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Published on September 28, 2018

The Scary Truth About Nightmare Disorder And Top Treatments that Work

The Scary Truth About Nightmare Disorder And Top Treatments that Work

Most of us have had the experience of deeply distressing nightmares that wake us up. But for those suffering symptoms of nightmare disorder, the experience can be terrifying, let alone the idea of falling asleep in the first place.

Untreated, nightmare disorder can have a significant, dastardly impact on our ability to just function normally, day to day. It’s not just about having a restless night’s sleep and struggling to get out of bed the next morning laden with fatigue.

If you suffer nightmare disorder, you often experience greater frequency of your nightmares either across different nights or as a sequence of disturbing dreams in the same night.

Fear and anxiety often wreak havoc on you emotionally, mentally and physically when trying to fall asleep, during and between your sleep cycles and also upon waking. You’re terrified of sleeping!

If you’re tired of experiencing no change even though you’ve reduced your alcohol intake, started exercising and have been going to bed earlier, there is help at hand.

Yes, physical changes you make can be extremely helpful (e.g. modifying your diet and eating plan, listening more to positive, inspiring audio books, music and podcasts, doing yoga) but you may be missing some key psychological strategies that can really help to kick your symptoms to the kerb.

How to know if I have nightmare disorder?

The International Classification of Sleep Disorders III provides minimum criteria to determine if individuals suffer from nightmare disorder described below:

a) Dreams are recurrent, clearly recalled and involve vividly feeling threats to survival, safety or physical integrity which often jolt you to awaken;

b) Upon wakening, you rapidly feel highly alert and become quickly oriented;

c) The nightmare itself or the sleep disturbance caused when awakening from it, causes clinically significant distress or impairment in social, occupational, or other important areas of functioning as indicated by experiencing at least one of the following:

Mood disturbance – emotions upon waking persist after the nightmare

The emotions aren’t vivid and distressing only during your nightmare. Even as you awaken they remain very real, are highly intense and usually contain intense levels of anger, fear, terror and/or sadness.

In fact the mood you experience can persist for awhile after you awake from the nightmare and the feeling is difficult to shake.

Dream recall is vivid

Many people find it difficult to recall their dreams upon waking even with making a concerted effort to do so.

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With nightmare disorder, dream recall is quick and vivid and there is little to no confusion about the details of the dream.

Falling asleep again is challenging

You can often suffer physical symptoms upon waking. Breathlessness, sweatiness and tightness in the chest can heighten your attention to remain awake.

Being unable to calm yourself physically and mentally makes falling asleep again not only difficult, but awfully frightening.

There also can remain the fear of re-entering the nightmare you’ve jolted awake from or re-experiencing the dream again.

You develop avoidant behaviors

Bedtime anxiety can become a common feature. A fear of the darkness associated with sleep time can also develop.

Social, interpersonal and occupational function starts to subside

Your ability to concentrate and focus at work or be fully present during social interactions starts to drop.

You might also start to feel silly and ashamed that you can’t ‘get over’ a silly nightmare.

Daytime sleepiness, fatigue and low energy

Your energy levels and fatigue can suffer from not getting enough of the right quality sleep, having incomplete sleep cycles and not getting enough cycles in the first place.

During the day you wake up groggy and feel like you’re dragging your feet to concentrate, focus and get anything done.

Other symptoms

In addition to the above, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) explains that a diagnosis of nightmare disorder is not catalyzed by the effect of medication nor drugs and also is not attributed to the presence of another mental disorder (e.g. post-traumatic stress disorder). The DSM-V also indicates how severe a diagnosis might be pending the different time periods of experiencing the symptoms.

To gain an accurate diagnosis, work with a qualified, registered mental health professional. Explore your medical history, your previous and current use of drugs and medication, your previous sleep disturbances as well as presence of any similar sleep disturbance in your family and the experience of traumatic events and/or relationships.

Whilst there doesn’t yet exist a stand-alone diagnostic tool for nightmare disorder, there can be valuable clues in exploring these potential influences as well.

The Scary Truth About Untreated Nightmare Disorder

According to the American Academy of Sleep Medicine, 4 % of the population suffer from nightmare disorder.[1] Untreated, prolonged effects can lead to the development of anxiety and depressive disorders. For those who might already be suffering symptoms of these, it can worsen them.

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Whilst development of different types of insomnia, breathing problems such as asthma and snoring have been linked to nightmare disorder, one of the most alarming links is the likelihood of the disorder to suicidality. Studies have not only discovered relationships between nightmares and the presence of suicidal thoughts (ideation) but also suicide attempts.

