Nightmares in Anxiety Disorders
Nightmares are a common feature of anxiety disorders. They tend to be a frequent occurrence for those suffering with PTSD but are also experienced by those with other forms of anxiety.
1. What are nightmares?
Nightmares are dreams which are especially vivid and unpleasant and which frighten us for some reason. In doing so they cause raised negative arousal or fear which, in turn, wakes us feeling as if whatever it was just happened for real.
Nightmares usually happen when there is something scary going on in everyday life. For instance if we have been involved in an accident we might have a recurring bad dream about it. Or it might be that we soon have to do something which we are really anxious about doing and fear it will all go wrong. Frequently in these dreams everything turns out badly. They often reflect what it was we were afraid could have happened i.e. the worst case scenario.
Generally, if a nightmare causes us to wake up we then lie there going over it again in our heads, re-living it.
We usually remember nightmares because they wake us up. This happens because during the dream we experience fear (raised negative arousal). This in turn causes the survival instinct to act. Thinking we could be in danger, it wakes us up.
2. What happens in normal sleep?
Dreaming is normal. Even those people who claim thay don't dream, do. It's just that they don't remember it.
In normal sleep everyone dreams about five times a night. Sleep follows a pattern of cycles. As we go into and out of each cycle we go through a period of REM (rapid eye movement) sleep.
It is called REM because our eyeballs can be seen to move under closed eyelids at this time. This is when we dream.
Each of the first few sleep cycles takes us into a deeper sleep than the one before.
Therefore the deepest cycles are the middle ones. After that they get shallower again as we sleep towards our normal waking time. The diagram attempts to demonstrate these cycles.
Dreaming is normal and the way that our minds attempt to make sense of various issues that are going on in our lives. Unless we specifically train ourselves to remember and record our dreams we often only remember those which happen immediately before or just as we wake up.
Our brains respond to dreams in exactly the same way as they would if those things were happening for real. Some people even find that their bodies behave as if those things are really happening as well.
I recall one incident many years ago when I woke one morning to find my husband closely examining my legs. When I asked what he was doing, he sheepishly admitted that he had been dreaming that our dog was being attacked by a lion and that he had been defending it. In order to repel the lion he was kicking at it and he'd woken to find he was actually kicking me. Therefore he was checking for damage - thankfully there was none.
3. Why do nightmares happen?
Nightmares happen if we have been involved in an accident or something similar during which time we were very afraid.
They may also occur if we are worrying constantly about something unpleasant which might happen or which we have to face.
Sometimes people start having nightmares about something which happened many years ago and which they had not been deliberately thinking about. Memories which had been buried may be triggered by a TV programme or similar causing the events to be relived in dreams as our minds to try to sort it out.
Dreams are the mind's way of making sense of what happens for real. If we are worrying a lot about something which has happened to us in daily life, the mind tries to come to terms with it during sleep.
To the brain, what we imagine is just as real as what really happens. If we are spending a lot of time during our waking hours imagining unpleasant events, the mind is unable to come to terms with them them because they don't actually exist. So, instead, it tries to confront them in dreams - or nightmares.
The nightmares don't necessarily relate to whatever it is that is stressing us at the time, although if we have recently suffered a trauma, it is most likely we will dream about that.
4. Why do nightmares wake us up?
If you have read the section which describes the brain functions involved in the Cause of Anxiety you will be aware that any raised negative arousal - fear, worry, discomfort, pain, etc - will cause the survival instinct to try and alert us to danger. The survival instinct assumes that any negative input of this kind is dangerous and could therefore kill us. So it draws our attention to it. If we are asleep it will wake us up.
For the same reason pain and worry tend to keep us awake and can cause insomnia. The survival instinct is not going to allow us to go to sleep, and so drop our guard, when we are experiencing negative feelings or thoughts in case danger gets us.
To the brain, things we imagine are just as real as what is actually real and it responds in the same way to both.
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5. What to do if you have nightmares
Unfortunately when woken by a nightmare, almost everyone will then make the situation worse by going back over the nightmare in their minds and re-living it. As they do this they feel all the same negative feelings again.
To your survival instinct this is reinforcing the fact that the situation you just dreamt and are now imagining is a source of threat to your safety. Therefore your survival instinct is going to revisit it again and again util it works it out - that means more nightmares!
What to do on waking from a nightmare
1. You may start off by going over it in your head again. As soon as you realise you're doing that, refocus your thoughts onto something neutral or pleasant. For example you may just look out of the window and look at the stars, or notice how big the moon is etc.
2. Get out if bed - go to the toilet, go and get a cup of tea - all the while being mindful of real sensations (stroke the cat) that are either neutral or pleasant. Ground yourself in the present moment.
3. On returning to bed again you might do a directed meditation or just play some baroque largo music quietly in the background as you go back to sleep.
By doing this you are switching off your arousal system and not reinforcing the danger message.
Whenever the survival instinct sends out a danger warning it waits to see how we respond to it. If we hear the warning and get more afraid, the survival instinct steps up the action and puts us into fight or flight mode. In the case of nightmares this is not what we want.
When we get a warning and we don't respond with increased arousal but, instead, we become calmer, then the survival instinct starts to question whether it still needs to give warnings about whatever it was and takes a step back. In the case of nightmares, over time by refocusing calmly (see Calm Scene and Dead Weight for possible techniques to practise) the scary scenario loses it scariness and the brain no longer feels the need to sort it during nightmares.
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Common Symptoms of Anxiety