Backwards question: Anyone know good ways to increase nightmares? I personally find them more interesting than most of my other dreams, and almost never get to experience them.
I think it seems like a great resource. As I was reading, all the questions I had (like, "is he going to include the thing about melatonin and B vitamins?") were answered very soon after I had them. Only two exceptions to this to consider: 1) I think putting the PTSD caveat up front in the first or second paragraph would be smart, given that many people suffering from PTSD have nightmares and their treatment will likely be different so you might as well put that info out there early, and 2) inositol is another supplement that can cause nightmares in folks (esp. those who get nightmares with B and melatonin), so maybe include that?
I rarely dream and hadn't had nightmares since childhood, but started taking Singular after age 50. It triggered very bad nightmares for the first two weeks. One so vivid that I recall it in detail a year later. I was about to stop taking the medicine, but then the nightmares stopped with no recurrence in the last year. I recommend adding a reference to it as a possible trigger for nightmares.
It's such a foreign experience to me that most people have common themes in dreams, let alone nightmares. But I have a pretty strange central hypersomnia, so I think it makes my dreams more random and sort of hypnogogic-ish. Anyways, only real recommendation I might have is to give a good primer on sleep stages in general, both REM and NREM, but maybe that content belongs elsewhere.
I was just learning about Glycine as a treatment for anxiety, which I didn't know about. I know a doctor who prescribes it for that. It comes as a powder and the dose recommended is 2,000mg up to 2x/day. Vital Nutrients - Glycine Powder sells on Amazon for $25 and the dose recommended on it is 2-4,000mg. I'm going to try it out for anxiety and will report back.
I had a terrible recurring nightmare as a teen to young adult -- that was clearly related to trauma -- and finally stopped it with lucid dreaming, which I'd done on occasion without knowing how to consistently do it. The dream never returned after that one time I intervened in the midst of it.
I think every client I've ever had who had consistent trouble with nightmares also had PTSD symptoms from earlier trauma, so I like that you encourage people to find treatment for trauma. You might consider making that even clearer earlier on (I think it comes in middle of paragraph under item 3).
Most of my practice is with people who have anxiety, and the folks with anxiety and not so much trauma don't talk so much about nightmares. Your framing above emphasizes anxiety a lot more than trauma, which makes me interested to know if you see people who have a lot of trouble with nightmares who have anxiety alone.
I rarely have nightmares, and when I do, I usually wake up quickly. When I try to lucid dream, the dream sometimes "resists" my attempts to change it and increasing my mental "effort" tends to wake me up.
I'm not sure what resources exist at Lorien or elsewhere w/r/t this problem, but I think it would be appropriate to link or otherwise reference some specific guidance regarding anxiety disorders generally.
Anecdotally, from a non-psychiatrists perspective, nightmares are closely linked in the popular consciousness to PTSD. This is referenced in the post in passing, but I imagine many readers will be especially concerned with differentiating PTSD-related nightmares from other nightmares. Not a huge change, but it might be helpful to link to somewhere with guidance re: PTSD signs and symptoms.
I have had regular bad dreams since I was in a young enough to be in a cot. I'm 37 now so it's been a while. Around 6 y/o I used to physically pull my eyelids open to wake myself up out of nightmares. I have gone in and out of periods where lucid dreaming was available to me. The older (and less stressed) I get, the less reoccurring the themes are - though the intensity, cruelness, and randomness has increased. I have committed to all the sleep hygiene elements, dark/cool room; no eating/drinking/caffeine; meditation helps me get to sleep and possibly enjoy a few hours before the madness begins. I have tried IRT with a Sleep Psychologist with little effect due to the random nature of my dreams. I trialled Prazosin for 3 and 2 months respectively, a couple of years apart, with disastrous results both times. My nightmares were SIGNIFICANTLY worse on this medication. I dream anywhere from 2am until the time I wake up. Yes sadly, sleeping-in means increasingly random and intense nightmares. I can recall a lot of them with stupid specificity. I gave up writing them down because it was taking too long. Occasionally I'll talk about a theme if it's relevant with a Psychologist (i.e. no brakes on a car - feeling out of control). I wake up from sleep feeling absolutely rubbish EVERY DAY. I'm exhausted. My jaw hurts. This brings on corresponding headaches. If the nightmare is particularly bad, I sometimes clench my hands. Cue ongoing joint pain. I wake up in sweats often. I used to wake up crying or distressed a lot. Now I just sleep through or go back to sleep through the most horrific of dreams. Because I'm legit exhausted. How am I functioning during the day? Poorly, at best. I'll stay on the lookout for any new techniques or medications that are being trialled. Because at this present state, I've got my doctors stumped. (Context: Childhood trauma, 15+ years of psychotherapy, current meds: duloxetine, amitriptyline).
You mention stimulants, either as prescription medication or caffeine or nicotine, as one of the things that might make people's sleep worse.
Anecdotally, from my own experience and talking to friends, for people with ADHD taking stimulants during the day can make their sleep at night better (compared to not taking any stimulants at all).
The first few times I took ADHD medication during the day, I fall asleep much, much quicker than normal in the evening and then slept like a log. I was up and about earlier than usual, because I had slept so well.
I used to have used dreams quite commonly. Usually when my sleep hygiene was bad, ie I slept irregular hours, went to bed late, stayed in bed late. That's also when I had more sleep paralysis, and weird dreams that could be nightmares for other people (but I wasn't afraid..)
In some sense, it's an irony of biology that bad sleep hygiene can cause both nightmares and one of the cures for them (lucid dreaming).
If it isn't too much off topic, I'd love to see a section added on night terrors/sleep paralysis. I've had the typical hypnagogic hallucinations for decades and am not particularly bothered by them, as I know what they are and have a fair bit of practice in lucid dreaming. (No, I've never been narcoleptic, and though it looks like a lot of the literature associates hypnagogic and hynopompic hallucinations with narcolepsy, I've never noticed a correlation between sleep paralysis and narcolepsy in people I've known that have this problem.)
I've seen two adults reduced to tears recounting their experiences of these things. If my experience is any guide, I think the (real but not really terrible) psychological trauma of these events would be minimized for others if the word got out that this is a pretty common experience for many people and has no "supernatural" significance, as many people seem to assume.
(Just for fun: One of my sleep paralysis experiences was actually published in a collection of ghost stories, as it happened in a notorious old "haunted" house and involved a hallucinated character that strangely resembled a real person that had died there many years before.)
Note for those unfamiliar with the topic, in layman's terms from a non-psychologist: this is a strange state some people occasionally get stuck in, somewhere between full sleep and being awake where a nightmare begins after your normal motor control is shut off for sleep... but you still feel like you're completely awake. You feel paralyzed and hallucinate in frightening ways; a stereotypical example is being unable to move as a witchy sort of character does something unpleasant to you, such as sitting on your chest, making it hard to breathe (probably a side effect of the inability to use motor control over your breath as you normally can). Funnily, it has even been called "Old Hag Syndrome", as this particular hallucination is apparently quite common.
Good to see you included the section on sleep apnea. I use to have nightmares about drowning all the time, then I got diagnosed with sleep apnea, got a machine to help me breathe and the nightmares went away.
"as can (too much) of some B vitamins" -> "as can (too much of) some B vitamins"
Thanks for posting this! Somehow despite knowing about the predictive processing model *and* hearing a lot of the folk wisdom about nightmares, it never occurred to me that I could just make changes that reduce them.
As a child, I suffered from what is called "Night Terrors". Thankfully, they are in the past. Even to this day, I have daytime episodes where I catch a glimpse of those dreams and it fills me with dread. I suppose I have a fear of falling asleep from this past. I once asked my physician for a sleep medication and she gave me zaleplon. The daytime episodes increased.
Years ago a Chinese girlfriend pointed out to me that sleeping with my hands folded over my heart would guarantee nightmares. Try it and you will see that it's true
As a child of about 10 or 12 years old I used to have dreams that happened to me while I was still awake shortly after going to bed of a distinctly frightening nature. Does anyone know what that's called?
This is very nitpicky but I don't really know what the word valence means here, I thought it was just a chemistry thing but I've seen it popping up in a few places now. I get the impression it is a bit of a California thing?
I can think of several supplements to *avoid* when you're trying to avoid nightmares.
Lucid dreaming forums recommend high dose vitamin B6, choline, and many acetylcholinesterase inhibitors. So if you want the opposite (less vivid/emotional/memorable dreams), probably do the opposite. Don't overdo it with vitamin B6 or choline or AChEIs right before bed. Timing is important for B6 because it's a water soluble vitamin. If you take it in the morning the effect on your dreams will be much attenuated. I take all my vitamins and choline in the morning. But I have repeatedly experimented with B6 before bed with obvious positive results at the 25mg dose (the UL is 50mg). (edit: the effect was to make dreams vastly more vivid without actually giving me control over them. That's an uncanny valley where you probably don't want to be if trying to minimize nightmares.) I haven't tried choline or AChEIs before bed or seen any formal studies on them but the common mechanism makes the praxis claims more credible than they would be if it was just a random grab bag of chemicals. (edit: also nicotine is a selective acetylcholine receptor agonist that several people are recommending, which probably has the same mechanism of action)
From an evolutionary perspective, play, storytelling, daydreaming, fantasizing, dreams, and nightmares have a common benefit: They help us practice. Dreams and nightmares exercise our emotional reactions to various situations. From this perspective some number of nightmares is expected, and maybe even beneficial.
This is great. I think that the first paragraph of section 1 is a little too definitively worded, and undersells the degree to which the “predictive modeling” framework is idiosyncratic and speculative. The second sentence does use the word “suggests,” but the rest of the paragraph seems a little off to the races, making definitive, unqualified statements about predictive modeling as if this was a well accepted and highly confirmed model of cognition.
By chance I happened to be reviewing this literature for a paper on what utilitarians should think about dreaming, which is currently under review. Below are some key points along with copied sections and in-text references.
1) We all really underestimate how much we dream, and 2) NonREM sleep also involves dreaming:
When asked in surveys how often they dream, people report dreaming roughly 1–2 times per month on average (Schredl, 2009), with very wide variability both between and within individuals (.g. Bulkeley (2012) and Stepansky et al. (1998) find that ~30% of people recall them several times a week, while another ~30% report less than once a month). But when people are asked to keep a dream diary—to write what they remember dreaming as soon as they wake—they report far more dreams than on surveys, recalling having a dream roughly 50% of the time (though again with large variation between individuals; Watson, 2003). In fact, these higher figures from dream diaries still grossly under-estimate total dream time. People who are woken up in the middle of their sleeping report being able to recall dreams at substantially higher rates than when they are asked to use a dream diary. It seems that most dreams fade almost entirely from memory shortly after being experienced.
