'Inception' in Real Life? Researchers Rewrite Nightmares of PTSD Patients
Dreamers Can Incubate Their Own Narratives to End the Terror, Say Sleep Experts
By SUSAN DONALDSON JAMES
Aug. 2, 2010
Two years ago, self-defense fight instructor Laurie Gotcher suffered a concussion during training and since has developed nightmares so extreme that they seem to continue long after waking up.
The Austin, Texas, mother has jumped out of bed in terror thinking someone was in the house and grabbed a knife to look for the threat in her dreams.
"I have no idea how to control the fear or anger that comes from the dreams "The biggest, most recurring nightmare is when something happens to my child and a stranger threatens my home, but that's the nature of my business," said Gotcher, 36. "It's a hellish experience."
She has sought sleep studies, advice from doctors and medications, but nothing has worked.
"I am so open to trying anything," she said.
Now, researchers say they have a better understanding of sleep disorders and can often help those like Gotcher whose waking lives are traumatized by the Technicolor terror that reigns at night. In a scenario oddly reminiscent of the Hollywood film "Inception," dream researcher Deirdre Barrett, uses "lucid dreaming" techniques along with behavioral therapy to help patients gain control over their subconscious.
"You can tell yourself at bedtime that you want to dream on a particular topic -- that you want to be lucid in your dream, realize you're dreaming," said Barrett, a psychologist at Harvard University. "People who have had bad nightmares may want to script a different outcome, a kind of mastery dream to replace the nightmares."
One of her patients dreams a black line is chasing her or that she is falling. Barrett is trying to change the terrifying ending into a happy one.
"Say to yourself as you're falling asleep some phrase like tonight if I fall in my dreams I want to fly instead," Barrett tells her.
Since the dawning of mankind, dreams have been viewed as some kind of window to the soul. Central to mythology and literature, they are thought to reveal God-like secrets and even portend cataclysmic events. Of all life's nourishment, sleep "knits up the ravell'd sleeve of care, according to Shakespeare's "Macbeth."
But many Americans don't find sleep restful or nourishing. Seventy million of them have a sleep disorder, according to the American Academy of Sleep Medicine.
Nightmares Affect Up to 8 Percent of Adults
Nightmares , which are more common in children, affect about 4 to 8 percent of adults, sometimes as often as once a week or more. They can make insomnia worse and even cause psychiatric distress. Some of the most important research is coming from studies of the rising number of war veterans suffering from post-traumatic stress -- 90 percent of whom have nightmares.
"Most people with PTSD have insomnia and nightmares. It's almost a given," said Dr. Barry Krakow, director of the PTSD Sleep Clinic at Maimonides Sleep Arts and Sciences center in Albuquerque, N.M. "The effects are devastating for them and others."
Post Traumatic Stress Patients Rescript Their Dreams
While they are awake, patients take a few minutes to create a new dream script. He asks one of his patients to change a demonic black racing car with giant eyeballs to a white Cadillac with bubbles, gently tooling along.
His studies show that this new cognitive therapy can help reduce the frequency and intensity of nightmares and perhaps even end them altogether.
Krakow's PTSD research has implications on all people with sleep disorders. In studies of more than 1,000 patients with post-traumatic stress symptoms, he found 5 to 10 other sleep problems may be involved, including high rates of sleep apnea.
"There's a connection a lot of people are missing in the complexity of PTSD sleep disturbance," said Krakow. "Everybody thinks these kinds of people have psychological issues. What we learned is there is a tremendous physiological component."
"What is being missed by many people is breathing disorders or sleep movement disorders all run together," he said. "It's not one thing."
Sleep disorders are serious business, according to Krakow. Those with nightmares can "actually act out their dreams and move around and hurt somebody."
Such is the case with Gotcher, who said her brain "feels like it's in a war, even in a conscious state."
"My training is so realistic to me, I can't turn it off and on in my sleep," she said. "I can do things with my body that are very harmful to other people, and I could not live with myself if I hurt my husband and my daughter."
Parasomnias are some of the most misunderstood of all human behaviors. In REM (rapid eye movement) behavior disorder, sleepers can react in direct response to a dream and hurt their bedmates.
