Nightmares

Childhood Parasomnia, Like Nightmares, May Significantly Increase Risk For Psychotic Symptoms

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The term parasomnia is one experts use to classify sleep abnormalities and disorders, such as nightmares, night terrors, and sleepwalking. And according to a new study published in the British Journal of Psychiatry, children who experience parasomnias may experience psychotic symptoms when they grow older.

“We have previously demonstrated a cross-sectional relationship between the presence of nightmares and night terrors and psychotic experiences at age 12,” researchers wrote. “However, it is essential to determine whether parasomnias are possible precursors of psychotic experiences using longitudinal data. Therefore, we examined the relationship between the most common parasomnias in childhood…to later psychotic experiences reported at 18 years using data from a large UK birth cohort.”

The cohort is the Avon Longitudinal Study of Parents and Children, which began in order to see what factors into development, health, and disease during childhood. The present study culls the cohort’s parental reports and participant interviews to assess individuals’ experience with nightmares at certain ages throughout the study: between ages 2 and 9; age 12; and age 18.

The results showed those who have nightmares and night terrors at age 12 are more likely to experience psychotic symptoms at age 18. However, this link was influenced by cofounding variables, such as age, mood, family history, as well as baseline psychotic experiences at age 12.

“The presence of anxiety and depressive symptoms as confounding factors in those with sleep disturbance could potentially explain the findings,” Dr. Andrew Thompson, lead study author from Warwick Medical School, said inpress release. “Experience of stressful events has also been related to both the development of both nightmares and psychotic symptoms in late childhood and may be important.”

While this confirms the prior study’s finding of a relationship between nightmares, night terrors, and psychotic symptoms, it doesn’t speak to sleepwalking. And in this study, the relationship with night terrors wasn’t as strong. Even so, researchers conclude these findings “suggest that specific parasomnias … are a potential risk indicator for the development of … psychotic experiences.”

The National Sleep Foundation reported parasomnias often run in the family, and there may be a genetic factor in many cases. Brain disorders, too, influence parasomnias, as do other sleep disorders, such as obstructive sleep apnea.

But for some, parasomnias can be improved just by adopting healthy sleep habits. Maintaining a regular schedule, managing stress, and getting the recommended amount of sleep can control symptoms. Drug therapies are also available.

Source: Fisher L, Wolke D, et al. Childhood sleep disturbance and risk of psychotic experiences at 18: UK birth cohort. British Journal of Psychiatry. 2015.

A Bad Dream Is More Than Just A Dream: The Science Of Nightmares

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Dirty woman's hand holding a bloody axe outdoor in night forest
Why your nightmare is more than just a bad dream and what it means for your overall health. 

The jolt of fear and terror felt as we run for our lives to escape danger quickly eases us back into consciousness in bed to help us flee the dreamscape. Nightmares tend to creep in and out at night in our lifetime, primarily during childhood, but why do they happen in the first place? Do we ever outgrow bad dreams?

Why Nightmares Happen

Nightmares can be vivid and frightening detailed images that can leave us in a state of panic and fear after we wake up. Most young children experience nightmares, with an estimated 10 percent to 50 percent between the ages of 5 and 12 years having nightmares severe enough to disturb their parents, according to the American Academy of Sleep Medicine (AASM). Children’s nightmares may stem from listening to a scary story, TV show or movie, or even feeling anxious and stressed during the day from starting school to a death in the family. Typically, most kids will grow out of them, but what happens to adults?

Only two to eight percent of the adult population is plagued by nightmares, says the AASM, which involves some of the same triggers seen in children’s nightmares. Lauri Quinn Loewenberg, a professional dream analyst and author of Dream On It, Unlock Your Dreams Change Your Life, stresses the importance of understanding that dreaming is actually a thinking process; a continuation of our thoughts stream from the day. “[T]he nightmare is when we are thinking about difficult issues during REM (Rapid Eye Movement) and trying to sort them out. We often try to ignore our difficult issues with distractions during the day but when we are asleep and are forced to be alone in our own heads, these difficult issues will be addressed,” she told Medical Daily in an email.

Unresolved conflict is not the only causation of nightmares, poor eating habits can also contribute to the frequency of these terror episodes. People can have nightmares after having a late-night snack. Eating meals or snacks that are high in carbohydrates in the late hours of the night can increase brain activity and body metabolism.