When woken up in the middle of rapid eye movement (REM) sleep, people report dreaming ~80% of the time, and ~40% of the time when awoken from non-REM sleep (Nielsen 2000). REM sleep makes up 20-25% of our total sleep time, while non-REM sleep makes up 75-80% of our sleep time. Previous estimates that we dream for only two hours a night (e.g. Crick & Mitchison, 1983; Hobson, 1988), since this is how long we typically experience REM, are mistaken. While non-REM sleep dreams tend to be relatively more thought-like, less bizarre, and less emotionally charged than REM sleep dreams on average, they regularly include genuine phenomenal experiences. 80% REM dreaming x 22.5% REM duration + 40% nREM dreaming x 77.5% nREM duration = roughly 49% total dream time on average (again, wide variability).
This is a *lot* of time spent having experiences that we could potentially improve. For reference, an average of 1 hour of dreaming per night adds up to 3.3 years over the course of an 80-year lifetime. Or, to make our grasp of the figures slightly more accurate, it adds up to the equivalent of what we would ordinarily think of as 5 years, given we are ordinarily only awake for 16 hours per day and tend to intuitively think of sleep as time in which we are unconscious
3) Might we just be reporting our last dream which may have happened hours ago?
It has notably been found that when woken and asked to describe as much of their dream as possible, subjects’ report length and narrative structure drops dramatically as the interval between the end of a REM period and being woken increases (Hobson, Pace-Schott, and Stickgold 2000). This suggests that, in general, dreams are the kind of thing that we lose memory of very quickly, and so subjects are often only remembering their most recent dream.
4) How frequent are nightmares?
On surveys, 2.5–6% of adults report having nightmares at least once a week, while 8%–29% report having them monthly (Sandman et al., 2013; Zadra and Donderi 2000). But in studies using dream logs, 12.7% of subjects’ reported dreams were experienced as negative (Robert and Zadra, 2014). Contemporary studies with valid estimates of nightmare frequency by waking people up in a laboratory are almost non-existent because the novel location changes the dream content significantly, and most studies focus on unrepresentative populations, typically those with sleep disorders. In laboratory wake-up studies on subjects with no disorders, 20-36% of dreams directly feature aspects of the laboratory environment (Picard-Deland, Nielsen, & Carr, 2021; Schredl, 2003, 2008), and there is a dramatic reduction in dreams featuring aggression or hostility (Paul, Schredl, & Alpers, 2015; Zadra & Domhoff, 2011).
5) Lucidity is easier to achieve if you combine triggering cues.
Carr et al. (2020) managed to induce lucid dreaming in 50% of experimental subjects by playing a tone to them while asleep, after having them earlier attend a single session in which they were asked to think about their own self-awareness while hearing that same tone. This method thus combined a few previously studied interventions. Lucidity can be verified by having subjects engage in particular eye movements while dreaming, rather than simply relying on self-report.
I very rarely have any dreams at all (or at least any that I have any memory of): maybe a few times a year. I don't think I've had a nightmare for a decade or two, though the occasional dreams I have sometimes include me doing unpleasant things to other people (generally not anyone I know in real life). The one time I had recurrent nightmares (30 years ago), they were very abstract and formless, just threatening patterns and colours and emotions without any semantic content.
I think dreams is a way for the brain to determine which memories are important. The dream-maker part of the brain tells a story to the dreamer part of the brain based on memories. If the dreamer has a strong emotional reaction, the dream-maker assumes the memories are important and keeps them. If not, the memories are unimportant and gets deleted or kept in a harder to reach place. If you are scared in a dream, having a nightmare, the brain thinks this memory is really important, it's about something dangerous, so it wakes you up, so you'll remember for sure.
Right after waking up it is easy to remember a dream, but if you don't you soon forget it. This is the brain's last test to see if a memory is important, if you think about the dream the memories are, otherwise the brain deletes the memory of the dream.
I'd add a note about parasomnias, especially night terrors and confusional arousal - those tend to be lumped together with nightmares by laypeople, despite a completely different mechanism. Treating these probably should be the topic of a whole another article.
Speaking of which, 3+ mg of melatonin seems to be the most promising treatment for parasomnias, from both pubmed and recent personal experience.
When I was around 14, I watched A Nightmare on Elm Street and it affected me pretty badly. I started having multiple nighmares a night - often 3-4 levels of "dream-within-a-dream" where I dream that nightmare woke me up, and then something scary happens again, and I again dream that it woke me up, until a few iterations later I finally wake up for real - often with some sleep paralysis that would than take a very scary minute or two to shake off. The whole dream-within-a-dream thing forced me to start figuring out how to recognize that I am within a dream - and once I was able to actually do it during a dream and not immediately wake up - and in that dream I though "oh cool - this is a dream, so I am perfectly safe, and I can go explore" (really fun! Think - fully immersive video game!) - and then promptly forgot it was a dream, but "not scary" stayed and I had a dream where weird stuff was happening (such as grandma disappearing into thin air), but now it was all "wow, how interesting" and not scary... After that the nightmares went away... Had maybe a couple (unrelated to Elm Street) in the next 30 years...
P.S. My parents tried to take me see somebody, but the guy was all like ,"Do you realize that none of that is real?" with respect to my being scared of the dark at the time - completely useless.
"We’ll look at a few of these further: Desensitization and LDT, the two highest-performing therapies. IRT, the best-studied therapy. And prazosin, the highest-performing medication."
This section may be marginally easier to understand if the acronyms are explained in this sentence instead of just in the table.
I can reliably induce nightmares by sleeping on left side. It took me many years to figure out the relationship but now I simply roll to tge other side and now nightmares are very rare. When I lay on left side for a longer period I start to hear heartbeat pounding in my ears and that somehow correlates with feeling of fear and doom. I can speculate that something about this particular body position affects the way my heart operates and the change in pulse/pressure/rythm gets interpreted as a stressful situation maybe?
For what it's worth, I suffered for many years not from nightmares as such, but from deeply unpleasant dreams, usually caricatural versions of difficult episodes in the distant past. The pharmacist (most European pharmacists are trained in homeopathy) suggested Stramonium 15 if you wake up after a nightmare. She said that it was known to be very effective with children. I also took it before sleep occasionally, and found that it improved the general quality when I was anxious or disturbed.
What I have found during lucid dreaming is that it is quite hard to redirect them, or even to think too hard about the fact that one is in a dream, without waking up. The way I perceive it, while waking up, is that I have run out of imagination, or made too large an effort: it is like writing a novel or short story while sedated, only more so, since one is actually asleep.
From my experience, a retired cognitive behavioural therapist, schema work to understand the beliefs that make nightmares will work because they then can be transformed by understanding what the dream is doing; processing emotions, and in doing so, I find nightmares are a prompt to deal with issues I've been avoiding.
"A sufficiently threatened, stressed, or traumatized person will naturally have more threatening dreams."
I don't think this is necessarily true: I am quite anxious and prone to stress, and yet the vast majority of my dreams are remarkably boring; nightmares are exceedingly rare for me.
This is a nitpick I wouldn't have bothered to mention if you hadn't asked for feedback, but fwiw I think "REM sleep, a very light stage of sleep on the border of wakefulness" is not exactly right. It is on the border of wakefulness in a couple senses (you are more likely to wake up during it, and it is less/more dominant when you more/less sleep deprived), but in other senses it isn't usually described that way (the atonia, for starters, but also the basic need for it such that if you are specifically deprived of REM sleep your body starts to plunge into it immediately).
- "fainting" and "fainting while standing" are both in the side-effects list separately; perhaps "fainting, including while standing" is better?
- Sleep apnoea is said to be "a relatively common condition", but I always find this unhelpful. What's the reference class of "conditions" in which it's a relatively common one, and how far up the distribution is "relatively common"? If there's a number available, I'd far prefer it.
Peer Review: Scott, the statement in the first paragraph that "the predictive models go out of control and become essentially random" seems unclear or mistaken.
The content of dreams is not random. We do not sample randomly from a distribution of pure sensations and concepts. There is internal coherence to what we experience in dreams, even if less so than in waking life.
Maybe the sentence is intended to mean that we draw "random samples" from an internal generative model of the world? Even there, the sampling is not random: for example, the content of dreams is related to specific episodes of waking life, and is recency-biased. Do any current models of memory consolidation, replay, or dream-generation assume random sampling?
Maybe you are emphasizing randomness in order to counter the notion that dreams are deterministically related to something that happened in the day... e.g. the article is meant to counter the idea that "we work through our daily traumas in our dreams", which would make people obsess too much about the meaning of their dreams? That seems a good goal. Still, I think it's worth trying to be more nuanced, because I don't know of any evidence that dream content is sampled at random or "essentially" at random from our memories and internal models. More recent, more surprising and more personally significant events all seem more likely to influence our dream content (even if they are not explicitly "replayed"), and surely there are many other regularities.
A lot of the time when something particularly unpleasant or even just weird and magical happens in my dreams, I end up interpreting it not as me actually being in that situation, but as me roleplaying a character who's in that situation (or an odd mixture of the two), so even when I'm having dreams that would sound like they should be nightmares if I just described the plot, they aren't actually particularly unpleasant. I assume this is because I have a lot of experience playing roleplaying games. This sounds kind of like a less specific version of Image Rehearsal Therapy, although I don't know how repeatable it would be.
Let me share the story of my worst night mate ever. I believe the circumstances that led to it may be helpful in understanding. What causes nightmares.
So I went to a an afterhours party and I took way too much MDMA I probably took around 700mg (this was not intentional, I misjudged the density of the crystals) at first I felt amazing, euphoric, wanting to socialize with everyone but then I began to feel overwhelmed. I asked my date if we could go home. We called an Uber and in the Uber I spent most of my time in my dates arms passing in and out of consciousness. Once we got home we drank some electrolyte beverages (thank God I always keep those on hand) had sex for bit (which felt amazing but orgasm was impossible) and then passed out.
When I awoke a few hours later I would say I was experiencing serotonin syndrome. I was sweating, overheating, delirious and just generally felt like I was dying. Luckily I am well prepared so I I took 2 25mg tabs of cyproheptadine that I keep around for such occasions. Those helped a lot, they took me from feeling like I was dying to just feeling like I had a flu. I still didn't feel good so I went to lie back down. I spent the next several hours in and out of consciousness, sweating trying to rehydrate basically feeling like I had a had flu. After the night passed I actually felt much better the next day and went through my day about as normal. That night however I could not get to sleep
And now after that overly long introduction I am finally ready to tell you about my worst nightmare ever.
Since I was struggling to fall asleep I decided to take a melatonin gummy. I believe it was 5mg.