Dreams -- good and bad -- occur during REM sleep, and escalate during the final third of the night, according to Dr. Matthew Ebben, assistant professor of neurology and neuroscience at New York Presbyterian/Weill Cornell Medical Center.
"Nobody exactly knows why we dream," he said. "But there are two theories."
One theory, activation synthesis, suggests that during REM random brain activation occurs, which accounts for the bizarre narrative of dreams.
The other theory, which supports Krakow's work, posits that dreams originate in the frontal lobe of the brain -- or the thinking center -- and sleepers can experience "lucid dreaming."
"It's like the old Freddie Kruger movies," he said. "People are learning they can have more control of their dreaming."
Some psychologists challenge dream control techniques, saying dreams impart psychological meaning and should never be interrupted.
But Ebben, who is also a psychologist, argues, "relief of the symptoms should be the primary focus in most cases and not the origination of problems," he said. "Trauma patients are suffering."
Sleep Apnea, Brain Injuries Can Cause Nightmares
As for Gotcher, her night terrors have taken a toll on her waking life. She has tried muscle relaxants, Valium, sleeping pills, acupuncture and biofeedback.
Gotcher said she even bought a book and tried rewriting her dreams herself, but it didn't work, "but I would love to be proved wrong."
Some of her dreams recur 15 or 20 times a night, usually revolving around four themes: falling, an airplane, a house intruder after her 10-year-old daughter and outer space.
"It seems odd, but some of the scariest things are irrational," she said. "I am in the grocery store locked in and I can't get out, and the bad guy is in the store with me."
But in the worst night terrors, she believes someone is in the home.
"Sometimes, I can tell I am moving and cannot wake up," she said. "My spouse said I just start crying, like I send him a signal to help wake me up. But I don't respond."
The only clue she has found to her own condition has come reading about football players who experienced nightmares after head injuries.
That makes sense, according to Patrick McNamara, author of "Nightmares: The Science and Solution of Those Frightening Visions During Sleep."
Concussions, which can cause dysfunction of the brain's frontal lobe, can frequently cause sleep disorders. As Krakow's work suggests, the same can happen when the brain is deprived of oxygen in sleep apnea.
Nightmares are tied to over-activity in the amygdala, which is regulated by the front lobes in the brain.
"The amygdala is specialized to handled negative emotions -- fear and aggression, but mostly fear," said McNamara, who is director of evolutionary neurobehavior laboratory at the Boston University School of Medicine.
The highest amygdala activation levels during the course of the day are during REM sleep.
"REM produces negative emotions and dreams defang that emotion," said McNamara. "Dreams get rid of the access emotion and when that breaks down, you get a nightmare."
With trauma victims, "that huge carriage of emotions has to go somewhere, and the REM system can only process so much of it at a time and it shuts down," he said. "All the amygdala is in hyperdrive. There is no regulatory system handling the process."
Nightmares can also be caused by genetic vulnerability, hormones, sex and sometimes antidepressants.
As for Gotcher, she is desperate for relief from the unending nightmares and night terrors.
"I have gotten to the point a couple of times when my lack of sleep made me feel psychotic, where I actually was concerned about my own mental fitness," she said.
For her, these new techniques sound intriguing.
At this point, she will try anything.
"I am determined to get better to live a well life," she said, "and that means having sleep."
Sidebar: How to Try it Out
Try Deirdre Barrett's "incubation" techniques for problem solving dreams from her book, "The Committee of Sleep:" Write down the problem as a brief phrase of sentence and place this by the bed.
Review the problem for a few minutes just before going to bed.
Once in bed, visualize the problem as concrete image if it lends itself to this.
Tell yourself you want to dream about the problem just as you is drifting off to sleep.
Keep a pen and paper -- perhaps also a flashlight or pen with a lit tip -- on the night table.
Upon awakening, lie quietly before getting out of bed. Note whether there is any trace of a recalled dream and invite more of the dream to return if possible. Write it down.
If you want to be more elaborate, incubation can include:
At bedtime, visualize yourself dreaming about the problem, awakening and writing on the bedside note pad.
Arrange objects connected to the problem on the night-table or on the wall across from bed if they lend themselves to a poster.