Carol Wasserman, a certified holistic health practitioner with a private practice in Manhattan, N.Y., also suggests an unknown allergy can trigger reoccurring episodes. “For example, if you have an allergy to peaches, but are not aware, you could be getting nightmares, and once you stop eating peach ice cream at night the nightmares stop” she told Medical Daily in an email. Wasserman adds she was unaware she was allergic to shrimp and had nightmares after consumption. “Every time I ate shrimp I had a restless night and bad dreams. So I stopped the shrimp and now I sleep peacefully.”

Nightmares in adults can be spontaneous, but are generally triggered by psychological factors like anxiety and depression, and the result of poor nutrition. Moreover, sleep disorders including sleep apnea and restless legs syndrome can cause people to experience chronic, recurrent nightmares. What happens to the brain when these factors contribute to the onset of nightmares?

The Brain During A Nightmare

Nightmares tend to occur in the last third of the night when REM sleep is the strongest. Sleep is divided into four stages: stage 1 (sleep onset), stage 2 (light sleep) and stages 3 and 4 (deep sleep) — the REM stages. REM sleep occurs every 90 minutes during the night, and is associated with high brain activity, rapid eye movements and inhibited voluntary motor activity. Typically, dreaming occurs in all stages, with 80 percent of people awakened during REM sleep and sleep onset (stages 1 and 2), while 40 percent of persons are awakened from a deep sleep, according to an article in the American Family Physician.

The amygdala, which is regulated by the front lobes of the brain, seems to be the culprit when it comes to nightmares. Neuroimaging studies of the brain while dreaming show the amygdala is highly activated during REM. In Patrick McNamara’s book, Nightmares: the Science and Solution of Those Frightening Visions During Sleep, he emphasizes the amygdala’s role in handling negative mentions such as fear and aggression. This may explain why the over-activation of the amygdala during REM can produce fear-responses in the dreamer.

“[O]nce we enter REM sleep, which is when dreaming takes place, the brain is working differently (certain parts of the brain become dormant while others become highly active), so instead of thinking in literal terms and words you are thinking in pictures, symbols and emotions… metaphors!” Loewenberg said.

The Dreamers Who Have More Nightmares

Most young children are susceptible to nightmares, and a pocket of the adult population will experience the occasional nightmare in their lifetime. However, which adults are more prone to bad dreams than others?

Several studies have found age, personality type, and trauma can influence the frequency of nightmares for dreamers. A 1990 study published in the Journal of Abnormal Psychology found 47 percent of college students had at least one nightmare in a two-week study. These nightmares were not tied to self-reported anxiety, suggesting nightmares are more prevalent than previously thought in young adults.

However, an everyday fear, like a car accident, is known to trigger nightmares in the blind. A 2014 study published in the journal Sleep Medicine found blind people have four times more nightmares than those with vision. The study confirmed the nightmares were associated with emotions the blind experience while awake, such as the potential of embarrassing social situations like spilling a cup of coffee.

“I have found that it can depend on past trauma and, more common, personality type,” Loewenberg said. She added, the more sensitive people, those who avoid confrontation at all costs and who get let down very easily are more prone to nightmares, simply because life and choices are more difficult for them.”

The Dark Truth Behind The Nightmare

There a few common symbols in nightmares, such as death and murder. Death is typically about something changing or ending. When dreaming about death and children, they tend to occur when the child has reached a milestone such as learning how to walk, starting preschool, or learning how to drive. Loewenberg shares, “dreaming our child dies, for example, is typically caused by the difficult realization of how fast time is going and the young, needy child we love to cuddle and care for is dying off and a more independent child is emerging.”

Like death, murder is about an ending or change, but with a forced ending. We often tend to dream someone is trying to murder us when we are feeling pressured to put an end to or change something either about ourselves or our lives. Loewenberg uses the example of when a relationship has ended or when there’s a pregnancy; the pregnancy forces a dramatic change in our behavior.

However, the causation of nightmares can be tied to a difficult issue from long ago. One of Loewenberg’s clients had nightmares her husband would leave her in a dark, frightening parking lot at night, or that she was being attacked in a war. The client was in a happy marriage, financially secure, and healthy. “But it turns out, she was abused by both her parents as a child and made to feel unloved and unwanted. She never got help with her childhood trauma and learned how to process it so those feelings and memories were pushed down,” Loewenberg said.

