When Dreams Turn Into Nightmares

Last Editorial Review: 1/31/2005

Not-So-Sweet Dreams

By Jeanie Lerche Davis
WebMD Feature

Reviewed By Michael Smith

At Dulles Airport that fateful morning, air-traffic-controller Danielle O'Brien guided the routine take-off of American Airlines flight 77. An hour later, she watched it -- as a blip on her radar screen -- speed toward the White House, veer, and slam into the Pentagon.

"I've sat up straight in bed many times, reliving it, re-seeing it, re-hearing it," she told a TV reporter in the days following Sept 11.

But eventually, O'Brien's recurring nightmare was transformed, says Deidre Barrett, PhD, an assistant professor of psychology at Harvard Medical School. "In the magic fantasy world of dreams, she reaches into the radar screen to stop the flight, to stop the plane. She holds the plane in her hands -- and that prevents the tragedy."

After the Dust Settled

We've all had unpleasant dreams: You're naked at the mall or unprepared for a big test at school.

But in the aftermath of Sept. 11, 2001, people all over New York City reported especially disturbing dreams -- true nightmares, says Barrett, author of the book, Trauma and Dreams.

"Those who escaped the trauma found themselves reliving actual events -- going down a stairwell, choking from smoke, seeing bodies falling and buildings come down, running," she tells WebMD. "But some dreams went one step further. In their dreams, their worst fears came true."

An example: One man who worked one of the lowest floors got out early, but didn't know the fate of his wife, who worked on a higher floor. Later that day, he found her and she was fine. "But in his dream, he saw his wife's body at the bottom of the staircase," says Barrett.

These reactions mirror what Barrett discovered in Kuwait, when interviewing people after the Gulf War, as part of her ongoing research into nightmares. It's a phenomenon found around the world, she says -- among Vietnam war veterans and in cases of domestic violence.

"The dream may be very true-to-life, but it is changed a bit to include your worst fear," she says.

One Kuwaiti woman dreamed that Iraqi soldiers had broken into her house. In reality, that had happened -- the man held a gun to each kid's head, threatened to shoot them, but didn't. "But in her nightmares, he did shoot each of the children," says Barrett. "It was a recurring nightmare for her."

The Purpose of Nightmares

What purpose do such dreams serve? Why does our subconscious re-enact -- time and again -- horrific events we wish to forget? Why do we have nightmares at all?

One-time nightmares are likely delivering a message, says Barrett. "The more vivid a dream is, the more important it tends to be, whether unpleasant or pleasant. So explore them as you would any dream -- how they relate to your life, what message they may have for you personally."

People who are a bit more sensitive, more anxious, tend to have more nightmares, says Barrett. Those who have experienced trauma before, like physical abuse or a terrible house fire, also have more nightmares -- especially after yet another trauma. In fact, they may dream about the previous events.

Even our close cousins, the gorillas, seem to have nightmares, says Barrett.

California-based ethnologist Penny Patterson, PhD, has reported dreams that gorillas Koko and Michael seem to have had. The gorillas have learned sign language from Patterson and use it to communicate with her.

"Koko will awaken in the morning and describe fantastic events about people and animals not there at the time more than she does it any time of the day," Barrett tells WebMD.

Michael's mother was killed by poachers when he was very young, and researchers suspect that he might have witnessed some of it. "He will report 'bad people kill gorilla' upon awakening in the middle of the night or in the morning, more like recounting a dream than a memory," Barrett says.

Whether bad dreams are full-fledged nightmares, anxiety dreams, or just a bit unsettling, they serve as "pressure-release therapy," says Craig Webb, executive director of the DREAMS nonprofit foundation, which works in collaboration with Sacre-Coeur Hospital in Montreal.

"They have a very powerful, emotional impact," says Webb. "It's like your psyche is saying, 'thank goodness, you're finally listening.'"

"We like to say that nightmares are very bitter but much-needed medicine," Webb tells WebMD. "That's why it's become a powerful, emotional message -- to shake you out of your sleep. By analyzing the dream, trying to find what behavior might not be serving you, you likely won't have that nightmare again. You got the message."

Dreams After Disaster

Posttraumatic nightmares, like those we had after Sept. 11, are likely part of our flight-or-fight mechanism gone out of control, says Barrett.

"In evolution, such dreams probably served a very important purpose, to keep us anxious about something that could happen again," she says. "If a tiger killed in the nearby village, a nightmare would keep you anxious about that happening that to you. It would be a valuable emotional message."

However, in today's world, recurring nightmares "just retraumatize you."

For most people, recurring nightmares gradually become less fearful over subsequent weeks and months. "The nightmares become less frequent, milder, and content becomes mixed with everyday ongoing events," Barrett tells WebMD. "In some dreams, there is mastery over the fear."

Two New York City women had recurring nightmares about seeing people jump, although they had only witnessed the events on TV. "In their dreams, they were actually there, at the World Trade Center," says Barrett. "But gradually over time, both reported that their dreams changed. In one case, the firemen were giving people parachutes. The other had a less realistic, more fanciful element -- she was handing out parasols."

"The dreams still contained anxiety, but they didn't contain the sheer horror of earlier dreams," says Barrett. "Some people were getting out alive. There was some degree of mastery."

Creating A Happier Ending

If recurring nightmares don't ease, there are steps you can take. A therapist can help you change your dream content, possibly through hypnosis. There are also things you can do on your own.

You can "program" a new dream ending, Barrett says. "Just decide what outcome you would like to have happen. Picture the recurring dream and realistically picture another outcome. Make the imagery as vivid as possible. If you have a history of childhood abuse and trauma, practice telling your abuser what this did to you. Dialoguing with him can help."

The minutes while you're drifting off to sleep are "a real suggestive time," Barrett tells WebMD. "Remind yourself, 'when I dream tonight, I want "X" to happen.'"

Some medications have also helped bring relief from nightmares. Antianxiety drugs tend to facilitate sleep, but they also tend to make people less anxious, too. Drugs like MAO inhibitors, a form of antidepressant that repress the part of sleep in which you dream, can also repress nightmares.

"If your dreams are not getting better -- if you feel like you would be OK except the nightmares keep happening -- try changing the dream on your own," says Barrett. "If that doesn't work, see a therapist for help. There are more elaborate techniques for changing those dreams."

Also, a therapist can help you better understand the message the dream may be sending, she says. "Someone else can see something that you may not."

Published Sept. 9, 2002.

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