10 people with PTSD have recurrent distressing nightmares that
interfere with their ability to function.
So for people with repetitive nightmares going to sleep is terrifying.
They may avoid it as much as possible or cope by using substances
or other unhealthy things, but this can make it hard to function
and live the life they value.
And the sleep avoidance and sleep deprivation can also lead
to more intense nightmares.
So this is the awful cycle of PTSD.
The more you try to escape it, the worse it gets, but there is a way out.
And some researchers have found that treating nightmares helps accelerate the
other aspects of the PTSD healing process.
In this video, you'll learn one reason.
Why nightmares could be a good thing and nine ways that you can treat nightmares
process through them and get them to stop.
One of those skills is called the imagery rehearsal technique, and
it's an evidence-based treatment for nightmares that you can do at home.
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So first, let's start with a disclaimer.
If you have past trauma, please work with a therapist.
This is some really sensitive stuff, and PTSD can be really
hard to work through on your own.
What I'm going to teach you today are some ways to process through
nightmares and bad memories, but this process can trigger PTSD symptoms
like flashbacks and dissociation.
So I encourage you to get the help.
If you think you might have PTSD and you choose to go
through this exercise, you do.
So at your own risk, you do this knowing that it might be uncomfortable at times.
However, that being said, I know that many people aren't able to get counseling
and I believe that healing is possible and that there are some things you
can try on your own to create change.
Okay.
So let's talk about what causes nightmares.
Everyone has nightmares sometimes, but with PTSD, it's different
PTSD dreams often repeat the same terrifying storyline over and over.
And this can last for years or even decades, but your brain and
your body, they aren't out to get you dreaming, serves a function.
Researchers believe that dreaming is one way that our brain processes
through emotions and experiences.
When we dream we're in REM sleep, that's rapid eye movement sleep.
And usually we don't remember our dreams unless we've woken up during.
During REM sleep.
Your body turns down adrenaline, which is one of the chemicals that
turns on your body's activated state, the fight flight freeze response.
Now this makes it so that healthy people can process through their emotions
without that nervous system activation, it's like taking the intensity out of
a situation so that you can process your emotions or your experiences.
Now I've certainly had experiences where during the day something
seems so overwhelming, but after a good night's sleep, I feel better.
And the situation doesn't seem so bad anymore.
Your dreams help you let go of the sharp emotions and hang onto the memories, like,
like what you've learned from a situation.
So basically dreaming is a way for you to process through intense experiences
and come to a resolution so that you can make peace with these experience.
But with PTSD, your system, doesn't turn off the adrenaline during a
dream, which means that your brain can't process through the emotions.
So instead it just cycles through them over and over again.
So in this way, dreams and even repeated nightmares may be a sign
that your brain is asking you to heal.
It's trying to process through a memory or an experience or an emotion,
but with PTSD or other intense, repetitive nightmares, we don't finish
the process of working through the nightmare either because the dream
wakes us up so that we don't complete the nightmare, or because our brain
doesn't know what to do with the dream.
It doesn't know how to raise.
Nightmares are not a sign of weakness.
They're a sign that your brain is trying to process something.
So let's talk about how to help you process the dream all the way to
resolution so that you don't have to keep.
First of all.
Let me give you an example.
When my five-year-old daughter watches Disney movies, she gets really scared.
So in a movie like the lion king, when faucet dies and then Simba
believes that it's his fault.
That's one of the emotionally intense parts of the movie.
Now I don't really have her watch these movies right now, but if.
She would beg me to turn it off at that part of the movie.
So imagine watching the lion king over and over and over, but the movie always
ends at the spot where my dad died a horrible death, and it was my fault.
This is similar to what someone with PTSD experiences, they remember
their trauma and it gets so intense that they can't process through it.
They try to turn it off by avoiding it during the day.
And then when the brain tries to reprocess it at night, it
gets flooded with adrenaline.
And as the brain tries to resolve the trauma by dreaming,
the stress wakes you up right.
In the worst part.
So the processing gets interrupted over and over.
It's like move faucet, dying over and over again.
Like that is not an enjoyable.
So instead we work to help people process traumatic events by reaching some kind of
resolution by going all the way through the trauma, getting to the second half
of the movie, you know, like Hakuna Matata, and it's not your fault Simba.
And then successfully defeating the bad guys and restoring the balance of nature
and, you know, making babies and stuff.
We help people get through the difficult part of the movie and
get to the resolution of their.
So, how does this work with nightmares?