Like the client, unresolved conflicts don’t go away, and shape our personality. Childhood trauma can lead to feelings of insecurity or constantly seeking validation, and feel like you’re constantly under attack if you receive criticism. This suggests our life experiences, both past and present, not only have an influence on our lives but in our dreams as well.

In order to have a better grasp of our dreams, we must begin to address the issues that plague us in the day. “We talk to ourselves all day long while awake. That doesn’t change when we sleep,” Loewenberg said. She advises, “the better conversation you have with yourself while awake will ensure better dreams at night.”

Blind people have four times more nightmares than those who can see

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A new study has provided a fascinating insight into the dreams of people who are born blind, and the cause of nightmares.

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The study by the University of Copenhagan and Glostrup Hospital in Denmark revealed that people who are blind have more nightmares than people who can see, and, interestingly, they also have more bad dreams than people who go blind later in life.

On average, a terrifying 25 percent of the dreams that people who are born blind experience are nightmares, while for people who can see, that number is only around six percent.

“The study confirms an already existing hypothesis that people’s nightmares are associated with emotions they experience while awake. And blind people apparently experience more threatening or dangerous situations during the day than people with normal sight,” the lead author of the study, Amani Meaidi, from both the University of Copenhagan and Glostrup Hospital, told Science Nordic.

Over a period of four weeks, the researchers asked 50 people to record what they dreamt about every night – of those, 11 were born blind, 14 had become blind later in life, and 25 had normal vision.

Fascinatingly, they found that the participants who were born blind didn’t dream any visual content.

“The study also points out that the sensory input and experiences we get while awake are decisive when it comes to what we dream. So people without visual sensory input dream to a much greater extent in terms of sounds, tastes, smells, and touch,” said Meaidi.

A quarter of their dreams were also nightmares, the research found, often involving threats experienced in daily life, such as spilling coffee or being run over by a car.

“At the core of my nightmares is a feeling of complete helplessness,” 41-year-old Heidi Andersen, who was born blind, told Science Nordic.

The researchers also discovered that people who lost their sight later in life often had visual content in their dreams, but the longer they were blind, the fewer dreams they had with visual content. Only seven percent of their dreams were nightmares.

People with healthy vision experienced nightmares just six percent of the time, and their dreams were all image-based.

Although scientists still don’t know for sure what the role of dreams is, it’s generally believed that dreaming helps us sort through information and remember things that are key to our survival and welfare. Generally, the more emotional and scary a dream is, the more important the lesson.

These results, which are published in the journal Sleep Medicine, suggest that people who are born blind have a greater need for these lessons, which arrive in the form of nightmares.

Albert Gjedde, a neuroscientist from the University of Copenhagan who was not involved in the research, believes that this explains why people who lose their sight later in life have fewer nightmares than those who were born blind.

“Because people who lose their sight later in life have previously seen their surroundings it might be that their brains do not experience being threatened by circumstances to the same degree as people who are born blind. For this reason they may not need to process impressions from everyday life to the same extent by means of nightmares,” Gjedde told Science Nordic. “It might help them navigate the world with confidence, in traffic for instance.”

Although it’s pretty horrible to think about one in four dreams being a nightmare, the researchers also looked into whether these bad dreams impacted negatively on the lives of people who are born blind. Thankfully, their results showed no pronounced anxiety or depression as a result of the nightmares.

This study is a fascinating insight into what dreams look and feel like when you’ve never been able to see the world around you, and the lengths our brains will go to to keep us alive.

The Science of Dreams and Why We Have Nightmares.

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The agency charged to protect patients from dangerous drug side effects needs to be far more vigilant when it comes to medications that affect blood pressure.

Robert P. Blankfield, MD, MS, a clinical professor of family medicine, issues this call to the U.S. Food and Drug Administration (FDA) in an editorial published recently in an online edition of the Journal of Cardiovascular Pharmacology and Therapeutics; the print version of the article is expected to appear this autumn.

The editorial notes that several medications survived FDA scrutiny, only to be pulled from the market after reports of increased heart attacks and strokes related to use of the drugs. These include rofecoxib (Vioxx), valdecoxib (Bextra), and sibutramine (Meridia). What these drugs have in common is that they raise blood pressure. Other medications approved by the FDA, including some antidepressant medications as well as medications used to treat attention deficit hyperactivity disorder, also raise blood pressure but remain on the market despite inadequate safety data.

