Unlike sleep terrors, nightmares occur during REM sleep, or vivid
dreaming. Thus they are more memorable, complex and coherent. During a nightmare breathing, heart rate and sweating increase but the thrashing around that is sometimes shown in films
doesn’t happen because the person is in REM paralysis.157 Nightmares will be remembered only if the person wakes up.
People try to interpret nightmares in the same way they do dreams158 and many possible interpretations are possible.
Retelling a nightmare can be therapeutic.
Nightmares can be common throughout childhood and the teenage years and their frequency seems to increase across the age span from 12 to 21.
About a third of University students report having nightmares at least once a month. Reports are more likely in females across all ages. While
nightmares can be very frightening, they very rarely in themselves suggest
156 See sleep drunkenness in the previous question
157
a medical problem. In many cases they happen for no particular reason, although being sleep deprived does make them more likely. They may occur with certain medications that can lead to a REM rebound.159 Some illegal drugs,160 alcohol,161 cold and flu tablets, anti smoking (nicotine) patches and sleeping tablets, for example, can lead to nightmares during use or when stopping. We know that in some cases recurring, intense nightmares162 can follow a traumatic experience and may suggest the person is under a lot of stress. If this is the case they should seek help for their waking stress and anxiety.163 If nightmares are causing a problem then getting plenty of sleep is also important. Writing out the events of a recurring nightmare or retelling it to others seems to have a therapeutic effect, reducing the emotion associated with the nightmare. Some dream researchers argue that if a troubled person has a dream that wakes them up, especially a recurring nightmare, they should retrieve the last image of that dream and create a more positive ending. For example if a person felt overwhelmed by an event they should try to dream of themselves being resourceful and changing things so they can cope. A similar idea is behind hypnosis therapy. Through hypnosis the person is taught how to change their frightening dreams and may even invent some clever, dramatic events or a “protector” in their dreams to keep them safe.164 Case Study 6.2 describes the successful treatment of a recurring nightmare using such a technique.
158 See Chapter 7 for more on dream interpretation
159 See Q4.7 about sleeping tablets and REM rebound (Box 4.3)
160 See Q3.6 for information on drugs
161 see Q3.4 for more on alcohol and sleep
162 See Q7.18 about recurring dreams
163 See Q3.14 about stress and its effects
Case Study 6.2165
Sabina came to the psychologist complaining of a recurring, frightening nightmare that had begun two years earlier when she was first separated from her live in boyfriend. They happened two or three times a week and she found it hard to sleep after being awoken by it, so she often felt tired during the day. The nightmare went like this: She hears a noise and realises that a man is breaking into her flat. She flees out the back door, but the man, who is large and dressed all in black clothing with a black stocking mask, chases her. He is carrying a large knife and she is terrified. She runs until she is exhausted but the man is still there and approaches her with the knife raised. She feels she is going to be murdered and awakes frightened and shaking. The psychologist felt that it was appropriate to try to treat Sabina using hypnosis. A guided self-hypnotic approach was used, where Sabina was taught the technique in the clinic and played a tape recording to herself prior to bedtime. This tape led her into a state of deep relaxation and then suggested to her that since it was her nightmare she could control the outcome in any way she wished. She could try to escape from the man, or trap him. One suggestion was that if she ran in a different direction from the one she usually ran in, she would come to a deserted fun park. In this fun park she could lure him into the Hall of Mirrors where he would be confused by all the images of her, and she could escape, locking the door behind her. The tape suggested that she replay her nightmare in her mind while still awake, as if it were on TV and change the ending to allow her to escape. She should then do the same thing if she experienced the nightmare once asleep.
Sabina reported that the nightmare happened during the next week, but was not as intense as it normally was and she had a feeling of control. She enjoyed luring the attacker into the Hall of Mirrors and reported that in her dream she had called the police and he had been taken away and locked up. Follow up sessions helped her with overall relaxation166 and coping with any setbacks.
She continued to listen to the tape for a few weeks and reported no further nightmares on that theme. Over the next three months Sabina continued with the self hypnosis and had some other dreams that made her anxious, but she used the same technique of manipulating the outcome of the dream to a harmless conclusion.
165 Based on a case study in Kennedy (2002).