Nightmares

Most nights, I am visited by nightmares. They range from “being chased by a crazed murderer” to “being swallowed by a tsunami” to “I’m late for a test in a class I didn’t know I have” to “It’s been a mistake, my mom/dad/cat didn’t actually die.” I wake up feeling sad, depressed, scared, and unrested. And so I wondered: What causes nightmares?

Originally (c. 1200s), the word nightmare referred to something tangible: an incubus or goblin who tormented the sleeper by suffocating them. By the 1500s, the word meant not the creature, but the feeling. Its current meaning only dates from 1829. (“Mare” comes from a word meaning “goblin or incubus” and is not related to “female horse.”)

Most people will have nightmares at some point, and as a sleep disorder, nightmares affect about 5% of the population.

In an article published in the journal Sleep, University of Montreal researchers defined nightmares as, “Dreams intense and disturbing enough to wake you up.” If you don’t wake up, it’s just a bad dream. Nightmares don’t necessarily leave one feeling scared; they can lead to feelings of sadness or guilt. The survey reports:

Physical aggression was the most frequently reported theme in nightmares, whereas interpersonal conflicts predominated in bad dreams. Nightmares were rated by participants as being substantially more emotionally intense than were bad dreams. Thirty-five percent of nightmares and 55% of bad dreams contained primary emotions other than fear. When compared to bad dreams, nightmares were more bizarre and contained substantially more aggressions, failures, and unfortunate endings.

The Mayo Clinic explains that nightmares tend to decrease with age, and that after age 13, girls have them more often than boys. Other studies suggest the rates are statistically insignificant, and at least as teens, boys and girls have nightmares at close to the same rate. Women tend to be able to remember their dreams better, though, so that may account for the difference. In fact, men and women tend to dream differently; male dreams tend to be more aggressive and about strangers. The University of Montreal researchers, Geneviève Robert and Antonio Zadra, found that men’s nightmares were about natural disasters, but women’s were about interpersonal conflicts.

The University of Maryland Medical Center offers some likely nightmare causes:

• A major life event, such as the loss of a loved one or a traumatic event
• Increased stress at home or work
• A new drug prescribed by your health care provider
• Abrupt alcohol withdrawal
• Drinking too much alcohol
• Eating just before going to bed
• Illegal street drugs
• Illness with a fever
• Over-the-counter sleep aids and medicines
• Stopping certain drugs, such as sleeping pills or narcotic pain pills

Repeated nightmares may also be a sign of:

• Breathing disorder in sleep (sleep apnea)
• Post-traumatic stress disorder (PTSD)
• More severe anxiety disorders or depression
• Sleep disorder (for example, narcolepsy or sleep terror disorder)

Last summer, I asked my general practitioner about nightmares; it was the first time I had talked to an MD instead of a psychiatrist or psychologist about it. Her best guess was sleep apnea (I don’t show any of the symptoms, though). Since I’ve seen various therapists over the years for anxiety and depression, those are likely causes, yet the advice I was given has proved unhelpful (think about happy things before bed, try lucid dreaming). Which is what prompted this article in the first place: am I missing something?

I’ve finally gotten a referral to a sleep specialist, but it’ll be some weeks before I can even get in to see him/her.

When any dream reoccurs, it’s only natural to look for signs or meanings. I loved dream dictionaries as a teenager, and in college, I had the honor to work as a research assistant on Carole Levin’s book Dreaming the English Renaissance: Politics and Desire in Court and Culture. To medieval Europeans, dreams were generally considered supernatural in nature, and usually sent by a devil or demon. (This idea can be found in Ancient Egypt, as well.) “Dream visions” were a popular genre of medieval literature, where a dreamer receives wisdom through visions. Into the Renaissance, many people still believed dreams and nightmares to be supernatural, but other voices, such as Thomas Nashe, suggested dreams were not real, or at least not caused by supernatural forces. When used in media, such as plays, dreams were a way to foreshadow that something bad would happen or had happened. Dream dictionaries were incredibly popular. Interestingly, they always assumed a male reader, whereas today I think dream interpretation is considered “feminine.”

As a teen, I desperately scoured my dreams for meaning. As an adult, I don’t think dreams have meaning per se, only that they can reveal what is already on one’s mind. That I’m anxious or depressed is not new information.

Ultimately, it’s not clear where in the brain dreams and nightmares originate (different parts of the brain are active depending on the stage of the sleep cycle). Even their purpose is unclear, though some suspect nightmares, at least, helped prepare our ancestors for threats they might face in the night. And bad dreams tend to be hereditary: “Nightmares were highly heritable and attributed to an additive genetic influence (51%).” My parents were both night owls and had trouble sleeping, but I don’t know if they had nightmares.

Interestingly, most dreams are bad, if not nightmares, so perhaps dreams in general are trying to prepare us for those contingencies. Bad dreams can allow the sleeper to deal with and process danger and other negative emotions. Nightmares are a failure of this system; the sleeper awakes and no resolution is achieved.

How to avoid or prevent nightmares is a list as long as what causes them:

• Lucid dreaming (waking up enough to realize it’s a dream and manipulate the dream world) or imagine a different ending of the dream after one is awake
• Avoid eating before bed
• Meditation or yoga
• Exercise
• Write/talk about the dream
• Avoid caffeine and alcohol

The British Cheese Board suggests eating a small amount of cheese.

I was hoping the Association for the Study of Dreams would have more to say, but alas, their advice is the same. They have a detailed resource list, though, for further reading. And a nightmare laboratory!

The Sleep Association also suggests hypnosis, which my GP suggested as well. There’s not a lot of data yet on the effectiveness of hypnosis; I’m willing to try it because at least that’s something, but I have my doubts as to whether it will really work.

I might try some cheese, too.