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Sleep is undoubtedly an important part of daily life and crucial for restoring and revitalizing the body. It indicates a period where the mind and body relax to maximize the healing process. However, people with a history of a traumatic past can experience significant changes in their sleep patterns, often getting in the way of this much-needed relaxation and rest. This is particularly true for people diagnosed with complex posttraumatic stress disorder (CPTSD), who frequently experience nightmares where they re-live their trauma.
The prevalence of CPTSD nightmares is supposedly higher in people with co-existing mental health disorders. For them, these nightmares may occur multiple times a week and are often distressing enough to disrupt the underlying sleeping patterns. However, with the latest research, it is possible to keep these CPTSD nightmares under control and continue to lead a high-quality life.
Complex PTSD and Nightmares: An Overview
Surveys suggest that nearly 8 million people across the United States have been diagnosed with PTSD. The condition can lead to a variety of symptoms, such as the following:
- Feeling like they are re-experiencing the traumatic event
- Frequently having thoughts about the traumatic event
- Being constantly on alert
- Increased negative feelings
- Being easily startled
- Avoiding triggers that remind them of the trauma
Nightmares are one of the most common re-experiencing symptoms for most people with PTSD. Studies suggest that the prevalence of these nightmares for people with PTSD can sometimes go as high as 72%. Following are some of the most commonly reported contents of nightmares:
Replaying the traumatic experiences in the sequence they happened
Experiencing the exact emotions felt during the time of trauma
Going through similar situations or experiences
What Causes CPTSD Nightmares?
Experts theorize dreams as an essential part of the sleep process as they help people store learning experiences and memories. Research also strongly supports this theory, suggesting that dreams are experienced when the brain is busy processing the emotionally intense experiences of everyday life. Due to this phenomenon, many researchers believe that dreams are a way to dampen the effects of an overwhelming situation.
When it comes to CPTSD-associated nightmares, these dreams may seem as terrifying as the original trauma-inducing event. Unfortunately, the association between PTSD and nightmares remains unclear so far. Some believe that these nightmares are the sleeping version of reliving the past traumatic event. In contrast, these experiences occur in the form of flashbacks when the person is awake. The cause of these intrusive nightmares is thought to be the changes PTSD can induce in certain brain areas involved in the regulation of memory recall and fear response.
CPTSD can potentiate a state of hypersensitivity in the brain, which may make it fixate on traumatic events and keep them fresh in a person’s memory. When these memories constantly remain in an individual’s mind, they are more likely to experience nightmares about them. Further research conducted on animal models has confirmed that traumatic stress can induce changes in specific neural pathways in a brain affected by PTSD. These altered pathways can trigger nightmares by impacting emotional responses and memory recall in certain ways.
Complex PTSD and Nightmares: What are the Impacts?
Nightmares related to trauma typically occur during REM sleep when most people experience vivid dreams. When a person wakes up from these nightmares, they can experience panic, sadness, frustration, distress, anxiety, or fear. Moreover, some also wake up drenched in sweat with a pounding heart because some nightmares can be highly distressing.
Due to the high-stress levels associated with CPTSD nightmares, a patient may start fearing sleep or attempt to aid their sleep by using drugs, drinking, or taking too much of their prescribed medication. Additionally, they may also adopt the following behaviors:
- Staying up late
- Avoiding sleep as much as possible
- Leaving the lights or the TV on at night
Nightmares can also negatively affect the overall quality of sleep, making it difficult to fall or stay asleep. Due to the consequent poor sleep, all aspects of life take a hit, leading to problems like anxiety, mood swings, and irritability. This vicious cycle continues as poor sleep generates problems, further exacerbating the sleep issues while adding to the underlying PTSD. The cycle also keeps feeding itself as it leads to many issues that act as potential triggers for PTSD nightmares, such as stress, medications, sleep deprivation, and substance use.
Can You Manage Complex PTSD and Nightmares Together?
Living with Complex PTSD and nightmares can be extremely challenging, especially when it keeps disturbing your sleep consistently. Fortunately, there are many ways to manage CPTSD nightmares and the background trauma triggering these episodes. For this purpose, experts may use one or more of the following interventions:
Trauma-focused psychotherapy is widely used to prevent and manage PTSD nightmares. This type of therapy takes place in a controlled and safe environment under the supervision of a trained professional. Following are some subtypes of trauma-focused psychotherapy that may benefit a person with CPTSD nightmares:
Cognitive behavioral therapy: Also known as CBT, this psychotherapeutic approach focuses on the connections between a person’s emotions, thoughts, and behavior. CBT can help a patient visualize their nightmares as learned responses that can be changed through the right support.
- Image reversal therapy: Also known as IRT, image reversal therapy is an effective and brief yet well-tolerated treatment to manage CPTSD nightmares. It includes recalling the nightmares and writing them down while changing certain parts of the storyline or the overall theme. The aim is to make the dream more positive and less traumatic. Once the dream becomes positive, an individual is advised to act out the altered version in an attempt to displace the original dream when it is re-experienced. IRT takes place daily during waking hours for at least 10 to 20 minutes. Studies suggest that it can improve overall sleep quality while reducing disturbing sleep and improving PTSD symptoms by 60%.
