When Nightmares Won't Go Away

Yael Levy recalls having chronic nightmares as far back as elementary school, when she was living in Israel. The grandchild of Holocaust survivors, she says her dreams were filled with images of suffering and death.

In one recurrent nightmare, Levy was trapped in a concentration camp, facing death. In another, she was drowning in deep water. At their worst, the nightmares occurred on an almost weekly basis, leaving her jittery and desperately fatigued.

"I would wake up so terrified that I was afraid to go back to sleep," Levy says. "And the bad feelings were hard to shake. I would continue to feel frightened throughout the next day."

Chronic Nightmare or Bad Dream?

There's nothing unusual about having an occasional nightmare (which sleep experts define simply as a bad dream that causes the sleeper to wake up). But up to 8% of the adult population suffers from chronic nightmares, waking in terror at least once a week.

Sometimes the nightmares are so frequent and so upsetting that they make sound sleep all but impossible, setting the stage for fatigue and emotional problems like anxiety and depression.

Nightmares vary widely in their themes and specific content -- experts say they can be "about" anything -- but all cause fear, sadness, anger, shame, or another negative emotion. They occur during REM sleep, typically in the latter part of the night. Though more common in children and adolescents, they also strike in adulthood.

In many cases, chronic nightmares are triggered by psychological stress -- such as that stemming from posttraumatic stress disorder, a severe anxiety disorder that strikes people who have been exposed to combat, violent assaults, accidents, natural disasters, and other terrifying ordeals.

Other causes of chronic nightmares include alcohol abuse, the use of certain medications (including going off antidepressants), and sleep disorders, including the disordered breathing condition known as sleep apnea.

Plagued by Nightmares

Now 29 years old and living in New York City with her husband and 4-month-old son, Levy says she endured years of fractured sleep and persistent anxiety because of chronic nightmares. It never occurred to her that help was available.

"People have nightmares," Levy says. "I had mine, and that was that. I didn't think it was the sort of problem that could be treated."

It's a common misconception.

"Lots of people think that nightmares can't be treated," says Shelby Harris, PsyD, director of the behavioral sleep medicine program at Montefiore Medical Center's Sleep-Wake Disorders Center in New York City. "But there are effective treatments."

Help for Chronic Nightmares

One treatment option is psychodynamic psychotherapy, in which patients meet regularly with a therapist to discuss their nightmares and consider any emotional problems that might be causing them.

Another option is taking prazosin, a medication usually prescribed for high blood pressure; studies have shown that nightly doses of the drug are effective against chronic nightmares in people with posttraumatic stress disorder.

But Levy found relief not in pills or psychotherapy but from a simple behavioral technique she learned from Harris after seeking treatment not for nightmares but for insomnia.