The first skill that we're going to talk about is the imagery rehearsal technique.
This is a CBT technique developed to help people, reprocess memories and
dreams, randomized controlled trials, which is the best type have shown that
for people with moderate to severe PTSD, this technique reduces their nightmares
and their PTSD symptoms significantly.
In one trial, the nightmares and symptoms were reduced by 60% and in
another, they were reduced by 72 hours.
And these results lasted four months, two years.
This technique is basically a way to retrain your brain to
work through the nightmare.
So you simply take the memory or the nightmare and you write
it down and then you rewrite it and change something about it.
You can change the ending theme, the storyline, or any part of the
dream to make it more positive.
This helps you retrain your brain on how to handle the distressing.
And as I said before, if thinking about your nightmare might be overwhelming for
you, then please work with a therapist who could help you work through flashbacks
or dissociation in a safe place.
A therapist will help you break it down into manageable chunks and they'll help
you work within your window of tolerance.
However, if you can't access a therapist, I recommend that you learn
about the window of tolerance and start with a non non-trauma nightmare or
skip the rehearsal of the nightmare.
If it's very triggering, so start slow, and then you can build.
Okay.
So here's the process.
You start by doing some grounding or relaxation, like deep breathing
or progressive muscle relaxation.
And then you choose a recruiting nightmare that you want to work on.
And you write out the script and you go into detail, write about
what you feel in your body and what's happening, your thoughts
and your actions and your emotions.
And then.
Rewrite the nightmare with a different outcome.
Think about how you would like to feel about this experience.
This different outcome could prevent the bad thing from happening
or present a solution after it does your imagined solution.
Doesn't have to be moral or realistic dreams.
Aren't reality.
Either your solution can break the laws of physics.
It can be pure fantasy.
It can be silly.
You can protect yourself in a powerful way and, um, you know,
just feel free to explain.
You can try out one scenario and then if that's not helpful, try a different one.
Uh, the changes that you write down this new ending can include different
thoughts or feelings about yourself.
Okay.
You know, it could just really change this dream in any way
that you can possibly imagine.
And it's best when you write this, if you go into a lot of detail about this
new ending that has a resolution, right?
We're getting through the trauma to the end of the story where things turn out.
Okay.
Once you've written this down, you want to practice rehearsing this new
dream throughout the day, read it out loud and then practice relaxation.
And if possible, do this multiple times throughout.
Read the new dream with a new ending before you go to bed at
night and practice the physical relaxation techniques afterward.
If you'd like to hear a practical example, check out the video by Dr.
Marks about how she did this with a dream about her grandma dying.
She used to have repeated nightmares about it and she Re-Scripted it so that she
came to peace with her beloved grandma's.
Another essential way to treat nightmares is to reprocess the emotions
and the memories during the daylight.
So if you have experienced trauma, it's easy to get stuck in a cycle
of being overwhelmed by intense emotions and then avoiding them.
So you get overwhelmed avoid, and then the emotions come back, bigger,
overwhelmed, avoid, right with the help from a therapist who specializes
in trauma treatment like EMDR or somatic experiencing, you can learn.
Through the emotions and memories that are keeping you stuck.
And you'll learn about the window of tolerance, which is how to use skills
to stay out of the panic zone and stay in the growth zone while facing
these painful thoughts and emotions.
So moral of the story is.
Don't avoid these memories and thoughts during the day, because that's kind
of like, um, your computer wants to do an update and you keep pushing,
wait, wait, wait on that update.
And so then finally, when you're ready to give a big presentation or
something, your computer is like, sorry, I'm forcing the update, right?
It's forcing you to process those memories at night.
If you do the update, if you process those memories during the day, then
your brain might not be forcing you to face them at night because
you're already facing them during.
Okay.
Something else that can help break the cycle of a nightmare is learning
to ground yourself after having one.
So nightmares feel like you're in danger in the present moment,
but you're actually safe.
So you can put sensory objects near your bed or in your bedroom to remind
you that you're in the present moment, that you are not in your dream.
And this could be something like a pillow that smells like lavender or a super
soft Teddy bear or whatever, you know, works for you to help you feel grounded.
Another thing that can help with nightmares is you can practice changing
how you think about nightmares.
So you could say something like in this present moment, I am safe.
Or even though I've had a nightmare, I got through it.
Some people may find themselves thinking, oh, I don't want to go to
sleep because I'm going to have another nightmare and I can't handle it.