That did help me sleep but once I fell asleep I experienced the most terrifying thing in my life. I've had sleep paralysis before but this was 10x worse no matter how hard I tried I couldn't get out of it. And not. Only that but was a two headed demon attacking as I was paralyzed and struggling to cry for help. Now rationally I knew that what I was experiencing was sleep paralysis and that the demon wasn't real but that didn't stop the sheer terror I felt as I lay paralyzed struggling with all my might to squeak out a tiny cry for help. This experience lasted longer than any other sleep paralysis I have ever experienced and when it finally ended I woke up gaspping for breath. I called one of my best friend who thankfully picked up even though it was like 3:40 and he talked me down.
Absolutely one of the most frightening experiences of my life.
So I think the takeaway here is v that something to do with the interplay between serotonin and melatonin has a lot to do with nightmares
The mention of REM sleep being very light sleep is interesting, because "on the border of wakefulness" is how I usually experience dreams but multiple (popular, not scholarly) sources I've read say that REM sleep is deep sleep. Does that reflect older scholarship, or is that a sort of folk belief?
Really happy to see lucid dreaming on here. It's been super helpful for me, both for dealing with nightmares and for self-exploration.
You might consider mentioning galantamine, which fairly reliably induces lucid dreams (see this paper by Stephen LaBerge: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6082533/) and is available OTC. The handful of times I've taken it the experience has been rather intense, but reliably lucid.
I experience this more than seasonally, and by extension poor sleep. In part because in the wee hours I am just a dumb creature of habit. My auto-pilot script makes no adjustment for climate. I also plainly have difficulty with thermoregulation, unable to rely on even a light comforter or duvet in the summer, and often not even in the winter if I'm sharing the bed. I stack sheets and material instead.
Nefariously, being too cold will yield the same outcome through tossing and turning. You want your surface-skin temperature to be warm enough (according to research papers I've leafed through, approx 30 degrees Celsius), but the bedding micro-climate not to trap too much heat. Warming your skin promotes bloodflow to the extremities, allowing you to lower your core temperature near onset. You effectively need both cold (ambient) and heat (trunk, upper body) for optimal results.
To add insult to injury, chronic insomniacs have impaired thermoregulation. Leveraging sunlight, relaxation methods, cognitive therapy exercises was the bare minimum I needed to recover because thermal discomfort drove me insane. Now I can at least sleep, but periodically I'll wake in a sweat.
I have experimented with more intricate ideas I had discovered in some papers, such as thicker material on legs than upper body, and targeting specific areas. I didn't really fare any better, except that I move aside most of the sheets at the foot of the bed, so they don't feel cold but can expel heat effectively. We tend to expel most heat through our head, hands and feet. I tried keeping my hands out - it sucks. Material itself is pretty much whatever, it's all cotton. The current comforters are not but they might as well be for show. I had spent an inordinate amount trying bamboo sheets, breathable weighted blankets, "cooling" blankets, etc.
I get acephalic migraines, where parts of the visual field are… weird. Not invisible, or blocked, just kind of sparkly and not there.
I rarely get nightmares, but when I do it is usually something like “I’m talking to someone and suddenly they are a spirit and not an actual person” or “I’m driving on the freeway and just went blind”.
If the nightmare is stressful enough to wake me, almost invariably I find it’s the middle of the night and I’m having an acephalic migraine: part of my visual field is unprocessable.
So FWIW I’ll second biological/neurological quirks as one input to dreams and nightmares.
1) For othrostatic hypotension in the prazosin section, I believe that telling the subject to rise to a sitting possition, pausing for a moment, then standing up is more effective than telling them to stand up slowly.
2) Under the temperature control section, in addition to AC, window, fans, etc, there are active cooling devices that go under the bedding to actively cool the bed. I believe that some have been shown to encourage quicker transition to NREM sleep, but I don't know for sure off hand.
3) In the sleep apnea section, you may want to link to a STOP BANG self screening test.
I've had very few nightmares, and those when I was much younger, but I've had a lot of unenjoyable dreams; dreams in which I'm late and/or lost, naked in public, really need a washroom bad and can't find one, and dreams in which I am working all night. Can those dreams be considered similar to nightmares? They are certainly reality-based, aside from the naked in public; but I'm guessing the last is just an exaggerated fear of being judged by other people. Lucid dreaming is difficult; because either I accept the internal logic of the dream, or recognizing the implausibility causes me to wake up.
* palmar and plantar surfaces are equally important for cooling, so in addition to removing socks, it can be helpful to learn to sleep with hands and feet out of the coverings
* while it's not IRT, traditional dream sculpting using art therapy methods can help with non-recurrent nightmares; common interventions include making and displaying art of a helpful guide or object -- a ball of yarn to find one's way, a doorknob to create a door, a green EXIT sign, a rope ladder up to an invisible helicopter, or whatever else strikes one's fancy
Given your description of causes, I'd expect that I would have nightmares. I don't. I've got lots of dreams, but they don't match the description of nightmare. I do, often, just as I'm waking up, have a dream where I realize that I've forgotten the basis of a logical chain of reasoning I was following, but there's no strong emotion associated with it.
P.S.: I have (treated with CPAP) sleep apnea. But there was (nearly?) a decade before it was diagnosed, and while I ended up too sleepy to think straight, there were still no nightmares.
FWIW, I think your description of what causes nightmares is largely things that make one have lots of dreams and/or be uncomfortable. But the connection has to be considerably more indirect.
RE: heat causing nightmares and ways to reduce hot sleeping
A few different companies sell products that actively cool (or heat) your bed. Essentially a mattress cover with water tubes running through it that cycles the water into a unit that cools it. Ooler and Eight Sleep are the ones I'm aware of, I just ordered an Ooler as I'm a hot sleeper and don't have A/C.
Might be worth pursuing if hot sleeping is a major trigger.
> (I’m not sure how you do these therapies if your nightmares don’t have recurring themes. If any therapists understand this, please email me at scott@lorienpsych.com. Some sources suggest that if you do these practices with enough different nightmares, your brain learns the meta-lesson that nightmares in general aren’t scary or end with pleasant content, and you don’t have to keep doing the same therapy for ever new theme.)
I'm not a therapist, but if I'm understanding image rehearsal therapy, I basically invented a better version of this on my own as a kid. I would wake up from nightmares and within a couple minutes (as soon as I calmed down enough) would start replaying the dream from the point where it became scary, but with modifications that made it non-scary and put me in control. (Writing about this, it now seems similar to the example about trauma integration in Body Keeps the Score about the kid who drew the twin towers with a trampoline, using imagination to make a less scary version of his experience.). Eventually, I learnt to do this "rewind time and rewrite the dream" mental motion without waking up (and also without the need to be aware that I was dreaming).
If I generalize from sample size 1, the way to do IRT when there are no common themes is to (a) figure out how to get the patient to wake up from nightmares at least some of the time, and then (b) teach them to apply IRT to whatever nightmare they just had, rehearsing the no-longer-nightmarish dream until either they are fully calmed down or until they fall asleep. Then (c) make sure this process actually calms them down as they're doing it (otherwise they're probably doing it wrong), and (c) hope that they learn this trigger-response pattern automatically.
These days I basically don't have nightmares unless either (a) the nightmare is actually a thing that I'm worried about in real life and don't have a solution for (or is obviously a close metaphor for such a thing), or (b) is an "unexpected" turn, e.g., I had a dream recently where I was digging holes in the sand (a normally fun activity) and then realized partway though that I had dug them in a way that I never would when awake and that the way I had dug them made me being buried alive a possibility; this was very scary, and I promptly woke up (but it was clear to me that the generator of this dream was "digging holes in the sand" and the anxiety/fear was an accidental byproduct of observing the result, rather than the generator being "anxiety/fear").
You're missing the obvious explanation of dreaming from a predictive processing standpoint: eliminating Turing surprise.
This also gives an obvious explanation for why infants sleep so much more than adults: when you're starting from basically nothing, there's a lot more insight to be mined by observing the output of your predictive processes.
Speaking of silexan, I think it has a mildly positive effect on anxiety. I hadn't noticed any effect for about two weeks, then forgot to take it a few nights in a row. I realized that I was more anxious than I had been over the last week or so while on it. I definitely get the lavender burps.
Not fully clear yet on whether I want to incorporate it into my regular regimen, but I'm leaning toward giving a longer trial period to see if it's really helping.
I need to follow up on this to verify, but I learned that healthy people with good sleep sometimes have nightmares because during sleep, the prefrontal cortex is downregulated and the amygdala is upregulated, resulting in an anxious state of mind while dreaming even if you're not anxious while awake. This is claimed to be the reason why dreams about teeth falling out or being naked in public are so common: it's an easy thing for the anxious dreaming brain to latch onto. There is some random variation in amygdala activity and if it happens to spike one night, that may cause a nightmare instead of a more tame anxious dream, even if there's nothing else causing them. It may not be very strong evidence, and "the brain just does this" is not very helpful, but it's worth considering.
Edit: A quick literature search turns up nothing conclusive, although there appear to be many studies about changes in functional connectivity of the amygdala and prefrontal cortex during sleep deprivation. So, in the absence of any solid evidence from neuroscience, I would just point to the fact that many people experience the same types of dreams, which tend to be somewhat fearful, and random variation pushes this tendency into nightmares occasionally, even for healthy people with normal sleep habits.
I'm surprised you didn't include THC as a potential medication treatment for nightmares. It's well-studied, its mechanism of action is clear (it reduces time spent in REM), it's available to most of the population OTC, and there aren't significant side effects associated with THC consumption.
There are a lot of small reality-check habits you can practice during the day to improve your likelihood of lucid dreaming that might be worthwhile to include (though I don't know how rigorous you want to be, and all of these are super anecdotal and just things I've picked up from sources I can't remember over time). Lots of people have mentioned some of them already; you precede them by thinking, in your waking life, 'is this a dream?' followed by:
*pushing your finger into your palm -- in a dream many/most people experience the feeling that their finger goes through their palm
*reading something, looking away, then reading it again -- text in dreams is wild and jumbly for most people, and tends to change between glances if you pay attention. works with clocks, books, all sorts of shit
*pinch your nose -- you'll still be able to 'breathe' through it in a dream
*jumping up and down -- gravity is weird in dreams, and you might notice that you float and land bizarrely
Basically, you just do this stuff every once in a while during the day until it becomes a habit, then when you habitually do it while you're dreaming, you achieve lucidity.
"Nobody really knows why we dream. Modern neuroscience suggests that the brain processes data by creating predictive models, then double-checking them against reality. We experience the predictive models, not reality - although the double-checking process is so fast that they usually match well enough to be the same for all practical purposes. When we can’t double-check with reality - for example because we're asleep and not receiving sense-data - then the predictive models go out of control and become essentially random. This results in us having kind of random experiences."
I recommend this paper by Tore Nielsen on nightmares, dreaming, and emotion regulation. He has done important work on the dynamics of nightmares and treatment approaches.
