More than 1,600 members of the PTSD community on have reported experiencing severe nightmares, and there are dozens of forum threads tagged with topic. So, we took a deeper dive into PTSD nightmares and some of the research-backed approaches you can try to help manage them.
How common are nightmares after trauma?
The quick answer: Very common.
- According to one study, 71% to 96% of people with PTSD experience nightmares. And the number is even higher for those also living with another mental health condition like panic disorder.
- At least 50% of people with PTSD suffer from nightmares that incorporate elements or contain exact replications of a traumatic event (these are called replicative nightmares).
- An additional 20-25% experience post-traumatic nightmares that don’t exactly replay the trauma memory, but are symbolically related to the traumatic event.
Why do PTSD nightmares happen?
Scientists have been studying dreams for years, but they still don’t fully understand how or why we dream.
Matthew Walker, a psychology researcher at the University of California, Berkeley, has one theory. Walker found that during rapid eye movement (REM) sleep, the chemistry of the brain actually changes. Levels of norepinephrine — a kind of adrenaline — drop out completely. REM sleep is the only time of day when this happens. In people not living with PTSD, REM sleep is kind of like therapy; it’s an adrenaline-free environment where the brain can process its memories while stripping away the emotional edges.
Walker’s theory suggests that in people with PTSD, REM sleep is broken. The adrenaline doesn’t go away like it’s supposed to. The brain can’t process tough memories, so it just cycles through them, again and again. This theory is being put to the test: The VA is currently running several clinical trials on prazosin, a drug that lowers sensitivity to adrenaline. Check out this page to see if there’s a trial in your area.
Treatments for PTSD nightmares
- Imagery rehearsal therapy (IRT) – This approach helps people change how their nightmare ends by reimagining it while they are awake. The idea is that by changing the storyline of the dream to something not scary, your nightmare becomes less upsetting and occurs less often.
- Prazosin – Mentioned above, prazosin is currently in clinical trials to evaluate its effectiveness for treating PTSD nightmares. In the few trials that have been conducted, results have been positive. In one 15- week study involving 67 active duty soldiers with PTSD, prazosin was found to improve trauma-related nightmares and sleep quality and reduce PTSD symptoms. See what PatientsLikeMe members have said about taking prazosin for nightmares.
Here are 5 common treatments members of the PatientsLikeMe PTSD community have tried in order to manage insomnia :
- Zolpidem (sedative-hypnotic)
- Trazodone (antidepressant)
- Quetiapine (antipsychotic)
- Mirtazapine (antidepressant)
- Amitriptyline (antidepressant)
Interested in finding out more about what other people living with PTSD are trying in order to manage their condition? Join PatientsLikeMe and become part of a community of others like you.
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