For many, time is not on their side. Having suffered long enough, medication can be a quick and instant way to dampen and numb the symptoms and provide temporarily relief.

However, there are some incredibly effective psychological treatments that have not only helped restore an astonishing quality of slumber to sufferers but opened their gateway to rebuilding a remarkable quality of life.

5 Top Treatments to Turn Your Sleep Experience Around

If you don’t feel you have time on your side, you may wish to consult with a medical professional to explore medication that could provide instant relief.

Medication or not, the guidance of suitably trained and qualified mental health professionals can help you learn incredible strategies that will accelerate you back to experiencing a far better quality of life.

Let’s look at some of the top recommended strategies below.

1. Image Rehearsal Therapy (IRT)

Image rehearsal is a great technique applied whilst you are awake. You write down your dream but change the theme, story line, ending, or any part of the dream to be a far more positive one.

In rewriting the dream scenario, you build in all the sensations, thoughts and emotions you want to experience instead. You are working to displace the distressing experiences you originally had with your newly orchestrated dream.

This technique works by challenging the traumatic theme of your original nightmare by injecting a cognitive shift. You choose and design the shift.

By then rehearsing this scenario for just 10 – 20 minutes a day, you can be on your way to greatly reducing your symptoms and enjoying a slumber journey to paradise as opposed to the Amityville Horror House.

2. Eye Movement Desensitization Reprocessing (EMDR)

EMDR combines elements from a number of different therapies. It has become a primary treatment for those suffering from nightmares connected with having experienced either a single traumatic event or multiple events over time.

Using an eight-step approach a therapist manually induces processing of disturbing memories and experiences by stimulating neural mechanisms similar to those activated during rapid eye movement (REM) sleep.[2]

During sessions, therapists direct clients to switch their eye movements to swing back and forth, left to right either following the therapists fingers (or some other object) whilst recalling the disturbed memory. Tones directed through headphones alternately into each ear might be used in similar fashion, or alternate physical taps to each hand.

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Clients identify and process the disturbed memory and past experience, current triggers and also positive experiences to develop a helpful adaptive response to the traumatic experience.

Even though EMDR is a highly effective treatment, there are pre-requisites for engaging this method and this process should only be applied by well-trained professionals who are licensed and qualified to administer it.

However, when you experience the benefits, not just your sleep but your quality life can turn around in a massive way!

3. Graded Exposure Therapy

Graded exposure therapy is also known as systematic desensitization. Once again it is best advised to undertake the first steps of this process with a qualified, trained professional.

With this method, you build resilience to the distressing parts of the nightmare through gradually exposing yourself to recalling the experience of it.

Re-experiencing the memory of the traumatic parts of the dream are identified and organized into a hierarchy of what is least distressing to what is most distressing. Working with parts you feel you can handle, you gradually expose yourself to the different parts of the nightmare memory and re-ignite the stressful emotions, thoughts and sensations one by one at a pace you can handle.

As you experience and learn that you are not in danger, your resilience builds and your fear of experiencing the nightmare again gradually drops.

Research has shown graded-exposure therapy to be helpful in reducing the frequency of nightmares but more effective when used in combination with progressive deep muscle relaxation (PDMR).

4. Progressive Deep Muscle Relaxation

Whilst research has shown that PDMR has been effective in reducing the frequency of nightmares, the technique has a wide range of uses in managing types of anxiety.

In itself, it is an incredible mental health and physical self-care strategy everyone can benefit from, nightmare disorder or not.

Working sequentially through the muscle groups in your body – from head to toe or in the reverse direction – you deliberately tense your muscles for a few seconds, then let the tension go and concentrate on how relaxed you feel for longer.

By deliberately telling your body to relax and increasing focus on how calm and relaxed you physically feel, you send messages to your brain to relax. Working through the muscle groups sequentially helps to pacify those of us who can get particularly wound up.

There are plenty of electronic apps you can access for free on your android phone or download to your iPod (e.g. Calm, Relax Lite). Guided PDMR (i.e. with instructions) is extremely helpful to start with. You surrender to the voice guiding you how and when to tense and relax each muscle group. By creating a deeply relaxed state just before falling sleep, you increase the potential for you to have a more pleasurable sleep experience.

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By getting started with PDMR straight away you not only have a tool to help you alleviate your nightmare symptoms, but a great relaxation technique to help you combat the challenges life throws at you.