There are also studies that people with "thin boundaries" tend to have nightmares. Ernest Hartman studied this. Changing the personality can alter the nightmare experience.
I sometimes wake up in the middle of the night for any of the usual reasons, and have recently noticed the pattern from the stimulus that requires attention to the dream/ nightmare that ultimately wakes me. The pattern is:
Too cold -> cold, e.g. lost in an icescape without a jacket
Need to pee -> need to pee or peeing, e.g. searching the endless halls of urinals for a private one
Loud sound -> loud sound plus silly explanation for the sound
Too warm -> OVERWHELMING TERROR, e.g. THE HUNTERS HAVE CAUGHT ME AND ARE GOING TO FEAST ON MY LIVER AS I WATCH
When I was a kid I figured out how not to have nightmares. Before falling asleep I would think about the scariest things I could imagine. Then I would never dream about them.
Very interesting read. I believe however that dreams can also occur during non-REM sleep. There was recently an article published by The Human Brain Project examining the differences these dreams play in our brain. They saw that non-REM dreams are more “realistic” while when we dream during REM sleep our brain tends to be more creative. It is during those creative dreams that our brain tends to deconstruct concepts and experiences better. Here's the link: https://www.humanbrainproject.eu/en/follow-hbp/news/2022/05/12/strange-dreams-might-help-your-brain-learn-better-according-research-hbp-scientists/
As for lucid dreaming, last year some researchers had a "proof of concept" of 2 way communication with lucid dreamers. While this sounds a bit Inception like I guess it will be quite helpful for scientists that study dreams to get a more accurate view of dreams and not rely on retrospective reports that might be inaccurate. https://www.science.org/content/article/scientists-entered-peoples-dreams-and-got-them-talking
I notice you left hypnotherapy off your list. It helped me with a non-nightmare dream problem.
Personal anecdote, while I've never had a problem with nightmares, I once developed an annoying weekly dreaming habit, where on Monday around 3am I'd have a lucid dream where I'd need to make a list of the things I'd have to do at work for the coming week. In my dream, I had pen and paper, but because (at that time) I couldn't read or write in my dreams, I would realize that I'd have to wake up to actually write out this list. So every Monday morning, I'd wake at around 3am with an urge to make my to-do list. But I'd be wide awake and alert—because psychologically I was getting up to work—and I could never get back to sleep. So Monday's were always rough for me because of my lack of full night's sleep would catch up with me about mid-morning.
BTW, I was dreaming of the actual tasks that I'd need to accomplish in the coming week—because of the lucidity of the dreams, these were not imaginary task lists I was making up. Nor was this a stressful type of dream. It was just a non-stressful thing that I did at work that somehow I had transferred into my dreaming consciousness. I tried various mental tricks to avoid the need for making a list at 3am. For instance, I'd make up my to do list for the coming week Sunday evening before I went to bed hoping I'd remember that I already made that list when the 3am list-making dream rolled around. My dreaming self did remember making the list, but the dreaming urge was now to review the list I had made the evening before to see if I had left anything out (!) — and I'd have to wake up because I was unable to read the words on the list in my dreams.
I knew that alcohol and other drugs affect REM sleep, so I tried having a shot of whiskey before I went to bed on a Sunday night. That stopped the list-dreams and my waking at 3am for about four weeks, but then it started happening again despite the shot of booze. Then I tried chamomile tea, which also worked for about four weeks before I again started making the lists and waking. Then I got an Rx for Ambien. (I forget what the dosage was, but it was the minimum.) I started with 1/2 an Ambien Sunday night, and that worked for about six weeks. But then it stopped working, and the list-making dreams came back. I upped to a full pill, but that only worked for about six weeks before my dreaming mind was able to overcome the effects. I decided that pushing the Ambien dosage up any further would be unwise, and I didn't like the side-effects because I found that it made me tremendously groggy in the morning, .
Since my dreaming mind seemed intent on sabotaging me, I decided to try hypnotherapy to try to persuade my subconscious change its behaviors. The hypnotherapist did her relaxing spiel for me. I was conscious through the whole process — and I wouldn't have said I was hypnotized either — but it *was* a very relaxing experience. She gave me a simple post-hypnotic suggestion of: don't make lists in my dreams. She put it on recording that she gave me to listen to Sunday nights before I went to bed. It worked! Well, sort of...
Instead of waking up making a list of things to do for the coming week, I had the most hilariously funny dream that woke me up laughing out loud — at 3am, of course! But I figured I was on to something with hypnotherapy because her suggestion had stopped me from making the damn lists! I went back to the hypnotherapist. She hypnotized me again, and this time she gave me a more general post-hypnotic suggestion that was not to give into the urge to wake at 3am. And that mostly worked. I started sleeping much better on the Sundays before work.. Eventually, I gave up playing the suggestion before I went to bed on Sundays, and I've never had the problem recur again.
Does anybody else get too warm then take their socks of while they're in bed and then wonder where they've got to when they're all under the end of the duvet?
I really enjoyed reading the other content on your website about seasonal depression! It seemed very approachable and actionable, which I'm guessing is what you were going for.
In this post about nightmares, I found the first paragraph to be a little confusing and technical, to the point where it may be off-putting to some readers. Specifically, I know what "predictive modeling" means, but I would guess that many people wouldn't be able to immediately understand it and apply it to their understanding of dreaming. It might be worth rephrasing it to avoid scaring people off.
Someone else has already commented on how the table might be made more interpretable, and I agree. I have to admit that the way the table was introduced made me feel as if I was supposed to understand it right away, which made me slightly panic.
I also wanted to say, thank you for this work that you are doing! I'm so excited for this project, and I'm sure it will bring help and relief to a lot of people.
All I do is lucid dream when I sleep. It’s honestly annoying an exhausting. I never wake up feeling rested. I have no clue how I learned this either. I wish I could unlearn it and just sleep.
I seldom have nightmares(at least scary ones). My late husband was an alcoholic and I frequently dream about him coming back in bizarre circumstances. Vivid dreams run in my family, my mother and I both have them. One of her brothers who served in WWII had such horrible nightmares that dr. Had to give him medication to keep the frights under control. I just find mine entertaining.
It seems this article got linked from today's, Morning Brew (morningbrew.com/). Haven't noticed them linking ACX before. It might get more reads than usual.
I have dreams, mostly during when I am asleep in the morning. I wonder why they happen, and this seems to be telling me that it can be nightmares. But as far as I remember them, they aren't anywhere near as scary to be considered as nightmares. I just want to sleep more comfortably, without any dreams which make me get tired a little bit, it feels like I haven't slept well when I think I should have.
I should try changing my sleep schedule, as it can be the culprit. Thanks very much for this post, I learned a lot.
It’s not a treatment exactly, but in my clinical practice I found that non-elaboration was highly effective. Most people who have chronic nightmares have gotten in the habit of elaborating in them—either internally (worrying or ruminating) or with other people (waking a partner up and retelling the nightmare in the middle of the night, for example)—but when you decrease those elaboration behaviors, frequency and intensity tend to drop dramatically in my experience.
Thanks for adding in the section on sleep apnea. General medical opinion seems to be that if you're not a fat 55-year old man, then it can't be sleep apnea. Maybe add that not everyone with sleep apnea snores, and teeth grinding is a fairly common symptom:
This is a good article, but the first paragraph of section 1 is way more technical than the rest... and mostly more technical than it needs to be. "The brain goes a little haywire without input from the senses, and when the brain is anxious you get nightmares" is the key message you need for the rest of this piece, and that can be expressed in pretty simple language.
(At least Ritz was gesturing at this, but I figured it was worth making this a (more-)explicit comment.)
MORE SLEEP! This is info I got from research on children's nightmares. All the common issues that occur during children's sleep also occur for adults (only less often); nightmares, sleep terrors, sleep walking and talking. tooth grinding ....
I've had success helping pts to reduce their nightmares by increasing their sleep time. I usually suggest 15 minutes extra (usually by going to bed earlier, the most realistic for most adults) for a week, then another 15, until up as much as an hour of added sleep. When this helps, it helps a lot! I've also encouraged this when people report their kids are having any of the parasomnias OR insomnia; usually helps there, too.
Of course, more sleep requires better sleep hygiene, so there's a lot of coaching and trouble-shooting to do around that, to implement this.
Are there any registered lucid dream false positives? E.g. someone who got chased by a huge dog in real live, assumed it was a dream, tried some fantastic solution instead of more practical lines of action, and ended up mauled?
NightWare, an app for Apple Watches that decreases PTSD nightmares, might be worth watching. According to a study in Journal of Clinical Sleep Medicine, it significantly increases sleep quality in veterans with PTSD. It's prescription only :(
Backwards question: Anyone know good ways to increase nightmares? I personally find them more interesting than most of my other dreams, and almost never get to experience them.
"Oh god,, I could be bounded in a nut shell and count myself a king of infinite space were it not that I have bad dreams."
Pavlovian response to a post about nightmares.
The DBT Manual has a decent Nightmare Protocol potentially worth sharing in the Image Rehearsal section: https://depts.washington.edu/uwbrtc/wp-content/uploads/Nightmare-Protocol.pdf
"ever new theme" -> "every new theme"
I think it seems like a great resource. As I was reading, all the questions I had (like, "is he going to include the thing about melatonin and B vitamins?") were answered very soon after I had them. Only two exceptions to this to consider: 1) I think putting the PTSD caveat up front in the first or second paragraph would be smart, given that many people suffering from PTSD have nightmares and their treatment will likely be different so you might as well put that info out there early, and 2) inositol is another supplement that can cause nightmares in folks (esp. those who get nightmares with B and melatonin), so maybe include that?
I rarely dream and hadn't had nightmares since childhood, but started taking Singular after age 50. It triggered very bad nightmares for the first two weeks. One so vivid that I recall it in detail a year later. I was about to stop taking the medicine, but then the nightmares stopped with no recurrence in the last year. I recommend adding a reference to it as a possible trigger for nightmares.
It’s kind of unpleasant to learn that enough people have chronic nightmares to generate this much data.
Next time, can you figure out what drug I should take to get another dream where I can fly? I had one when I was eleven and still think about it.
nitpick: "will also improve nightmares" is ambiguous
I’m not clear on how well this might apply to children. Nightmares are a major parenting struggle.
It's such a foreign experience to me that most people have common themes in dreams, let alone nightmares. But I have a pretty strange central hypersomnia, so I think it makes my dreams more random and sort of hypnogogic-ish. Anyways, only real recommendation I might have is to give a good primer on sleep stages in general, both REM and NREM, but maybe that content belongs elsewhere.
So to be clear, is Lucid Dreaming actually a real thing? I've always been pretty skeptical, and I don't think I have ever experienced one.
