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Coping Strategies for Nightmares and Night Terrors

A Personal Perspective: The importance of therapy.

Key points

  • Dreams, night terrors, and nightmares possess immense power to affect one’s life.
  • Dream interpretation is an art not a science.

As a teenager, I began having a recurring nightmare where I awoke screaming—a man lurked in a dreadful darkness, often appearing like a mustachioed villain in a washed-out print of a silent movie. Sometimes masked and sometimes with a clouded face and always trying to suffocate or knife me without ever touching me. To gain some distance and lower the level of fear with a bit of levity, I named him Dudley Nightshade the archenemy of the cartoon characters Crusader Rabbit and Ragland T. Tiger. Dudley tormented me for years.

Obviously, I am not alone in my torment and there are many who experience this form of sleep disorder because, after my previous post about night terrors and daymares, I received a number of emails saying, “Thank you.” Some people expressed an aversion to speaking about their plight. From my 40-plus years of therapy, I’m aware that the problems of sleep and nightmares are complex, defy easy reductive answers and require the guidance of a professional.

I’ve read scores of journals, medical papers, and books regarding dreams, insomnia, and nightmares. Tales of nightmares and dreams are as old as the human ability to communicate. They appear in ancient myths, the Bible, and contemporary literature. Our modern views of dreams and nightmares began with the publication of Sigmund Freud’s The Interpretation of Dreams in 1900, no matter your opinion of the work, it begat a whole new industry.

Much has changed in 120 years, but not as much as one would hope. I recently read 12 contemporary medical research papers surrounding dreams and sleep disorders. (It helps to have a medical dictionary handy.) I found little in the way of a concrete consensus regarding definition, diagnosis, and treatment. In a reasonably accessible paper, Francesca Siclari, Katja Valli, and Isabelle Arnulf, reaffirmed my opinion. “Dreaming is generally agreed to refer to subjective experiences during sleep. Because the nature of experiences during sleep varies from simple static fragmentary impressions to full-blown, dynamic, hallucinatory story-like experiences, this has led to considerable variation in the definition of dreams.” No kidding.

When I started therapy at age 17, I worried my anxieties, ulcerative colitis, and most of all the traumatic nightmares would inhibit me from living the future I envisioned for myself. I make no claims to understand the unconscious, why dreams arise, or their ultimate significance. I do know dreams possess the immense power to affect one’s life. I define my night-world as my other reality because the leaps in time and space and surrealistic imagery are so vivid and feel as real as anything I experience during my waking hours. Even during periods of lucid dreaming, I know it’s a dream but it feels so real.

My first psychiatrist, Dr. S. asked what I wanted to address as we delved deeper into my emotional quagmire. My nightmares! This may sound like hyperbole, but it was not to this teenager, I feared my next stop was not a dorm room but a psych ward. Dr. S. reassured me that I was nowhere near needing hospitalization.

Dr. S and I implemented techniques to change my waking reaction to the night terrors that I have used for over four decades, with alterations along the way. To halt a panic attack, I breathe and take time to focus, despite feeling so real, it was a nightmare. I turn on a light. Usually my heart rate slows and my anxiety abates. If necessary, I take two to four milligrams of Valium. I change my T-shirt if it’s soaked in sweat. I drink a glass of water. Once I married, my wife would rub my head. Then I meditate. (I now use a meditation app.) This regimen has allowed me to regain a semblance of equanimity after waking up screaming and to fall back asleep.

I still wanted to eliminate the nightmares. Medications that must be prescribed and usage supervised by a psychiatrist are a preferred method to counter sleep disorders. I’ve tried many without success. Most recently Trazodone and Prazosin, which have been successful for others but did not help me. Despite the justified concerns about the long term side effects of benzodiazepines, and I am monitored closely, the same small dosage still calms my middle of the night anxieties. If I couldn’t stop the night terrors, at least I found an acceptable way to exist with them.

Soon after I started therapy, I began what became a lifelong habit of keeping dream diaries. My hope was to unlock some doors between my nightmares, my daytime life, and my daymares. I consider dream interpretation a potentially treacherous undertaking. There is no reliable textbook. The demystification of dreams and nightmares is imperative as is the avoidance of cockamamie theories about dreams. There is still a lesson to be learned from the great historian Herodotus, who reported a misunderstanding of a dream by Xerxes the Great of Persia, after which he attacked the Greeks. Bad idea. His forces suffered a humiliating defeat that historians believe ultimately led to the fall of the Persian Empire.

Having read widely about signs and symbols I believe there are some with a possible universal meaning. Still, most dreamworld signs and symbols are as unique to each individual as is their DNA. I am not demeaning the value of dream interpretation as a therapeutic tool. It can be cathartic if practiced with extreme caution and valuable insight can be gained. Having had ten therapists or psychiatrists over the 40 years, and all have helped me in different ways, yet all of them approached dreams and meaning differently. Some preferred never to offer an interpretation, which was fine by me. I agree with my wonderful current therapist, Dr. Jessica Schairer, “Dream interpretation is an art, not a science.”

The dream I described in the opening paragraph remains one of the few, out of thousands, where I found certainty and a tangibly helpful interpretation. Dudley Nightshade was a symbol of my biological father who deserted my mom and me when I was baby. He refused my entreaties to ever meet or speak to me. (My communications were with his sister.) My mom destroyed all photos of him so I never knew what he looked or sounded like. Discovering the key to that nightmare helped me and my therapists understand how his desertion affected my waking behavior so I could react more constructively to not only his but to all rejection. It took years, but when the case of the abandoning father came to a resolution, Dudley disappeared.

I credit my many therapists who have worked with me to consciously change my behavior that has allowed me to lead a fulfilling life. Still, after 40 years of therapy as well as two helpful UCLA sleep studies, my desire to halt night terrors has never been fulfilled. I keep searching. Both skeptical and hopeful, next month I’ll undergo my third sleep study in 12 years. The supervising doctor is both a sleep specialist and a neurologist. They are checking for “REM sleep behavior disorder that has important implications.” Can’t wait.