Spooky dreams may be just what the doctor ordered

  • Published
  • By Jon Stock
  • Air Force Surgeon General Public Affairs
Ghoulish figures, demonic clowns, man-eating zombies and vampires. There was enough frightening stuff out there this Halloween that even the most fearless may have been spooked this year. So which of these nightmares are still keeping you up at night?

For some individuals out there, Halloween was not their only nightmare of the year. As many as 25 percent of the adult population will wake up after an intense and fearful vision brings them out of their rest. In fact, almost three percent of adults were reported to have nightmares frequently to always, based on the "Diagnostic and Statistical Manual of Mental Disorders, DSM-IV-TR."

The Wilford Hall Clinical Health Psychology Center at Lackland Air Force Base, Texas, which specializes in behavioral sleep medicine, defines a nightmare as a frightening and complex dream that may lead to being awakened from sleep. These dreams are often a lengthy, elaborate dream sequence that is highly anxiety-provoking or terrifying. They may also become a beneficial habit after a traumatic event that leads to post-traumatic stress disorder and a way of processing the event. After time, these nightmares actually are reduced to being just a bad habit and involve the individual reliving the traumatic event multiple times over again.

"Many people do not realize that frequent nightmares may be able to be treated at one of our behavioral sleep clinics," said Capt. (Dr.) JoLyn Tatum, a Wilford Hall Clinical Health Psychology Center fellow. "We treat nightmares as a behavioral problem and use a form of treatment called 'imagery rehearsal therapy' in our 'Nightmare Class' offered at the clinic."

The Nightmare Class was developed from the studies of Dr. Barry Krakow, the Maimonides International Nightmare Treatment founder and a board certified sleep disorders specialist.

Dr. Krakow developed the technique of imagery rehearsal therapy, which basically consists of educating the individual on how to change the frightening imagery through techniques of rescripting the nightmare.

"Nightmares are often habitual and can be influenced by thoughts throughout the day," Tatum said. "They can also be provoked by stress, thus we offer classes to teach the individual ways to rescript, or change their nightmare, in addition to relaxation techniques to assist in calming the individual's nerves.
"Imagery rehearsal is a way of using the skill of imagery, which is different than just thinking and activates brain structures similar to those involved in dreaming," she continued. "By using imagery rehearsal while awake to rescript the nightmare, people can actually change the course that the nightmare will take once they are asleep."

For example, if a given patient was experiencing a re-occurring nightmare related to a combat experience, the clinic might assist the patient to rescript the dream so that it takes a different course, such as the convoy turning a different direction to avoid an IED. The patient would then use imagery to practice this new script a few times over the course of the day. With practice and time, the nightmare will typically begin to change as well.

Tatum said she believes that people should seek treatment at a local sleep clinic once the frightening dreams begin to significantly impact their sleep quality and begin to affect their daily functioning because of either missed sleep or high anxiety about the re-occurrence of the dream.

The treatment consists of four one-hour weekly sessions for one month. It is based on empirical supported protocol that has shown a meaningful improvement in nightmare frequency in approximately 70 percent of research participants, according to the "Behavioral Sleep Medicine Journal."

"The best part of the treatment is that it is unique in allowing people to manage their own conditions," Tatum said. "Thus, once someone successfully completes the treatment, they will be much more likely to be able to manage any re-occurrence of it in the future."

Service members suffering from PTSD should first seek treatment at their base mental health clinic before undergoing the Nightmare Class to successfully treat symptoms.

For more information on the Nightmare Class or other behavioral sleep treatment instead of using medication, visit a local Air Force sleep clinic.

Sleep well tonight ...