I was just learning about Glycine as a treatment for anxiety, which I didn't know about. I know a doctor who prescribes it for that. It comes as a powder and the dose recommended is 2,000mg up to 2x/day. Vital Nutrients - Glycine Powder sells on Amazon for $25 and the dose recommended on it is 2-4,000mg. I'm going to try it out for anxiety and will report back.
I had a terrible recurring nightmare as a teen to young adult -- that was clearly related to trauma -- and finally stopped it with lucid dreaming, which I'd done on occasion without knowing how to consistently do it. The dream never returned after that one time I intervened in the midst of it.
I think every client I've ever had who had consistent trouble with nightmares also had PTSD symptoms from earlier trauma, so I like that you encourage people to find treatment for trauma. You might consider making that even clearer earlier on (I think it comes in middle of paragraph under item 3).
Most of my practice is with people who have anxiety, and the folks with anxiety and not so much trauma don't talk so much about nightmares. Your framing above emphasizes anxiety a lot more than trauma, which makes me interested to know if you see people who have a lot of trouble with nightmares who have anxiety alone.
I rarely have nightmares, and when I do, I usually wake up quickly. When I try to lucid dream, the dream sometimes "resists" my attempts to change it and increasing my mental "effort" tends to wake me up.
I'm not sure what resources exist at Lorien or elsewhere w/r/t this problem, but I think it would be appropriate to link or otherwise reference some specific guidance regarding anxiety disorders generally.
Anecdotally, from a non-psychiatrists perspective, nightmares are closely linked in the popular consciousness to PTSD. This is referenced in the post in passing, but I imagine many readers will be especially concerned with differentiating PTSD-related nightmares from other nightmares. Not a huge change, but it might be helpful to link to somewhere with guidance re: PTSD signs and symptoms.
I have had regular bad dreams since I was in a young enough to be in a cot. I'm 37 now so it's been a while. Around 6 y/o I used to physically pull my eyelids open to wake myself up out of nightmares. I have gone in and out of periods where lucid dreaming was available to me. The older (and less stressed) I get, the less reoccurring the themes are - though the intensity, cruelness, and randomness has increased. I have committed to all the sleep hygiene elements, dark/cool room; no eating/drinking/caffeine; meditation helps me get to sleep and possibly enjoy a few hours before the madness begins. I have tried IRT with a Sleep Psychologist with little effect due to the random nature of my dreams. I trialled Prazosin for 3 and 2 months respectively, a couple of years apart, with disastrous results both times. My nightmares were SIGNIFICANTLY worse on this medication. I dream anywhere from 2am until the time I wake up. Yes sadly, sleeping-in means increasingly random and intense nightmares. I can recall a lot of them with stupid specificity. I gave up writing them down because it was taking too long. Occasionally I'll talk about a theme if it's relevant with a Psychologist (i.e. no brakes on a car - feeling out of control). I wake up from sleep feeling absolutely rubbish EVERY DAY. I'm exhausted. My jaw hurts. This brings on corresponding headaches. If the nightmare is particularly bad, I sometimes clench my hands. Cue ongoing joint pain. I wake up in sweats often. I used to wake up crying or distressed a lot. Now I just sleep through or go back to sleep through the most horrific of dreams. Because I'm legit exhausted. How am I functioning during the day? Poorly, at best. I'll stay on the lookout for any new techniques or medications that are being trialled. Because at this present state, I've got my doctors stumped. (Context: Childhood trauma, 15+ years of psychotherapy, current meds: duloxetine, amitriptyline).
You mention stimulants, either as prescription medication or caffeine or nicotine, as one of the things that might make people's sleep worse.
Anecdotally, from my own experience and talking to friends, for people with ADHD taking stimulants during the day can make their sleep at night better (compared to not taking any stimulants at all).
The first few times I took ADHD medication during the day, I fall asleep much, much quicker than normal in the evening and then slept like a log. I was up and about earlier than usual, because I had slept so well.
About lucid dreaming:
I used to have used dreams quite commonly. Usually when my sleep hygiene was bad, ie I slept irregular hours, went to bed late, stayed in bed late. That's also when I had more sleep paralysis, and weird dreams that could be nightmares for other people (but I wasn't afraid..)
In some sense, it's an irony of biology that bad sleep hygiene can cause both nightmares and one of the cures for them (lucid dreaming).
If it isn't too much off topic, I'd love to see a section added on night terrors/sleep paralysis. I've had the typical hypnagogic hallucinations for decades and am not particularly bothered by them, as I know what they are and have a fair bit of practice in lucid dreaming. (No, I've never been narcoleptic, and though it looks like a lot of the literature associates hypnagogic and hynopompic hallucinations with narcolepsy, I've never noticed a correlation between sleep paralysis and narcolepsy in people I've known that have this problem.)
I've seen two adults reduced to tears recounting their experiences of these things. If my experience is any guide, I think the (real but not really terrible) psychological trauma of these events would be minimized for others if the word got out that this is a pretty common experience for many people and has no "supernatural" significance, as many people seem to assume.
(Just for fun: One of my sleep paralysis experiences was actually published in a collection of ghost stories, as it happened in a notorious old "haunted" house and involved a hallucinated character that strangely resembled a real person that had died there many years before.)
Note for those unfamiliar with the topic, in layman's terms from a non-psychologist: this is a strange state some people occasionally get stuck in, somewhere between full sleep and being awake where a nightmare begins after your normal motor control is shut off for sleep... but you still feel like you're completely awake. You feel paralyzed and hallucinate in frightening ways; a stereotypical example is being unable to move as a witchy sort of character does something unpleasant to you, such as sitting on your chest, making it hard to breathe (probably a side effect of the inability to use motor control over your breath as you normally can). Funnily, it has even been called "Old Hag Syndrome", as this particular hallucination is apparently quite common.
Typo: "for ever new theme" -> "for every new theme"
Good to see you included the section on sleep apnea. I use to have nightmares about drowning all the time, then I got diagnosed with sleep apnea, got a machine to help me breathe and the nightmares went away.
Part 1 could use some links. I know it's speculative, but where would someone who is curious learn more about what evidence is available?
Pedantic correction:
"as can (too much) of some B vitamins" -> "as can (too much of) some B vitamins"
Thanks for posting this! Somehow despite knowing about the predictive processing model *and* hearing a lot of the folk wisdom about nightmares, it never occurred to me that I could just make changes that reduce them.
As a child, I suffered from what is called "Night Terrors". Thankfully, they are in the past. Even to this day, I have daytime episodes where I catch a glimpse of those dreams and it fills me with dread. I suppose I have a fear of falling asleep from this past. I once asked my physician for a sleep medication and she gave me zaleplon. The daytime episodes increased.
"Nobody really knows why we dream"
Behold David Eagleman's Defensive Activation Theory:
https://time.com/5925206/why-do-we-dream/
Great post. Henceforth I sleep sockless. Suggest "blue box" or "blue rectangle" rather than "blue square".
Years ago a Chinese girlfriend pointed out to me that sleeping with my hands folded over my heart would guarantee nightmares. Try it and you will see that it's true
As a child of about 10 or 12 years old I used to have dreams that happened to me while I was still awake shortly after going to bed of a distinctly frightening nature. Does anyone know what that's called?
This is very nitpicky but I don't really know what the word valence means here, I thought it was just a chemistry thing but I've seen it popping up in a few places now. I get the impression it is a bit of a California thing?
I can think of several supplements to *avoid* when you're trying to avoid nightmares.
Lucid dreaming forums recommend high dose vitamin B6, choline, and many acetylcholinesterase inhibitors. So if you want the opposite (less vivid/emotional/memorable dreams), probably do the opposite. Don't overdo it with vitamin B6 or choline or AChEIs right before bed. Timing is important for B6 because it's a water soluble vitamin. If you take it in the morning the effect on your dreams will be much attenuated. I take all my vitamins and choline in the morning. But I have repeatedly experimented with B6 before bed with obvious positive results at the 25mg dose (the UL is 50mg). (edit: the effect was to make dreams vastly more vivid without actually giving me control over them. That's an uncanny valley where you probably don't want to be if trying to minimize nightmares.) I haven't tried choline or AChEIs before bed or seen any formal studies on them but the common mechanism makes the praxis claims more credible than they would be if it was just a random grab bag of chemicals. (edit: also nicotine is a selective acetylcholine receptor agonist that several people are recommending, which probably has the same mechanism of action)
From an evolutionary perspective, play, storytelling, daydreaming, fantasizing, dreams, and nightmares have a common benefit: They help us practice. Dreams and nightmares exercise our emotional reactions to various situations. From this perspective some number of nightmares is expected, and maybe even beneficial.
This is great. I think that the first paragraph of section 1 is a little too definitively worded, and undersells the degree to which the “predictive modeling” framework is idiosyncratic and speculative. The second sentence does use the word “suggests,” but the rest of the paragraph seems a little off to the races, making definitive, unqualified statements about predictive modeling as if this was a well accepted and highly confirmed model of cognition.
By chance I happened to be reviewing this literature for a paper on what utilitarians should think about dreaming, which is currently under review. Below are some key points along with copied sections and in-text references.
1) We all really underestimate how much we dream, and 2) NonREM sleep also involves dreaming:
When asked in surveys how often they dream, people report dreaming roughly 1–2 times per month on average (Schredl, 2009), with very wide variability both between and within individuals (.g. Bulkeley (2012) and Stepansky et al. (1998) find that ~30% of people recall them several times a week, while another ~30% report less than once a month). But when people are asked to keep a dream diary—to write what they remember dreaming as soon as they wake—they report far more dreams than on surveys, recalling having a dream roughly 50% of the time (though again with large variation between individuals; Watson, 2003). In fact, these higher figures from dream diaries still grossly under-estimate total dream time. People who are woken up in the middle of their sleeping report being able to recall dreams at substantially higher rates than when they are asked to use a dream diary. It seems that most dreams fade almost entirely from memory shortly after being experienced.
When woken up in the middle of rapid eye movement (REM) sleep, people report dreaming ~80% of the time, and ~40% of the time when awoken from non-REM sleep (Nielsen 2000). REM sleep makes up 20-25% of our total sleep time, while non-REM sleep makes up 75-80% of our sleep time. Previous estimates that we dream for only two hours a night (e.g. Crick & Mitchison, 1983; Hobson, 1988), since this is how long we typically experience REM, are mistaken. While non-REM sleep dreams tend to be relatively more thought-like, less bizarre, and less emotionally charged than REM sleep dreams on average, they regularly include genuine phenomenal experiences. 80% REM dreaming x 22.5% REM duration + 40% nREM dreaming x 77.5% nREM duration = roughly 49% total dream time on average (again, wide variability).
