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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 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 The Scary Truth About Nightmare Disorder And Top Treatments that Work

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Last Updated on March 13, 2019

How to Get out of a Rut: 12 Useful Ways to Get Unstuck

How to Get out of a Rut: 12 Useful Ways to Get Unstuck

Have you gotten into a rut before? Or are you in a rut right now?

You know you’re in a rut when you run out of ideas and inspiration. I personally see a rut as a productivity vacuum. It might very well be a reason why you aren’t getting results. Even as you spend more time on your work, you can’t seem to get anything constructive done. While I’m normally productive, I get into occasional ruts (especially when I’ve been working back-to-back without rest). During those times, I can spend an entire day in front of the computer and get nothing done. It can be quite frustrating.

Over time, I have tried and found several methods that are helpful to pull me out of a rut. If you experience ruts too, whether as a working professional, a writer, a blogger, a student or other work, you will find these useful. Here are 12 of my personal tips to get out of ruts:

1. Work on the small tasks.

When you are in a rut, tackle it by starting small. Clear away your smaller tasks which have been piling up. Reply to your emails, organize your documents, declutter your work space, and reply to private messages.

Whenever I finish doing that, I generate a positive momentum which I bring forward to my work.

2. Take a break from your work desk.

Get yourself away from your desk and go take a walk. Go to the washroom, walk around the office, go out and get a snack.

Your mind is too bogged down and needs some airing. Sometimes I get new ideas right after I walk away from my computer.

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3. Upgrade yourself

Take the down time to upgrade yourself. Go to a seminar. Read up on new materials (#7). Pick up a new language. Or any of the 42 ways here to improve yourself.

The modern computer uses different typefaces because Steve Jobs dropped in on a calligraphy class back in college. How’s that for inspiration?

4. Talk to a friend.

Talk to someone and get your mind off work for a while.

Talk about anything, from casual chatting to a deep conversation about something you really care about. You will be surprised at how the short encounter can be rejuvenating in its own way.

5. Forget about trying to be perfect.

If you are in a rut, the last thing you want to do is step on your own toes with perfectionist tendencies.

Just start small. Do what you can, at your own pace. Let yourself make mistakes.

Soon, a little trickle of inspiration will come. And then it’ll build up with more trickles. Before you know it, you have a whole stream of ideas.

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6. Paint a vision to work towards.

If you are continuously getting in a rut with your work, maybe there’s no vision inspiring you to move forward.

Think about why you are doing this, and what you are doing it for. What is the end vision in mind?

Make it as vivid as possible. Make sure it’s a vision that inspires you and use that to trigger you to action.

7. Read a book (or blog).

The things we read are like food to our brain. If you are out of ideas, it’s time to feed your brain with great materials.

Here’s a list of 40 books you can start off with. Stock your browser with only the feeds of high quality blogs, such as Lifehack.org, DumbLittleMan, Seth Godin’s Blog, Tim Ferris’ Blog, Zen Habits or The Personal Excellence Blog.

Check out the best selling books; those are generally packed with great wisdom.

8. Have a quick nap.

If you are at home, take a quick nap for about 20-30 minutes. This clears up your mind and gives you a quick boost. Nothing quite like starting off on a fresh start after catching up on sleep.

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9. Remember why you are doing this.

Sometimes we lose sight of why we do what we do, and after a while we become jaded. A quick refresher on why you even started on this project will help.

What were you thinking when you thought of doing this? Retrace your thoughts back to that moment. Recall why you are doing this. Then reconnect with your muse.

10. Find some competition.

Nothing quite like healthy competition to spur us forward. If you are out of ideas, then check up on what people are doing in your space.

Colleagues at work, competitors in the industry, competitors’ products and websites, networking conventions.. you get the drill.

11. Go exercise.

Since you are not making headway at work, might as well spend the time shaping yourself up.

Sometimes we work so much that we neglect our health and fitness. Go jog, swim, cycle, whichever exercise you prefer.

As you improve your physical health, your mental health will improve, too. The different facets of ourselves are all interlinked.

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Here’re 15 Tips to Restart the Exercise Habit (and How to Keep It).

12. Take a good break.

Ruts are usually signs that you have been working too long and too hard. It’s time to get a break.

Beyond the quick tips above, arrange for a 1-day or 2-days of break from your work. Don’t check your (work) emails or do anything work-related. Relax and do your favorite activities. You will return to your work recharged and ready to start.

Contrary to popular belief, the world will not end from taking a break from your work. In fact, you will be much more ready to make an impact after proper rest. My best ideas and inspiration always hit me whenever I’m away from my work.

Take a look at this to learn the importance of rest: The Importance of Scheduling Downtime

More Resources About Getting out of a Rut

Featured photo credit: Joshua Earle via unsplash.com

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