Military personnel returning from wars in Afghanistan and Iraq show increasing rates of post-traumatic stress disorder (PTSD) and post-traumatic nightmares. Media coverage of these two vexing mental health conditions is also intensifying and raising public awareness about the need for more effective therapeutic options. With growing attention focused on patients with nightmares, sleep centers have an opportunity to engage these patients. Successfully doing so hinges on applying a standard of care for nightmare assessment and treatment through behavioral sleep medicine specialists.

MENTAL HEALTH VIEW OF NIGHTMARES

Traditionally, nightmares reflect emotional turmoil that needs venting through the process of dreaming. This psychological perspective fuels the entrenched and enduring focus on dream interpretation therapy as one of two core treatments for this potent sleep disrupter. The other primary approach known as exposure therapy is gaining ascendency in the mental health community because of the prevailing view that PTSD—the cause of the disturbing dreams—must be treated first. As the theory goes, the nightmares will resolve when their cause is treated. Yet, both these treatment paradigms (dream interpretation and exposure) trigger treatment avoidance among nightmare patients because of their fear of unmasking unpleasant mental health issues. Although this paradox creates an opening for nightmare patients to seek help outside of mental health facilities, it is rare for sleep medicine clinics to encounter patients seeking treatment exclusively for nightmares.

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Dr. Barry Krakow is a board certified internist and sleep disorders specialist who has spent over 30 years in medicine in the fields of internal, emergency, addiction and sleep medicine. He has conducted more than two decades of research in the treatment of chronic nightmares and disturbing dreams at the University of New Mexico School of Medicine (1988-1999) and the Sleep & Human Health Institute (2000-current).

Dr. Krakow graduated magna cum laude from the University of Maryland School of Medicine. He was residency trained and board certified in internal medicine and also has ten years of clinical work in emergency medicine. He is a member of the American Academy of Sleep Medicine and the Sleep Research Society and is the former medical director of University Hospital Sleep Disorders Center.

Dr. Krakow has published two books, Insomnia Cures and his most recent, Sound Sleep, Sound Mind, is the first book of its kind to focus on mental, emotional and physical causes to sleep disturbances. Dr. Krakow and his wife, Jessica Kohr-Krakow have also published Turning Nightmares into Dreams, an innovated self-help, audio series and workbook to eliminate bad dreams.

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“He was stuck on the needle,” says Deirdre Barrett, psychology professor at Harvard Medical School. He couldn’t get it through fabric and bring thread back again.

Then he had a frightening dream of island savages threatening to spear him if he didn’t finish the design. He awoke excited, because their spear tips had holes — like needles with eyes in the point — and the solution to his problem.

Our life is influenced by dreams whether we like it or not, says Barrett, author of “The Committee of Sleep.” But she and other experts say dreams can be harnessed to solve problems (especially when we have to think visually or out of the box) and increase our emotional intelligence.

Our sleeping minds took the spotlight this summer as the film “Inception” grossed $283 million at the box office and asked us to wonder if someone else could change our behavior by entering our dreams.

Most of us think of dreams as stories that help process waking life, says Dr. Barry Krakow, medical director of Maimonides Sleep Arts & Sciences in Albuquerque.
While science can’t say for sure, Krakow, author of “Sound Sleep, Sound Mind: 7 Keys to Sleeping Through the Night,” says he believes that’s true. “Life is multidimensional,” Krakow says. It would be impossible to consciously understand all of it — work, family, society — as a single unit. But “dreams have that capacity to integrate thoughts and images.” And dreams often do more than merely echo waking life, Barrett says. She points to past studies showing that, while bad dreams often follow bad days, it’s frequently the other way around. Our days often mirror dreams from the night before. “I think dreams do set the emotional tone for the day,” says Thomas McKenna, who does dream therapy at Life Change Psychotherapy Institute in Albuquerque. “Sometimes it’s more subtle,” he says, less a direct link than an “emotional coloring.”

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The same people reported trouble falling asleep, night waking, nightmares, periodic limb movements, and poor sleep. In the daytime, they had more trouble with memory and concentration, felt sleepier and more fatigued, and reported lower quality of life than those with lower PTSD scores. The severity of their symptoms was correlated with sleep factors that promote excess arousal, Barry Krakow, M.D., and colleagues at Maimonides Sleep Arts and Sciences in Albuquerque, N.M., reported at the annual meeting of the Associated Professional Sleep Societies in June. Changes in the brain during sleep in people with PTSD may maintain or increase activity in arousal-promoting brain centers and reduce activity in sleep-promoting centers, Anne Germain, Ph.D., an associate professor of psychiatry at the University of Pittsburgh School of Medicine, told Psychiatric News.

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