Just be sure to consult a medical professional beforehand if you are recovering from an injury or could be at risk some other way. If so, whatever muscle groups could be affected, simply skip those and go on to the next ones.

5. Exposure, Relaxation and Re-scripting Therapy (ERRT)

ERRT is a combination of different steps targeting the anxiety symptoms that exist with the experience of nightmare disorder. If you’re not yet familiar with them, you’ll undertake an introduction to sleep hygiene practices.

Clearing out electronic devices from your bedroom, reducing your exposure to blue light from electronic tablets, television and android phones at least 1 ½ hours prior to wanting to fall asleep…..they all help to reduce symptoms of anxiety that can escalate your experiencing nightmares.

Looking at bedding and undertaking relaxing activities at night before bed time all contribute to creating blissful sleep opportunities.

Once you have your bedroom and pre-sleep activities sorted, you then apply the PDMR strategies which direct your focus on sensations of feeling completely relaxed. You are telling and preparing your mind and body to wind down and prepare for calm, serene sleep.

Looking at problem-solving, rescripting (similar to IRT) and coping strategies when you might awaken are all reviewed so you have an all round plan to (i) prepare your mind and body for sleep, (ii) help catalyze a far better dreaming experience and (iii) also have a plan of what to do when you awake suddenly.

The bottom line

Today might have been a wake-up call and you might have thought medication might be the only solution. You have been suffering and letting those symptoms rob you of your ability to rest, restore and regenerate your mind and body long enough.

If you have not been aware until now of the techniques and strategies above, make the decision today to get acquainted and consider undertaking an assessment with a mental health professional.

You might just turn the tables to discover a whole new lease on life!

Featured photo credit: rawpixel via unsplash.com

Reference

More by this author

Helen D'Silva

Performance Psychologist for Business and Entrepreneurship, Sport and Personal Development

How to Improve Focus: 7 Ways to Train Your Brain How to Calm Down When You’re Stressed and Anxious How to Manage Anxiety: Sound Advice from a Mental Health Expert How to Cultivate a Positive Mindset (A Step-By-Step Guide) How to Cope with Anxiety and Stress at Work: 5 Psychology Techniques

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Last Updated on August 20, 2019

How to Control Your Thoughts and Be the Master of Your Mind

How to Control Your Thoughts and Be the Master of Your Mind

Your mind is the most powerful tool you have for the creation of good in your life, but if not used correctly, can also be the most destructive force in your life.

Your mind, more specifically, your thoughts, affect your perception and therefore, your interpretation of reality. (And here’s Why Your Perception Is Your Reality.)

I have heard that the average person thinks around 70,000 thoughts a day. That’s a lot, especially if they are unproductive, self-abusive and just a general waste of energy.

You can let your thoughts run amok, but why would you? It is your mind, your thoughts; isn’t it time to take your power back? Isn’t it time to take control?

Choose to be the person who is actively, consciously thinking your thoughts. Become the master of your mind.

When you change your thoughts, you will change your feelings as well, and you will also eliminate the triggers that set off those feelings. Both of these outcomes provide you with a greater level of peace in your mind.

I currently have few thoughts that are not of my own choosing or a response from my reprogramming. I am the master of my mind, so now my mind is quite peaceful. Yours can be too!

Who Is Thinking My Thoughts?

Before you can become the master of your mind, you must recognize that you are currently at the mercy of several unwanted “squatters” living in your mind, and they are in charge of your thoughts. If you want to be the boss of them, you must know who they are and what their motivation is, and then you can take charge and evict them.

Here are four of the “squatters” in your head that create the most unhealthy and unproductive thoughts:

1. The Inner Critic

This is your constant abuser who is often a conglomeration of:

  • Other people’s words; many times your parents.
  • Thoughts you have created based on your own or other peoples expectations.
  • Comparing yourself to other people, including those in the media.
  • The things you told yourself as a result of painful experiences such as betrayal and rejection. Your interpretation creates your self-doubt and self-blame, which are most likely undeserved in cases of rejection and betrayal.

The Inner Critic is motivated by pain, low self-esteem, lack of self-acceptance and lack of self-love.

Why else would this person abuse you? And since this person is actually you– why else would you abuse yourself? Why would you let anyone treat you this badly?

2. The Worrier

This person lives in the future; in the world of “what ifs.”