This is a *lot* of time spent having experiences that we could potentially improve. For reference, an average of 1 hour of dreaming per night adds up to 3.3 years over the course of an 80-year lifetime. Or, to make our grasp of the figures slightly more accurate, it adds up to the equivalent of what we would ordinarily think of as 5 years, given we are ordinarily only awake for 16 hours per day and tend to intuitively think of sleep as time in which we are unconscious
3) Might we just be reporting our last dream which may have happened hours ago?
It has notably been found that when woken and asked to describe as much of their dream as possible, subjects’ report length and narrative structure drops dramatically as the interval between the end of a REM period and being woken increases (Hobson, Pace-Schott, and Stickgold 2000). This suggests that, in general, dreams are the kind of thing that we lose memory of very quickly, and so subjects are often only remembering their most recent dream.
4) How frequent are nightmares?
On surveys, 2.5–6% of adults report having nightmares at least once a week, while 8%–29% report having them monthly (Sandman et al., 2013; Zadra and Donderi 2000). But in studies using dream logs, 12.7% of subjects’ reported dreams were experienced as negative (Robert and Zadra, 2014). Contemporary studies with valid estimates of nightmare frequency by waking people up in a laboratory are almost non-existent because the novel location changes the dream content significantly, and most studies focus on unrepresentative populations, typically those with sleep disorders. In laboratory wake-up studies on subjects with no disorders, 20-36% of dreams directly feature aspects of the laboratory environment (Picard-Deland, Nielsen, & Carr, 2021; Schredl, 2003, 2008), and there is a dramatic reduction in dreams featuring aggression or hostility (Paul, Schredl, & Alpers, 2015; Zadra & Domhoff, 2011).
5) Lucidity is easier to achieve if you combine triggering cues.
Carr et al. (2020) managed to induce lucid dreaming in 50% of experimental subjects by playing a tone to them while asleep, after having them earlier attend a single session in which they were asked to think about their own self-awareness while hearing that same tone. This method thus combined a few previously studied interventions. Lucidity can be verified by having subjects engage in particular eye movements while dreaming, rather than simply relying on self-report.
I very rarely have any dreams at all (or at least any that I have any memory of): maybe a few times a year. I don't think I've had a nightmare for a decade or two, though the occasional dreams I have sometimes include me doing unpleasant things to other people (generally not anyone I know in real life). The one time I had recurrent nightmares (30 years ago), they were very abstract and formless, just threatening patterns and colours and emotions without any semantic content.
I think dreams is a way for the brain to determine which memories are important. The dream-maker part of the brain tells a story to the dreamer part of the brain based on memories. If the dreamer has a strong emotional reaction, the dream-maker assumes the memories are important and keeps them. If not, the memories are unimportant and gets deleted or kept in a harder to reach place. If you are scared in a dream, having a nightmare, the brain thinks this memory is really important, it's about something dangerous, so it wakes you up, so you'll remember for sure.
Right after waking up it is easy to remember a dream, but if you don't you soon forget it. This is the brain's last test to see if a memory is important, if you think about the dream the memories are, otherwise the brain deletes the memory of the dream.
I'd add a note about parasomnias, especially night terrors and confusional arousal - those tend to be lumped together with nightmares by laypeople, despite a completely different mechanism. Treating these probably should be the topic of a whole another article.
Speaking of which, 3+ mg of melatonin seems to be the most promising treatment for parasomnias, from both pubmed and recent personal experience.
When I was around 14, I watched A Nightmare on Elm Street and it affected me pretty badly. I started having multiple nighmares a night - often 3-4 levels of "dream-within-a-dream" where I dream that nightmare woke me up, and then something scary happens again, and I again dream that it woke me up, until a few iterations later I finally wake up for real - often with some sleep paralysis that would than take a very scary minute or two to shake off. The whole dream-within-a-dream thing forced me to start figuring out how to recognize that I am within a dream - and once I was able to actually do it during a dream and not immediately wake up - and in that dream I though "oh cool - this is a dream, so I am perfectly safe, and I can go explore" (really fun! Think - fully immersive video game!) - and then promptly forgot it was a dream, but "not scary" stayed and I had a dream where weird stuff was happening (such as grandma disappearing into thin air), but now it was all "wow, how interesting" and not scary... After that the nightmares went away... Had maybe a couple (unrelated to Elm Street) in the next 30 years...
P.S. My parents tried to take me see somebody, but the guy was all like ,"Do you realize that none of that is real?" with respect to my being scared of the dark at the time - completely useless.
"We’ll look at a few of these further: Desensitization and LDT, the two highest-performing therapies. IRT, the best-studied therapy. And prazosin, the highest-performing medication."
This section may be marginally easier to understand if the acronyms are explained in this sentence instead of just in the table.
I can reliably induce nightmares by sleeping on left side. It took me many years to figure out the relationship but now I simply roll to tge other side and now nightmares are very rare. When I lay on left side for a longer period I start to hear heartbeat pounding in my ears and that somehow correlates with feeling of fear and doom. I can speculate that something about this particular body position affects the way my heart operates and the change in pulse/pressure/rythm gets interpreted as a stressful situation maybe?
For what it's worth, I suffered for many years not from nightmares as such, but from deeply unpleasant dreams, usually caricatural versions of difficult episodes in the distant past. The pharmacist (most European pharmacists are trained in homeopathy) suggested Stramonium 15 if you wake up after a nightmare. She said that it was known to be very effective with children. I also took it before sleep occasionally, and found that it improved the general quality when I was anxious or disturbed.
What I have found during lucid dreaming is that it is quite hard to redirect them, or even to think too hard about the fact that one is in a dream, without waking up. The way I perceive it, while waking up, is that I have run out of imagination, or made too large an effort: it is like writing a novel or short story while sedated, only more so, since one is actually asleep.
From my experience, a retired cognitive behavioural therapist, schema work to understand the beliefs that make nightmares will work because they then can be transformed by understanding what the dream is doing; processing emotions, and in doing so, I find nightmares are a prompt to deal with issues I've been avoiding.
"A sufficiently threatened, stressed, or traumatized person will naturally have more threatening dreams."
I don't think this is necessarily true: I am quite anxious and prone to stress, and yet the vast majority of my dreams are remarkably boring; nightmares are exceedingly rare for me.
This is a nitpick I wouldn't have bothered to mention if you hadn't asked for feedback, but fwiw I think "REM sleep, a very light stage of sleep on the border of wakefulness" is not exactly right. It is on the border of wakefulness in a couple senses (you are more likely to wake up during it, and it is less/more dominant when you more/less sleep deprived), but in other senses it isn't usually described that way (the atonia, for starters, but also the basic need for it such that if you are specifically deprived of REM sleep your body starts to plunge into it immediately).
Couple of minor review comments:
- "fainting" and "fainting while standing" are both in the side-effects list separately; perhaps "fainting, including while standing" is better?
- Sleep apnoea is said to be "a relatively common condition", but I always find this unhelpful. What's the reference class of "conditions" in which it's a relatively common one, and how far up the distribution is "relatively common"? If there's a number available, I'd far prefer it.
> might be biological, or due to some kind of sleep problem.
What does biological mean here and how is a sleep problem not a biological thing?
You might consider adding morning headache to the list of untreated sleep apnea symptoms.
Some beta blockers (e.g. Nadolol), when taken at night, have been associated with "bad" dreams.
Peer Review: Scott, the statement in the first paragraph that "the predictive models go out of control and become essentially random" seems unclear or mistaken.
The content of dreams is not random. We do not sample randomly from a distribution of pure sensations and concepts. There is internal coherence to what we experience in dreams, even if less so than in waking life.
Maybe the sentence is intended to mean that we draw "random samples" from an internal generative model of the world? Even there, the sampling is not random: for example, the content of dreams is related to specific episodes of waking life, and is recency-biased. Do any current models of memory consolidation, replay, or dream-generation assume random sampling?
Maybe you are emphasizing randomness in order to counter the notion that dreams are deterministically related to something that happened in the day... e.g. the article is meant to counter the idea that "we work through our daily traumas in our dreams", which would make people obsess too much about the meaning of their dreams? That seems a good goal. Still, I think it's worth trying to be more nuanced, because I don't know of any evidence that dream content is sampled at random or "essentially" at random from our memories and internal models. More recent, more surprising and more personally significant events all seem more likely to influence our dream content (even if they are not explicitly "replayed"), and surely there are many other regularities.
A lot of the time when something particularly unpleasant or even just weird and magical happens in my dreams, I end up interpreting it not as me actually being in that situation, but as me roleplaying a character who's in that situation (or an odd mixture of the two), so even when I'm having dreams that would sound like they should be nightmares if I just described the plot, they aren't actually particularly unpleasant. I assume this is because I have a lot of experience playing roleplaying games. This sounds kind of like a less specific version of Image Rehearsal Therapy, although I don't know how repeatable it would be.
Does discomfort due to coldness cause nightmares too, or is it just heat?
Let me share the story of my worst night mate ever. I believe the circumstances that led to it may be helpful in understanding. What causes nightmares.
So I went to a an afterhours party and I took way too much MDMA I probably took around 700mg (this was not intentional, I misjudged the density of the crystals) at first I felt amazing, euphoric, wanting to socialize with everyone but then I began to feel overwhelmed. I asked my date if we could go home. We called an Uber and in the Uber I spent most of my time in my dates arms passing in and out of consciousness. Once we got home we drank some electrolyte beverages (thank God I always keep those on hand) had sex for bit (which felt amazing but orgasm was impossible) and then passed out.
When I awoke a few hours later I would say I was experiencing serotonin syndrome. I was sweating, overheating, delirious and just generally felt like I was dying. Luckily I am well prepared so I I took 2 25mg tabs of cyproheptadine that I keep around for such occasions. Those helped a lot, they took me from feeling like I was dying to just feeling like I had a flu. I still didn't feel good so I went to lie back down. I spent the next several hours in and out of consciousness, sweating trying to rehydrate basically feeling like I had a had flu. After the night passed I actually felt much better the next day and went through my day about as normal. That night however I could not get to sleep
And now after that overly long introduction I am finally ready to tell you about my worst nightmare ever.
Since I was struggling to fall asleep I decided to take a melatonin gummy. I believe it was 5mg.
That did help me sleep but once I fell asleep I experienced the most terrifying thing in my life. I've had sleep paralysis before but this was 10x worse no matter how hard I tried I couldn't get out of it. And not. Only that but was a two headed demon attacking as I was paralyzed and struggling to cry for help. Now rationally I knew that what I was experiencing was sleep paralysis and that the demon wasn't real but that didn't stop the sheer terror I felt as I lay paralyzed struggling with all my might to squeak out a tiny cry for help. This experience lasted longer than any other sleep paralysis I have ever experienced and when it finally ended I woke up gaspping for breath. I called one of my best friend who thankfully picked up even though it was like 3:40 and he talked me down.
