Nocturnal Perdition

You hunt for a place to hide. Maybe you are drowning, struggling in dark water. Or perhaps your plane is hurtling toward the ground.

Nine out of ten of us awake suddenly from dreams such as these. Researchers estimate that at least 5 percent of the population, probably more, suffers regularly from nightmares. These bad dreams may strike a few times a week or a few times a month. Studies show recurrent nightmares are grossly underreported.

"Nightmares are so confusing to people," says Barry Krakow, M.D., medical director for the Center for Sleep Medicine and Nightmare Treatment in Albuquerque, N.M. "They think it is their psyche screaming out, but that's only part of the story."

Unlike most normal dreams, nightmares don't appear to help a person work through the events in their daily lives. Even after decades of research, scientists still puzzle over why some people have nightmares but others don't. Although the causes of recurrent nightmares are still mysterious, some personality patterns have emerged among those who experience them.

People with nightmare disorder are often characterized as "thin boundaried," says Ross Levin, Ph.D, associate professor of psychology at Yeshiva University in New York City, and a therapist who treats nightmare disorder and insomnia. For the most part, they are unusually open with others and can be emotionally vulnerable. Levin has also found nightmare sufferers to be more inward looking than the average person and prone to vivid fantasies. Their thoughts and daydreams are often negative, according to his study, published in the journal Imagination, Cognition and Personality.

"These people often have depressive background thoughts, but they don't know it," he says.

The majority of people who suffer from regular nightmares can trace their nighttime images to trauma. They are crime victims, rape survivors and others who are haunted by disturbing events. Most have post-traumatic stress disorder (PTSD), which is often characterized by bad dreams.

In most cases, the nightmares fade away. But for some trauma survivors, bad dreams linger and become destructive.

Krakow has treated hundreds of people with PTSD whose dreams have plagued them for up to 20 years. He has developed a way to break the cycle with image rehearsal therapy (IRT). Patients don't discuss the experience that spurred the nightmares or even the content of the dreams. Instead they focus on changing the imagery. They script the dream, perhaps only a scene. Then they practice it while awake.

"Nightmares can have many influences, but for these people, nightmares are a bad habit," he says. "They're a learned behavior."

The therapy's framework is similar to that used to manage pain and ease anxiety. Of those receptive to the therapy, a majority sees results, Krakow says.

He has found that treating nightmares can reduce many of the other symptoms of PTSD. "You don't have to get rid of the trauma to get rid of the nightmares," he says.