The Worrier is motivated by fear which is often irrational and with no basis for it. Occasionally, this person is motivated by fear that what happened in the past will happen again.

3. The Reactor or Trouble-Maker

This is the one that triggers anger, frustration and pain. These triggers stem from unhealed wounds of the past. Any experience that is even closely related to a past wound will set him off.

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This person can be set off by words or feelings, and can even be set off by sounds and smells.

The Reactor has no real motivation and has poor impulse control and is run by past programming that no longer serves you, if it ever did.

4. The Sleep Depriver

This can be a combination of any number of different squatters including the inner planner, the rehasher, and the ruminator, along with the inner critic and the worrier.

The Sleep Depriver’s motivation can be:

  • As a reaction to silence, which he fights against
  • Taking care of the business you neglected during the day
  • Self-doubt, low self-esteem, insecurity and generalized anxiety
  • As listed above for the inner critic and worrier

How can you control these squatters?

How to Master Your Mind

You are the thinker and the observer of your thoughts. You must pay attention to your thoughts so you can identify “who” is running the show; this will determine which technique you will want to use.

Begin each day with the intention of paying attention to your thoughts and catching yourself when you are thinking undesirable thoughts.

There are two ways to control your thoughts:

  • Technique A – Interrupt and replace them
  • Technique B – Eliminate them altogether

This second option is what is known as peace of mind!

The technique of interrupting and replacing is a means of reprogramming your subconscious mind. Eventually, the replacement thoughts will become the “go to” thoughts in the applicable situations.

Use Technique A with the Inner Critic and Worrier; and Technique B with the Reactor and Sleep Depriver.

For the Inner Critic

When you catch yourself thinking something negative about yourself (calling yourself names, disrespecting yourself, or berating yourself), interrupt it.

You can yell (in your mind), “Stop! No!” or, “Enough! I’m in control now.” Then, whatever your negative thought was about yourself, replace it with an opposite or counter thought or an affirmation that begins with “I am.”

For example, if your thought is, “I’m such a loser,” you can replace it with, “I am a Divine Creation of the Universal Spirit. I am a perfect spiritual being learning to master the human experience. I am a being of energy, light, and matter. I am magnificent, brilliant, and beautiful. I love and approve of myself just as I am.”

You can also have a dialogue with yourself with the intention of discrediting the ‘voice’ that created the thought, if you know whose voice it is:

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“Just because so-and-so said I was a loser doesn’t make it true. It was his or her opinion, not a statement of fact. Or maybe they were joking and I took it seriously because I’m insecure.”

If you recognize that you have recurring self-critical thoughts, you can write out or pre-plan your counter thoughts or affirmation so you can be ready. This is the first squatter you should evict, forcefully, if necessary:

  • They rile up the Worrier.
  • The names you call yourself become triggers when called those names by others, so he also maintains the presence of the Reactor.
  • They are often present when you try to fall asleep so he perpetuates the Sleep Depriver.
  • They are a bully and is verbally and emotionally abusive.
  • They are the destroyer of self-esteem. They convince you that you’re not worthy. They’re a liar! In the interest of your self-worth, get them out!

Eliminate your worst critic and you will also diminish the presence of the other three squatters.

Replace them with your new best friends who support, encourage, and enhance your life. This is a presence you want in your mind.

For the Worrier

Prolonged anxiety is mentally, emotionally and physically unhealthy. It can have long-term health implications.

Fear initiates the fight or flight response, creates worry in the mind and creates anxiety in the body.

You should be able to recognize a “worry thought” immediately by how you feel. The physiological signs that the fight or flight response of fear has kicked in are:

  • Increased heart rate, blood pressure, or surge of adrenaline
  • Shallow breathing or breathlessness
  • Muscles tense

Use the above stated method to interrupt any thought of worry and then replace it. But this time you will replace your thoughts of worry with thoughts of gratitude for the outcome you wish for.

If you believe in a higher power, this is the time to engage with it. Here is an example:

Instead of worrying about my loved ones traveling in bad weather, I say the following (I call it a prayer):

“Thank you great spirit for watching over _______. Thank you for watching over his/her car and keeping it safe, road-worthy, and free of maintenance issues without warning. Thank you for surrounding him/her with only safe, conscientious, and alert drivers. And thank you for keeping him/her safe, conscientious, and alert.”

Smile when you think about it or say it aloud, and phrase it in the present tense; both of these will help you feel it and possibly even start to believe it.

If you can visualize what you are praying for, the visualization will enhance the feeling so you will increase the impact in your vibrational field.