So if they, if, if you think that way you could switch that you could instead
say, I may have another nightmare, but I've made it through all the other ones.
I've had other mantras, including.
I can do hard things.
This is uncomfortable, but it's not dangerous.
This hurts, but it doesn't harm.
So just learning to practice willingness and other emotion processing skills
can really help with nightmares.
And this is the paradox of control, right?
The harder you try to avoid or distract or control the worse your
nightmares get, but you can learn to control them by, by learning to
process them by learning to face.
Eric Gentry, a trauma trainer told me the story of a Vietnam veteran who had
a nightmare of a tiger chasing him.
Uh, this, this veteran had the same nightmare over and over
and over again for decades.
And he always woke up as he was running away, but about to be caught.
And through the course of therapy, he decided that instead of running,
he would turn and face the tiger.
And when he did the tiger ended up not hurting him, but healing.
When treating nightmares, we can also look at treating underlying conditions
and causes other than PTSD for nightmares.
So sleep deprivation, sleep apnea and restless leg syndrome can
all contribute to nightmares.
So it can be helpful to rule out these causes.
I had a client who was constantly having the nightmare that he was being
hung, that he was being strangled, that he was being suffocated.
Uh, he was only 22, but I asked if he snored and his wife said,
yes, he's a terrible snore.
And I asked if he fell asleep easily.
And she said he falls asleep, sitting up all the time, both snoring and
being so exhausted that you fall asleep easily or signs of sleep.
When he got checked out, he did indeed have breathing problems at night, and this
was constantly cutting off his breathing.
And he felt like he was suffocating when he got a C-PAP his nightmares went away
because he was actually breathing through.
So along with sleep apnea at some medications like antidepressants can
also make nightmares, more frequent.
A few other things that can contribute to nightmares are like late night
snacks and blood pressure medication.
Also alcohol, caffeine, and nicotine.
These can all interfere with sleep, which can contribute to nightmare.
So if you're having consistent nightmares, you can consider, um, trying
to rule out some of these other ones.
And that takes us to number six.
If you want to sleep well, you need to work on your overall sleep levels
and improve your sleep hygiene.
So if you're super stressed out throughout the day, you'll have a
harder time sleeping well, and you'll be more likely to have nightmares.
So if you want to decrease nightmares, practice, self care, you know,
exercise during the day and process through your emotions during this.
Um, practicing good sleep.
Hygiene is also helpful.
I've got a video on this, but it's basically, you know, going to bed at
a regular time, getting enough sleep, having a good bedtime routine and
don't use substances like alcohol.
Okay.
Number seven, here's an interesting treatment.
That's still undergoing research to find out how effective it will be.
But a young man developed a smartwatch app to help his dad's nightmares.
His dad was a veteran of the war in Iraq, and when he got home from the
war, he had repeated nightmares.
He'd sweat profusely and he thrashed around in his bed and sometimes
he would get violent in his dream.
And the only way his dad could sleep was with vodka and pills, which
eventually ruined his marriage.
And then he lost his job and you know, his other relationships.
So his son worked to develop an apple watch app that interrupts the
nightmare by monitoring when the nightmares happening and then gently
vibrating to pull his dad out of REM sleep while still keeping him on.
And it worked for his dad.
Now the app is undergoing more testing to see if it's effective in the
long run for a broader population.
It's not available right now, but maybe in the future, it will be another option
to treat nightmares is proposing a you'll need to work with a doctor to
decide whether to use this medication.
It was originally developed to treat high blood pressure and it, it works
by calming down the fight flight freeze response by decreasing address.
I had a client who took this and it did help with her nightmares, but
for some, because it decreases blood pressure, it makes them a little dizzy.
So again, it remains to be seen if treatments that interrupt nightmares like
Prazosin and the, the smartwatch, right?
If these are as effective in the long run, as processing through emotions.
Now I, as a therapist, I definitely lean toward working through them.
But if something provides a long-term lasting relief, then
you know, obviously I'm in favor.
Okay.
Lastly, the VA has some free resources for PTSD and you can access them
whether you're a veteran or not.
They've got some apps like PTSD, coach PTSD, family, coach, mindfulness,
coach, progressive exposure coach.
And they've got a CVTI app, which teaches you all about how to manage insomnia.
Better.
Okay.
So there you have it nine tools.
You can try to stop having nightmares or bad dreams.
I hope this was helpful.
I think about all of you watching my videos every day
and you're in my thoughts.
Want to help you out?
I care about you.
Thank you for watching and take care of.