Absolutely one of the most frightening experiences of my life.
So I think the takeaway here is v that something to do with the interplay between serotonin and melatonin has a lot to do with nightmares
The mention of REM sleep being very light sleep is interesting, because "on the border of wakefulness" is how I usually experience dreams but multiple (popular, not scholarly) sources I've read say that REM sleep is deep sleep. Does that reflect older scholarship, or is that a sort of folk belief?
Really happy to see lucid dreaming on here. It's been super helpful for me, both for dealing with nightmares and for self-exploration.
You might consider mentioning galantamine, which fairly reliably induces lucid dreams (see this paper by Stephen LaBerge: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6082533/) and is available OTC. The handful of times I've taken it the experience has been rather intense, but reliably lucid.
I experience this more than seasonally, and by extension poor sleep. In part because in the wee hours I am just a dumb creature of habit. My auto-pilot script makes no adjustment for climate. I also plainly have difficulty with thermoregulation, unable to rely on even a light comforter or duvet in the summer, and often not even in the winter if I'm sharing the bed. I stack sheets and material instead.
Nefariously, being too cold will yield the same outcome through tossing and turning. You want your surface-skin temperature to be warm enough (according to research papers I've leafed through, approx 30 degrees Celsius), but the bedding micro-climate not to trap too much heat. Warming your skin promotes bloodflow to the extremities, allowing you to lower your core temperature near onset. You effectively need both cold (ambient) and heat (trunk, upper body) for optimal results.
To add insult to injury, chronic insomniacs have impaired thermoregulation. Leveraging sunlight, relaxation methods, cognitive therapy exercises was the bare minimum I needed to recover because thermal discomfort drove me insane. Now I can at least sleep, but periodically I'll wake in a sweat.
I have experimented with more intricate ideas I had discovered in some papers, such as thicker material on legs than upper body, and targeting specific areas. I didn't really fare any better, except that I move aside most of the sheets at the foot of the bed, so they don't feel cold but can expel heat effectively. We tend to expel most heat through our head, hands and feet. I tried keeping my hands out - it sucks. Material itself is pretty much whatever, it's all cotton. The current comforters are not but they might as well be for show. I had spent an inordinate amount trying bamboo sheets, breathable weighted blankets, "cooling" blankets, etc.
Anecdote:
I get acephalic migraines, where parts of the visual field are… weird. Not invisible, or blocked, just kind of sparkly and not there.
I rarely get nightmares, but when I do it is usually something like “I’m talking to someone and suddenly they are a spirit and not an actual person” or “I’m driving on the freeway and just went blind”.
If the nightmare is stressful enough to wake me, almost invariably I find it’s the middle of the night and I’m having an acephalic migraine: part of my visual field is unprocessable.
So FWIW I’ll second biological/neurological quirks as one input to dreams and nightmares.
Why have you chosen 12 mg as max dose for prazosin?
1) For othrostatic hypotension in the prazosin section, I believe that telling the subject to rise to a sitting possition, pausing for a moment, then standing up is more effective than telling them to stand up slowly.
2) Under the temperature control section, in addition to AC, window, fans, etc, there are active cooling devices that go under the bedding to actively cool the bed. I believe that some have been shown to encourage quicker transition to NREM sleep, but I don't know for sure off hand.
3) In the sleep apnea section, you may want to link to a STOP BANG self screening test.
I've had very few nightmares, and those when I was much younger, but I've had a lot of unenjoyable dreams; dreams in which I'm late and/or lost, naked in public, really need a washroom bad and can't find one, and dreams in which I am working all night. Can those dreams be considered similar to nightmares? They are certainly reality-based, aside from the naked in public; but I'm guessing the last is just an exaggerated fear of being judged by other people. Lucid dreaming is difficult; because either I accept the internal logic of the dream, or recognizing the implausibility causes me to wake up.
Brief points to append:
* palmar and plantar surfaces are equally important for cooling, so in addition to removing socks, it can be helpful to learn to sleep with hands and feet out of the coverings
* while it's not IRT, traditional dream sculpting using art therapy methods can help with non-recurrent nightmares; common interventions include making and displaying art of a helpful guide or object -- a ball of yarn to find one's way, a doorknob to create a door, a green EXIT sign, a rope ladder up to an invisible helicopter, or whatever else strikes one's fancy
I like nightmares.
Given your description of causes, I'd expect that I would have nightmares. I don't. I've got lots of dreams, but they don't match the description of nightmare. I do, often, just as I'm waking up, have a dream where I realize that I've forgotten the basis of a logical chain of reasoning I was following, but there's no strong emotion associated with it.
P.S.: I have (treated with CPAP) sleep apnea. But there was (nearly?) a decade before it was diagnosed, and while I ended up too sleepy to think straight, there were still no nightmares.
FWIW, I think your description of what causes nightmares is largely things that make one have lots of dreams and/or be uncomfortable. But the connection has to be considerably more indirect.
RE: heat causing nightmares and ways to reduce hot sleeping
A few different companies sell products that actively cool (or heat) your bed. Essentially a mattress cover with water tubes running through it that cycles the water into a unit that cools it. Ooler and Eight Sleep are the ones I'm aware of, I just ordered an Ooler as I'm a hot sleeper and don't have A/C.
Might be worth pursuing if hot sleeping is a major trigger.
> (I’m not sure how you do these therapies if your nightmares don’t have recurring themes. If any therapists understand this, please email me at scott@lorienpsych.com. Some sources suggest that if you do these practices with enough different nightmares, your brain learns the meta-lesson that nightmares in general aren’t scary or end with pleasant content, and you don’t have to keep doing the same therapy for ever new theme.)
I'm not a therapist, but if I'm understanding image rehearsal therapy, I basically invented a better version of this on my own as a kid. I would wake up from nightmares and within a couple minutes (as soon as I calmed down enough) would start replaying the dream from the point where it became scary, but with modifications that made it non-scary and put me in control. (Writing about this, it now seems similar to the example about trauma integration in Body Keeps the Score about the kid who drew the twin towers with a trampoline, using imagination to make a less scary version of his experience.). Eventually, I learnt to do this "rewind time and rewrite the dream" mental motion without waking up (and also without the need to be aware that I was dreaming).
If I generalize from sample size 1, the way to do IRT when there are no common themes is to (a) figure out how to get the patient to wake up from nightmares at least some of the time, and then (b) teach them to apply IRT to whatever nightmare they just had, rehearsing the no-longer-nightmarish dream until either they are fully calmed down or until they fall asleep. Then (c) make sure this process actually calms them down as they're doing it (otherwise they're probably doing it wrong), and (c) hope that they learn this trigger-response pattern automatically.
These days I basically don't have nightmares unless either (a) the nightmare is actually a thing that I'm worried about in real life and don't have a solution for (or is obviously a close metaphor for such a thing), or (b) is an "unexpected" turn, e.g., I had a dream recently where I was digging holes in the sand (a normally fun activity) and then realized partway though that I had dug them in a way that I never would when awake and that the way I had dug them made me being buried alive a possibility; this was very scary, and I promptly woke up (but it was clear to me that the generator of this dream was "digging holes in the sand" and the anxiety/fear was an accidental byproduct of observing the result, rather than the generator being "anxiety/fear").
You're missing the obvious explanation of dreaming from a predictive processing standpoint: eliminating Turing surprise.
This also gives an obvious explanation for why infants sleep so much more than adults: when you're starting from basically nothing, there's a lot more insight to be mined by observing the output of your predictive processes.
Speaking of silexan, I think it has a mildly positive effect on anxiety. I hadn't noticed any effect for about two weeks, then forgot to take it a few nights in a row. I realized that I was more anxious than I had been over the last week or so while on it. I definitely get the lavender burps.
Not fully clear yet on whether I want to incorporate it into my regular regimen, but I'm leaning toward giving a longer trial period to see if it's really helping.
Glycine comes in 1 gram pills in addition to powder. They're not ridiculously huge. I take three a day with no particular difficulty. Example: https://www.amazon.com/Thorne-Research-Relaxation-Detoxification-Function/dp/B000VYRROC
I need to follow up on this to verify, but I learned that healthy people with good sleep sometimes have nightmares because during sleep, the prefrontal cortex is downregulated and the amygdala is upregulated, resulting in an anxious state of mind while dreaming even if you're not anxious while awake. This is claimed to be the reason why dreams about teeth falling out or being naked in public are so common: it's an easy thing for the anxious dreaming brain to latch onto. There is some random variation in amygdala activity and if it happens to spike one night, that may cause a nightmare instead of a more tame anxious dream, even if there's nothing else causing them. It may not be very strong evidence, and "the brain just does this" is not very helpful, but it's worth considering.
Edit: A quick literature search turns up nothing conclusive, although there appear to be many studies about changes in functional connectivity of the amygdala and prefrontal cortex during sleep deprivation. So, in the absence of any solid evidence from neuroscience, I would just point to the fact that many people experience the same types of dreams, which tend to be somewhat fearful, and random variation pushes this tendency into nightmares occasionally, even for healthy people with normal sleep habits.
I'm surprised you didn't include THC as a potential medication treatment for nightmares. It's well-studied, its mechanism of action is clear (it reduces time spent in REM), it's available to most of the population OTC, and there aren't significant side effects associated with THC consumption.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6494011/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7388834/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8116407/
There are a lot of small reality-check habits you can practice during the day to improve your likelihood of lucid dreaming that might be worthwhile to include (though I don't know how rigorous you want to be, and all of these are super anecdotal and just things I've picked up from sources I can't remember over time). Lots of people have mentioned some of them already; you precede them by thinking, in your waking life, 'is this a dream?' followed by:
*pushing your finger into your palm -- in a dream many/most people experience the feeling that their finger goes through their palm
*reading something, looking away, then reading it again -- text in dreams is wild and jumbly for most people, and tends to change between glances if you pay attention. works with clocks, books, all sorts of shit
*pinch your nose -- you'll still be able to 'breathe' through it in a dream
*jumping up and down -- gravity is weird in dreams, and you might notice that you float and land bizarrely
Basically, you just do this stuff every once in a while during the day until it becomes a habit, then when you habitually do it while you're dreaming, you achieve lucidity.
Wow, I didnt know this:
"Nobody really knows why we dream. Modern neuroscience suggests that the brain processes data by creating predictive models, then double-checking them against reality. We experience the predictive models, not reality - although the double-checking process is so fast that they usually match well enough to be the same for all practical purposes. When we can’t double-check with reality - for example because we're asleep and not receiving sense-data - then the predictive models go out of control and become essentially random. This results in us having kind of random experiences."
Where can I read more about this?
