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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 Cope with Anxiety at Work: 5 Psychology Techniques How to Cultivate a Positive Mindset (A Step-By-Step Guide) How to Manage Anxiety: Sound Advice from a Mental Health Expert

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Last Updated on November 9, 2020

10 Real Reasons Why Breaking Bad Habits Is So Difficult

10 Real Reasons Why Breaking Bad Habits Is So Difficult

Bad habits expose us to suffering that is entirely avoidable. Unfortunately, breaking bad habits is difficult because they are 100% dependent on our mental and emotional state.

Anything we do that can prove harmful to us is a bad habit – drinking, drugs, smoking, procrastination, poor communication are all examples of bad habits. These habits have negative effects on our physical, mental, and emotional health.

Humans are hardwired to respond to stimuli and to expect a consequence of any action. This is how habits are acquired: the brain expects to be rewarded a certain way under certain circumstances. How you initially responded to certain stimuli is how your brain will always remind you to behave when the same stimuli are experienced.

If you visited the bar close to your office with colleagues every Friday, your brain will learn to send you a signal to stop there even when you are alone and eventually not just on Fridays. It will expect the reward of a drink after work every day, which can potentially lead to a drinking problem.

Kicking negative behavior patterns and steering clear of them requires a lot of willpower, and there are many reasons why breaking bad habits is so difficult.

1. Lack of Awareness or Acceptance

Breaking a bad habit is not possible if the person who has it is not aware that it is a bad one.

Many people will not realize that their communication skills are poor or that their procrastination is affecting them negatively, or even that the drink they had as a nightcap has now increased to three.

Awareness brings acceptance. Unless a person realizes on their own that a habit is bad, or someone manages to convince them of the same, there is very little chance of the habit being kicked.

2. No Motivation

Going through a divorce, not being able to cope with academic pressure, and falling into debt are instances that can bring a profound sense of failure with them. A person going through these times can fall into a cycle of negative thinking where the world is against them and nothing they can do will ever help, so they stop trying altogether.

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This give-up attitude is a bad habit that just keeps coming around. Being in debt could make you feel like you are failing at maintaining your home, family, and life in general.

If you are looking to get out of a rut and feel motivated, take a look at this article: Why Is Internal Motivation So Powerful (And How to Find It)

3. Underlying Psychological Conditions

Psychological conditions such as depression and ADD can make it difficult to start breaking bad habits.

A depressed person may find it difficult to summon the energy to cook a healthy meal, resulting in food being ordered in or consumption of packaged foods. This could lead to a habit that adversely affects health and is difficult to overcome.

A person with ADD may start to clean their house but get distracted soon after, leaving the task incomplete, eventually leading to a state where it is acceptable to live in a house that is untidy and dirty.

The fear of missing out (FOMO) is very real to some people. Obsessively checking their social media and news sources, they may believe that not knowing of something as soon as it is published can be catastrophic to their social standing.

4. Bad Habits Make Us Feel Good

One of the reasons it is difficult to break habits is that a lot of them make us feel good.[1]

We’ve all been there – the craving for a tub of ice cream after a breakup or a casual drag on a joint, never to be repeated until we miss how good it made us feel. We succumb to the craving for the pleasure felt while indulging in it, cementing it as a habit even while we are aware it isn’t good for us.

Overeating is a very common bad habit. Just another pack of chips, a couple of candies, a large soda… none of these are necessary for survival. We want them because they give us comfort. They’re familiar, they taste good, and we don’t even notice when we progress from just one extra slice of pizza to four.

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You can read this article to learn more: We Do What We Know Is Bad for Us, Why?

5. Upward Comparisons

Comparisons are a bad habit that many of us have been exposed to since we were children. Parents might have compared us to siblings, teachers may have compared us to classmates, and bosses could compare us to past and present employees.

The people who have developed the bad habit of comparing themselves to others have been given incorrect yardsticks for measurement from the start.

These people will always find it difficult to break out of this bad habit because there will always be someone who has it better than they do: a better house, better car, better job, higher income and so on.

Research shows that in the age of social media, social comparisons are much easier and can ultimately harm self-esteem if scrolling becomes a bad habit[2].

6. No Alternative

This is a real and valid reason why breaking bad habits is difficult. These habits could fulfill a need that may not be met any other way.

Someone who has physical or psychological limitations, such as a disability or social anxiety, may find it hard to quit obsessive content consumption for better habits.

Alternately, a perfectly healthy person may be unable to quit smoking because alternates are just not working out.

Similarly, a person who bites their nails when anxious may be unable to relieve stress in any other socially accepted manner.

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7. Stress

As mentioned above, anything that stresses us out can lead to adopting and cementing an unhealthy habit.

When a person is stressed about something, it is easy for bad habits to form because the mental resources required to fight them are not available[3].

We often see a person who had previously managed to kick a bad habit fall back into the old ways because they felt their stress couldn’t be managed any other way.

If you need some help reducing stress, check out the following video for some healthy ways to get started:

8. Sense of Failure

People looking to kick bad habits may feel a strong sense of failure because it’s just that difficult.

Dropping a bad habit usually means changes in lifestyle that people may be unwilling to make, or these changes might not be easy to make in spite of the will to make them.

Overeaters need to empty their house of unhealthy food, resist the urge to order in, and not pick up their standard grocery items from the store. Those who drink too much need to avoid the bars or even people who drink often.

If such people slip even once with a glass of wine, or a smoke, or a bag of chips, they tend to be excessively harsh on themselves and feel like failures.

9. The Need to Be All-New

People who are looking to break bad habits feel they need to re-create themselves in order to break themselves of their bad habits, while the truth is the complete opposite.

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These people actually need to go back to who they were before they developed the bad habit and try to create good habits from there.

10. Force of Habit

Humans are creatures of habit, and having familiar, comforting outcomes for daily triggers helps us maintain a sense of balance in our lives.

Consider people who are used to lighting up a cigarette every time they talk on the phone or eating junk food when watching TV. They will always associate a phone call with a puff on the cigarette and screen time with eating.

These habits, though bad, are a source of comfort to them, as is meeting with those people they indulge in these bad habits with.

Final Thoughts

These are the main reasons why breaking bad habits is difficult, but the good news is that the task is not impossible. Breaking habits takes time, and you’ll need to put long-term goals in place to replace a bad habit with a good one.

There are many compassionate, positive and self-loving techniques to kick bad habits. The internet is rich in information regarding bad habits, their effects and how to overcome them, while professional help is always available for those who feel they need it.

More on Breaking Bad Habits

Featured photo credit: NORTHFOLK via unsplash.com

Reference

[1] After Skool: Why Do Bad Habits Feel SO GOOD?
[2] Psychology of Popular Media Culture: Social comparison, social media, and self-esteem.
[3] Stanford Medicine: Examining how stress affects good and bad habits

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