If you are experiencing severe stress, you should seek out the support of friends and relatives. Talking about what is on your mind can go a long way. It is also recommended that you follow a regular fitness routine, including aerobic exercise if possible. You will find yourself able to fall asleep faster, having a deeper sleep and waking up feeling more refreshed. Learn techniques to reduce muscle tension (relaxation therapy), which will also help lessen anxiety.
Avoid long-term use of tranquilizers, and avoid caffeine and other stimulants.
If your nightmares started shortly after beginning a new medication, contact your health-care provider. He or she will advise you on discontinuing that medication if necessary and recommend an alternative.
For nightmares resulting from the effects of "street drugs" or persistent alcohol use, seek counsel on discontinuing usage. Alcoholics Anonymous, for example, might suggest a safe way for you to stop drinking. You can also attend their regularly scheduled meetings. In addition, look at your lifestyle—friends, work and family—to rid yourself of factors that encourage substance abuse.
Call your health-care provider if nightmares occur more often than weekly, or if they prevent you from getting a good night's rest and persist for a prolonged period. Your medical history will be obtained and a physical examination performed.
Medical history questions documenting nightmares in detail may include:
- Do the nightmares occur repeatedly (recurrent)?
- Do they occur in the second half of the night?
- Is there a sudden full awakening from sleep?
- Does the nightmare cause intense fear and anxiety?
- Is there memory of a frightening dream (one with vivid visual imagery and story-like plot)?
- Has an illness or fever occurred recently?
- Has an emotionally stressful situation occurred recently?
- Is alcohol used? How much?
- Are medications or "street drugs" used? Which ones?
- Are natural supplements or alternative medicine remedies used?
- What other symptoms are present?
Physical examination may include physical, neurological and psychological assessments.
If treatment options addressing stress and anxiety, side effects of medication and substance use, do not resolve the problem, your health-care provider may send you to a sleep specialist who will perform a sleep study (polysomnography). In extremely rare cases, a patient will need to take special medications that suppress or reduce REM sleep, thus preventing nightmares.
After an examination by your health-care provider, you may want to add a diagnosis related to recurrent nightmares to your personal medical record.
Tips for a Good Night's Sleep From the National Sleep Foundation
Set a schedule
Go to bed at a set time each night and get up at the same time each morning. Disrupting this schedule may lead to insomnia. Sleeping in on weekends makes it harder to wake up early on Monday morning as it resets your sleep cycles for a later awakening.
Exercise
Aim to exercise 20 to 30 minutes a day. Daily exercise often helps people sleep, although a workout before bedtime may have an adverse effect. For maximum benefit, work out about 5 to 6 hours before going to bed.
Avoid caffeine, nicotine and alcohol
Avoid drinks that contain caffeine, a stimulant. Sources of caffeine include coffee, chocolate, diet drugs, soft drinks, non-herbal teas and some pain relievers. Smokers tend to sleep very lightly and often wake up in the early morning due to nicotine withdrawal. Alcohol robs people of deep sleep and REM sleep, keeping them in the lighter stages.
Relax before bed
A warm bath, reading or another soothing routine can make it easier to fall sleep. You can train yourself to associate certain restful activities with sleep and make them part of your bedtime ritual.
Sleep until sunlight
If possible, wake up with the sun, or use very bright lights in the morning. Sunlight helps the body's internal clock reset itself daily. Sleep experts recommend exposure to an hour of morning sunlight for people having sleep issues.
Don't lie in bed awake
If you can't fall asleep, don't just lie in bed. Do something else, like read, watch TV or enjoy music, until you feel tired. The anxiety of being unable to fall asleep can actually contribute to insomnia.
Control room temperature
Maintain a comfortable temperature in the bedroom. Extreme heat or cold may disrupt sleep or prevent you from falling asleep.
See a doctor if your sleeping problem continues
If you have trouble falling asleep every night, or if you always feel tired the next day, then you may have a sleep disorder and should see a physician. Your primary care physician may be able to help you; also, you can probably find a sleep specialist at a major hospital near you. Most sleep disorders can be treated effectively.
Researchers now know that sleep is an active and dynamic state that strongly influences our waking hours. Innovative techniques, such as brain imaging, help researchers understand how different brain regions function during sleep and how activities and disorders affect sleep.
In fact, scientists have had success in controlling dreams. In one experiment, subjects were trained to play the computer game, Tetris, involving the manipulation of pieces of a falling wall. The scientists monitored the subjects' dreams over the first two nights, and more than half of the subjects reported dreaming of falling Tetris pieces. This type of research will most likely contribute to developing treatments for nightmares.
Nightmares. Last reviewed 03/30/2006
Sources:
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders
- National Institutes of Health - National Library of Medicine
- National Institute of Neurological Disorders and Stroke