I recommend this paper by Tore Nielsen on nightmares, dreaming, and emotion regulation. He has done important work on the dynamics of nightmares and treatment approaches.
https://www.academia.edu/468982/Nightmares_dreaming_and_emotion_regulation_A_review_2007_?email_work_card=view-paper
There are also studies that people with "thin boundaries" tend to have nightmares. Ernest Hartman studied this. Changing the personality can alter the nightmare experience.
"Anything that decreases stress, increases comfort while sleeping, and deepens sleep quality will also improve nightmares..."
"improve nightmares" reads weird.
Maybe "reduce nightmares"?
"Anxiety is a bias for the brain to interpret information in a threat-related manner."
I had to read this a few times to parse it.
Maybe something like "Anxiety is a mental bias that causes the brain to interpret information in a threat-related manner."
Or maybe for that last part "...interpret information more threateningly."
I sometimes wake up in the middle of the night for any of the usual reasons, and have recently noticed the pattern from the stimulus that requires attention to the dream/ nightmare that ultimately wakes me. The pattern is:
Too cold -> cold, e.g. lost in an icescape without a jacket
Need to pee -> need to pee or peeing, e.g. searching the endless halls of urinals for a private one
Loud sound -> loud sound plus silly explanation for the sound
Too warm -> OVERWHELMING TERROR, e.g. THE HUNTERS HAVE CAUGHT ME AND ARE GOING TO FEAST ON MY LIVER AS I WATCH
Not sure what's up with that last one.
When I was a kid I figured out how not to have nightmares. Before falling asleep I would think about the scariest things I could imagine. Then I would never dream about them.
Very interesting read. I believe however that dreams can also occur during non-REM sleep. There was recently an article published by The Human Brain Project examining the differences these dreams play in our brain. They saw that non-REM dreams are more “realistic” while when we dream during REM sleep our brain tends to be more creative. It is during those creative dreams that our brain tends to deconstruct concepts and experiences better. Here's the link: https://www.humanbrainproject.eu/en/follow-hbp/news/2022/05/12/strange-dreams-might-help-your-brain-learn-better-according-research-hbp-scientists/
As for lucid dreaming, last year some researchers had a "proof of concept" of 2 way communication with lucid dreamers. While this sounds a bit Inception like I guess it will be quite helpful for scientists that study dreams to get a more accurate view of dreams and not rely on retrospective reports that might be inaccurate. https://www.science.org/content/article/scientists-entered-peoples-dreams-and-got-them-talking
Scott:
I notice you left hypnotherapy off your list. It helped me with a non-nightmare dream problem.
Personal anecdote, while I've never had a problem with nightmares, I once developed an annoying weekly dreaming habit, where on Monday around 3am I'd have a lucid dream where I'd need to make a list of the things I'd have to do at work for the coming week. In my dream, I had pen and paper, but because (at that time) I couldn't read or write in my dreams, I would realize that I'd have to wake up to actually write out this list. So every Monday morning, I'd wake at around 3am with an urge to make my to-do list. But I'd be wide awake and alert—because psychologically I was getting up to work—and I could never get back to sleep. So Monday's were always rough for me because of my lack of full night's sleep would catch up with me about mid-morning.
BTW, I was dreaming of the actual tasks that I'd need to accomplish in the coming week—because of the lucidity of the dreams, these were not imaginary task lists I was making up. Nor was this a stressful type of dream. It was just a non-stressful thing that I did at work that somehow I had transferred into my dreaming consciousness. I tried various mental tricks to avoid the need for making a list at 3am. For instance, I'd make up my to do list for the coming week Sunday evening before I went to bed hoping I'd remember that I already made that list when the 3am list-making dream rolled around. My dreaming self did remember making the list, but the dreaming urge was now to review the list I had made the evening before to see if I had left anything out (!) — and I'd have to wake up because I was unable to read the words on the list in my dreams.
I knew that alcohol and other drugs affect REM sleep, so I tried having a shot of whiskey before I went to bed on a Sunday night. That stopped the list-dreams and my waking at 3am for about four weeks, but then it started happening again despite the shot of booze. Then I tried chamomile tea, which also worked for about four weeks before I again started making the lists and waking. Then I got an Rx for Ambien. (I forget what the dosage was, but it was the minimum.) I started with 1/2 an Ambien Sunday night, and that worked for about six weeks. But then it stopped working, and the list-making dreams came back. I upped to a full pill, but that only worked for about six weeks before my dreaming mind was able to overcome the effects. I decided that pushing the Ambien dosage up any further would be unwise, and I didn't like the side-effects because I found that it made me tremendously groggy in the morning, .
Since my dreaming mind seemed intent on sabotaging me, I decided to try hypnotherapy to try to persuade my subconscious change its behaviors. The hypnotherapist did her relaxing spiel for me. I was conscious through the whole process — and I wouldn't have said I was hypnotized either — but it *was* a very relaxing experience. She gave me a simple post-hypnotic suggestion of: don't make lists in my dreams. She put it on recording that she gave me to listen to Sunday nights before I went to bed. It worked! Well, sort of...
Instead of waking up making a list of things to do for the coming week, I had the most hilariously funny dream that woke me up laughing out loud — at 3am, of course! But I figured I was on to something with hypnotherapy because her suggestion had stopped me from making the damn lists! I went back to the hypnotherapist. She hypnotized me again, and this time she gave me a more general post-hypnotic suggestion that was not to give into the urge to wake at 3am. And that mostly worked. I started sleeping much better on the Sundays before work.. Eventually, I gave up playing the suggestion before I went to bed on Sundays, and I've never had the problem recur again.
Does anybody else get too warm then take their socks of while they're in bed and then wonder where they've got to when they're all under the end of the duvet?
My two cents:
I really enjoyed reading the other content on your website about seasonal depression! It seemed very approachable and actionable, which I'm guessing is what you were going for.
In this post about nightmares, I found the first paragraph to be a little confusing and technical, to the point where it may be off-putting to some readers. Specifically, I know what "predictive modeling" means, but I would guess that many people wouldn't be able to immediately understand it and apply it to their understanding of dreaming. It might be worth rephrasing it to avoid scaring people off.
Someone else has already commented on how the table might be made more interpretable, and I agree. I have to admit that the way the table was introduced made me feel as if I was supposed to understand it right away, which made me slightly panic.
I also wanted to say, thank you for this work that you are doing! I'm so excited for this project, and I'm sure it will bring help and relief to a lot of people.
All I do is lucid dream when I sleep. It’s honestly annoying an exhausting. I never wake up feeling rested. I have no clue how I learned this either. I wish I could unlearn it and just sleep.
I seldom have nightmares(at least scary ones). My late husband was an alcoholic and I frequently dream about him coming back in bizarre circumstances. Vivid dreams run in my family, my mother and I both have them. One of her brothers who served in WWII had such horrible nightmares that dr. Had to give him medication to keep the frights under control. I just find mine entertaining.
It seems this article got linked from today's, Morning Brew (morningbrew.com/). Haven't noticed them linking ACX before. It might get more reads than usual.
I have dreams, mostly during when I am asleep in the morning. I wonder why they happen, and this seems to be telling me that it can be nightmares. But as far as I remember them, they aren't anywhere near as scary to be considered as nightmares. I just want to sleep more comfortably, without any dreams which make me get tired a little bit, it feels like I haven't slept well when I think I should have.
I should try changing my sleep schedule, as it can be the culprit. Thanks very much for this post, I learned a lot.
It’s not a treatment exactly, but in my clinical practice I found that non-elaboration was highly effective. Most people who have chronic nightmares have gotten in the habit of elaborating in them—either internally (worrying or ruminating) or with other people (waking a partner up and retelling the nightmare in the middle of the night, for example)—but when you decrease those elaboration behaviors, frequency and intensity tend to drop dramatically in my experience.
How can they leave off the fact that holding a fuller bladder while trying to sleep causes nightmares as well?
Thanks for adding in the section on sleep apnea. General medical opinion seems to be that if you're not a fat 55-year old man, then it can't be sleep apnea. Maybe add that not everyone with sleep apnea snores, and teeth grinding is a fairly common symptom:
https://www.sleepapnea.org/if-you-grind-your-teeth-at-night-you-might-have-sleep-apnea/
"Dr. Mark Burhenne at the Ask the Dentist blog suggests these are the new “At-Risk Groups for Sleep Apnea” when a case of bruxism is also identified:
Petite women
Children with ADHD and other learning disabilities
People with a long neck
People who did not breastfeed as infants
People with anxiety and depression"
This is a good article, but the first paragraph of section 1 is way more technical than the rest... and mostly more technical than it needs to be. "The brain goes a little haywire without input from the senses, and when the brain is anxious you get nightmares" is the key message you need for the rest of this piece, and that can be expressed in pretty simple language.
(At least Ritz was gesturing at this, but I figured it was worth making this a (more-)explicit comment.)
MORE SLEEP! This is info I got from research on children's nightmares. All the common issues that occur during children's sleep also occur for adults (only less often); nightmares, sleep terrors, sleep walking and talking. tooth grinding ....
I've had success helping pts to reduce their nightmares by increasing their sleep time. I usually suggest 15 minutes extra (usually by going to bed earlier, the most realistic for most adults) for a week, then another 15, until up as much as an hour of added sleep. When this helps, it helps a lot! I've also encouraged this when people report their kids are having any of the parasomnias OR insomnia; usually helps there, too.
Of course, more sleep requires better sleep hygiene, so there's a lot of coaching and trouble-shooting to do around that, to implement this.
Are there any registered lucid dream false positives? E.g. someone who got chased by a huge dog in real live, assumed it was a dream, tried some fantastic solution instead of more practical lines of action, and ended up mauled?
nienor turambar posted on DSL:
"According to wikipedia and sleepfoundation.com and webmd etc etc, there is a common myth that "Dreams occur during REM sleep" only, but the current science is that it's not exclusive. (See e.g. https://en.wikipedia.org/wiki/Rapid_eye_movement_sleep#Dreaming, for details of some disagreement on the subject.)
Scott may not have meant this mistake, or he may have oversimplified for the sake of brevity. Just saying."
Piracetam is great for both lucid dreaming and increasing dreams in general.
> pain, discomfort, heat, caffeine, bright lights, alcohol, stimulant medications, a noisy environment, an uncomfortable bed
*laughs until tears begin to flow, then just keeps crying*
I've often wondered what I would be capable of if only it didn't hurt to sleep.
NightWare, an app for Apple Watches that decreases PTSD nightmares, might be worth watching. According to a study in Journal of Clinical Sleep Medicine, it significantly increases sleep quality in veterans with PTSD. It's prescription only :(
https://www.apple.com/newsroom/2022/11/veterans-find-relief-from-nightmares-with-nightware-and-apple-watch/