- positive effects were also maintained at three- and six-month follow-ups.
- Exposure, relaxation, and rescripting therapy (EERT): This therapy is similar to IRT in a way that it educates people about their nightmares and trauma. After being exposed to the memories of their dreams, a patient acquires various relaxation strategies and changes the content of their nightmares to reduce the trauma they cause. EERT also helps people improve their sleep hygiene to make their sleep quality better.
In addition to the types of therapy mentioned above, experts may add the following additional ones to better control the underlying CPTSD.
- Eye movement desensitization and reprocessing: EMDR therapy is a neurological-based treatment that activates specific mechanisms in the body to process trauma in a better way. It helps patients identify and discuss a traumatic memory while making quick back-and-forth movements similar to the ones they make during the REM stage of sleep.
- Lucid dreaming therapy: During a lucid dream, the dreamer is aware that they are dreaming and can control what happens during an active episode. What this means is someone with PTSD can change the course of what happens in their dreams and wake up when they become too traumatic. Consequently, lucid dreaming therapy gives people a sense of self-responsibility and self-control in addition to reassuring them that they are not in physical danger. Lucid dreaming therapy is a unique type of treatment as it happens when a person is actively having a nightmare. Experts believe that this therapy can reduce the level of distress a PTSD nightmare may cause.
Maintaining sleep hygiene is essential for people experiencing PTSD nightmares. This may involve the following tips and tricks:
- Taking a warm shower before going to bed
- Sleeping in a safe environment
- Avoiding eating large, greasy meals, alcohol, or caffeine before bedtime
- Turning off electronic devices at least an hour before going to sleep
- Keeping the room cool, dark, and quiet and using a nightlight if needed
- Developing a relaxing routine before bedtime
- Only use the bed for intimacy and sleep and avoid other activities, like watching TV or using electronic devices.
Playing violent or aggressive video games can act as a type of exposure therapy for people with past trauma, according to research. Playing a game related to trauma can also help people manage their PTSD symptoms by giving them a sense of control. The research on the benefits of video games for people with PTSD is limited and still in preliminary phases.
Research suggests that living with a chronic pain disorder can sometimes increase the frequency of experiencing nightmares with PTSD. Management of pain through physical therapy, supplements, medication, and relaxation techniques can lower the frequency of these nightmares.
Aromatherapy with essential oils has been a go-to therapy for people with high stress and anxiety levels. Research suggests that having pleasant odors while sleeping can drastically improve sleep quality, especially in people with PTSD. However, the opposite may be true in terms of nightmares, as familiar smells can sometimes increase the chances of having one. According to researchers, this is because the area in the brain related to smell is very close to the regions responsible for processing memory and emotions. Experts encourage patients to use essential oils during wake hours to check if they relax their minds. However, if there is any doubt, consider dropping the idea altogether.
Journaling about Nightmares
Journaling about nightmares is essential to overcome their distressing effects on the mind and body. The technique is commonly used in a therapy called image rehearsal therapy, where a patient writes down their nightmares and changes their content to make them more positive. Eventually, the positive version replaces the negative one to give them more control over their life.
Why does CPTSD affect dreams?
Experts suggest that CPTSD dreams occur when someone tries to make sense of their guilt and anxiety from the traumatic experience. These nightmares are a way to process trauma while avoiding activating the defense mechanisms. The deference mechanism gets triggered in a normal person every time they experience trauma but switches off when the stressor goes away. However, in people with PTSD, this switch is chronically activated, leading to a higher level of hyperarousal at all times during the day and night. This hyperarousal also causes imbalances in the brain structure that regulate mood.
Can you get PTSD from a dream?
Waking up from a nightmare can be distressing and scary. However, scientists are not sure whether this can trigger trauma or PSD. Some research suggests that nightmares can speed up the process of acquiring PTSD while strengthening the trauma-associated symptoms. For instance, people who already experience nightmares before acquiring PTSD are likely to suffer from more severe symptoms associated with this disorder.
Are CPTSD nightmares and flashbacks the same?
Both nightmares and flashbacks refer to intrusive symptoms of PTSD, which cause a person to relive their traumatic experiences. Despite being similar, the two phenomena have many underlying differences, such as the following:
- Flashbacks are dissociative, making a person feel like they are reliving the trauma in the present. These events occur while a person is awake.
- Nightmares, on the other hand, occur when a person is asleep and the mind knows that it is not real.
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3 Carras MC, Kalbarczyk A, Wells K, Banks J, Kowert R, Gillespie C, Latkin C. Connection, meaning, and distraction: A qualitative study of video game play and mental health recovery in veterans treated for mental and/or behavioral health problems. Social Science & Medicine. 2018 Nov 1;216:124-32.