The cause of nightmares remains a mystery

Posted2/6/2016 7:18 AM

Q: Is there anything I can do to stop having terrible nightmares? They scare me, and ruin my sleep.

A: There may be something you can do. The first thing you should know is that everyone has nightmares occasionally. That includes yours truly. Just as we don't really know why we sleep, we don't really understand nightmares. We also don't know why some people are more likely to have them.


Nightmares and two related phenomena -- sleep terrors and sleep-related panic attacks -- can make sleep more stressful than restful:

Nightmares can be a side effect of certain medications. These include antidepressants, narcotics and barbiturates. So talk to your doctor to see if any medication you're taking might be contributing to your problem.

Nightmares can also occur if you stop taking certain drugs, including drugs used to treat them (such as benzodiazepines), if those drugs are stopped abruptly. Alcoholics who stop drinking often have nightmares.

If your frequent nightmares are not likely due to medicines you are taking, then counseling may help. You may be wrestling with problems that cause anxiety -- and would cause anyone anxiety. A type of behavioral therapy known as desensitization may help.

In this therapy, you will be asked to recall the details of your nightmare and use relaxation techniques to overcome your fear. The therapist may guide you through typical dream sequences. For example, the therapist can help you imagine confronting or driving off a pursuer.

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Some doctors recommend psychoanalysis to identify and resolve past and present emotional issues that may be playing themselves out in your nightmares.

I'm a skeptic. I'm not aware of solid research that demonstrates that psychoanalysis is more helpful in reducing nightmares than behavioral therapy.

During a sleep terror, the sleeper may let out a bloodcurdling scream, sit bolt upright and attempt to fight or flee. The person may seem confused and agitated. After the spell is over, he or she is likely to go right back to sleep. Later, the person may not remember what happened.

In an earlier column about sleep terrors, I mentioned a college roommate of my sister's. Every few nights, in the middle of the night, her roommate suddenly sat upright in bed shouting, "Oh, oh, oh, my God!" Then she promptly lay down and fell asleep, and had no memory of this the next morning. If you consistently remember your nightmares, you're probably not suffering from sleep terrors.

Medications such as benzodiazepines are sometimes prescribed for sleep terrors. Hypnosis or a relaxation technique known as guided imagery may also help.


If you have sleep-related panic attacks, you may awaken suddenly because of episodes of intense panic. You may experience a racing heartbeat, sweating, trembling, breathlessness, or the feeling that something terrible is about to happen -- like you are about to die. Anti-anxiety drugs are often useful for such panic attacks.

The cause of these sleep disorders is a mystery. They might seem like a trivial mystery, but I think that if we understood them, we'd understand a lot more about how the brain works.

• Dr. Anthony Komaroff is a physician and professor at Harvard Medical School. To send questions, go to, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.

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