Now take a calming breath, slowly in through your nose, and slowly out through the mouth. Take as many as you like!

Replacing fearful thoughts with gratitude will decrease reactionary behavior, taking the steam out of the Reactor.

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For example:

If your child gets lost in the mall, the typical parental reaction that follows the fearful thoughts when finding them is to yell at them.

“I told you never to leave my sight.” This reaction just adds to the child’s fear level from being lost in the first place. Plus, it also teaches them that mom and/or dad will get mad when he or she makes a mistake, which may make them lie to you or not tell you things in the future.

Change those fearful thoughts when they happen:

“Thank You (your choice of Higher Power) for watching over my child and keeping him safe. Thank you for helping me find him soon.”

Then, when you see your child after this thought process, your only reaction will be gratitude, and that seems like a better alternative for all people involved.

For the Trouble-Maker, Reactor or Over-Reactor

Permanently eliminating this squatter will take a bit more attention and reflection after the fact to identify and heal the causes of the triggers; but until then, you can prevent the Reactor from getting out of control by initiating conscious breathing as soon as you recognize his presence.

The Reactor’s thoughts or feelings activate the fight or flight response just like with the Worrier. The physiological signs of his presence will be the same. With a little attention, you should be able to tell the difference between anxiety, anger, frustration, or pain:

  • Increased heart rate and blood pressure; surge of adrenaline
  • Shallow breathing or breathlessness
  • Muscles tension

I’m sure you’ve heard the suggestion to count to ten when you get angry—well, you can make those ten seconds much more productive if you are breathing consciously during that time.

Conscious breathing is as simple as it sounds; just be conscious of your breathing. Pay attention to the air going in and coming out.

Breathe in through your nose:

  • Feel the air entering your nostrils.
  • Feel your lungs filling and expanding.
  • Focus on your belly rising.

Breathe out through your nose:

  • Feel your lungs emptying.
  • Focus on your belly falling.
  • Feel the air exiting your nostrils.

Do this for as long as you like. Leave the situation if you want. This gives the adrenaline time to normalize.

Now you can address the situation with a calmer, more rational perspective and avoid damaging behavior.

One of the troubles this squatter causes is that it adds to the sleep depriver’s issues. By evicting, or at least controlling the Reactor, you will decrease reactionary behavior, which will decrease the need for the rehashing and ruminating that may keep you from falling asleep.

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Master your mind and stop the Reactor from bringing stress to you and your relationships!

For the Sleep Depriver

(They’re made up of the Inner Planner, the Rehasher and the Ruminator, along with the Inner Critic and the Worrier.)

I was plagued with a very common problem: not being able to turn off my mind at bedtime. This inability prevented me from falling asleep and thus, getting a restful and restorative night’s sleep.

Here’s how I mastered my mind and evicted the Sleep Depriver and all his cronies.

  1. I started by focusing on my breathing—paying attention to the rise and fall of my belly—but that didn’t keep the thoughts out for long. (Actually, I now start with checking my at-rest mouth position to keep me from clenching.)
  2. Then I came up with replacement strategy that eliminated uncontrolled thinking—imagining the word in while breathing in and thinking the word out when breathing out. I would (and do) elongate the word to match the length of my breath.

When I catch myself thinking, I shift back to in, out. With this technique, I am still thinking, sort of, but the wheels are no longer spinning out of control. I am in control of my mind and I choose quiet.

From the first time I tried this method I started to yawn after only a few cycles and am usually asleep within ten minutes.

For really difficult nights, I add an increase of attention by holding my eyes in a looking-up position (Closed, of course!). Sometimes I try to look toward my third eye but that really hurts my eyes.

If you have trouble falling asleep because you can’t shut off your mind, I strongly recommend you try this technique. I still use it every night. You can start sleeping better tonight!

You can also use this technique any time you want to:

  • Fall back to sleep if you wake up too soon.
  • Shut down your thinking.
  • Calm your feelings.
  • Simply focus on the present moment. 

The Bottom Line

Your mind is a tool, and like any other tool, it can be used for constructive purposes or for destructive purposes.

You can allow your mind to be occupied by unwanted, undesirable and destructive tenants, or you can choose desirable tenants like peace, gratitude, compassion, love, and joy.

Your mind can become your best friend, your biggest supporter, and someone you can count on to be there and encourage you. The choice is yours!

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Featured photo credit: Priscilla Du Preez via unsplash.com

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