At issue is the apparent disconnect between what patients and doctors might consider “clinically significant” risk and the standards that some FDA reviewers apply when evaluating the safety of new therapeutics. When it comes to medications that affect blood pressure, a few FDA reviewers only classify “clinically significant” blood pressure spikes as those that raise systolic blood pressure by 20 mm Hg (milliliters of mercury) or diastolic blood pressure by 10 to 15 mm Hg.

Increases in systolic blood pressure of more than 2 mm Hg or increases in diastolic blood pressure of more than 1 mm Hg raise the risk for heart attack by 10 percent and stroke by 7 percent in middle-aged adults, according to an epidemiological study published in Lancet in 2002. Younger individuals have less risk. For example, studies published in 2011 in the New England Journal of Medicine and the Journal of the American Medical Association indicate that attention deficit hyperactivity disorder medications are safe when used by young adults. While different populations differ in terms of cardiovascular risk, Blankfield believes one point should draw broad agreement: unless one is a healthy, young adult, clinicians and patients should have adequate cardiovascular safety data before they make prescription decisions.

“It is unwise to allow medications that predictably increase risk to be marketed without adequate safety data,” said Blankfield, also a family physician at University Hospitals Berea Health Center. “Risk should be quantified, and the product label should accurately communicate the risk.”

Blankfield, who has published other editorials recommending that the FDA require safety data for drugs that raise blood pressure, advocates a three-step solution. First, the FDA needs to establish specific guidelines regarding what degree of blood pressure elevation constitutes a risk for different populations (i.e. young adults, middle aged adults, older adults, diabetics, hypertensives, etc.). Then the agency should require pharmaceutical companies to provide cardiovascular safety data on medications that increase blood pressure. Finally, the agency should require pharmaceutical companies to post relevant data and/or warnings on medication labels.

“This would allow physicians and patients to make informed decisions about medications,” he said. “Physicians and the general public may assume that if a drug is approved by the FDA, it is safe. Yet even modest elevations in blood pressure increase the risk of heart attacks and strokes.”

Blankfield was moved to write this editorial now because of the public health importance of the issue.

Nightmares may be ‘health warning’

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Nightmare of a clown
Disturbed sleep may be a sign of mental health problems.

Regular nightmares in childhood may be an early warning sign of psychotic disorders, researchers in the UK warn.

The study, in the journal Sleep, said most children had nightmares, but persistent ones may be a sign of something more serious.

Having night terrors – screaming and thrashing limbs while asleep – also heightened the risk.

The charity YoungMinds said it was an important study which may help people detect early signs of mental illness.

Nearly 6,800 people were followed up to the age of 12.

Parents were regularly asked about any sleep problems in their children and at the end of the study the children were assessed for psychotic experiences such as hallucinations, delusions and thinking their thoughts were being controlled.

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Nightmares are relatively common, as are night terrors, it is quite normal, but if they persist then there may be something more serious about it””

Prof Dieter Wolke University of Warwick

The study showed that the majority of children had nightmares at some point, but in 37% of cases, parents reported problems with nightmares for several years in succession.

One in 10 of the children had night terrors, generally between the ages of three and seven.

Warning light

The team at the University of Warwick said a long-term problem with nightmares and terrors was linked to a higher risk of mental health problems later.

Around 47 in every 1,000 children has some form of psychotic experience.

However, those having nightmares aged 12 were three-and-a-half times more likely to have problems and the risk was nearly doubled by regular night terrors.

One of the researchers, Prof Dieter Wolke, told the BBC: “Nightmares are relatively common, as are night terrors, it is quite normal, but if they persist then there may be something more serious about it.”

The relationship between sleep problems and psychosis is not clear.

One theory is that bullying or other traumatic events early in life can cause both symptoms.

Or the way some children’s brains are wired means the boundaries between what is real and unreal, or sleeping and wakefulness, are less distinct.

It means treating the sleep issues may not prevent psychotic events.

However, nightmares may act as an early warning sign of future, more serious, problems.

Prof Wolke said a regular routine and quality sleep were key to tackling nightmares: “Sleep hygiene is very important, they should have more regular sleep, avoid anxiety-promoting films before bed and not have a computer at night.”

Night terrors occur at specific points during sleep and can be managed by briefly waking the child.

Lucie Russell, the director of campaigns at YoungMinds, said: “This is a very important study because anything that we can do to promote early identification of signs of mental illness is vital to help the thousands of children that suffer.

“Early intervention is crucial to help avoid children suffering entrenched mental illness when they reach adulthood.”