Nightmares

The teaching

As the sleep clinic's way with nightmares, after Barry Krakow teaches it.

What a nightmare is

A nightmare is a long, frightening dream that wakes the dreamer, who comes round quickly, knows where they are, and remembers the dream clearly. Nightmares come mostly from the dream sleep of the second half of the night, when dreams are longest. Nearly everyone has them now and then. They are common in childhood, under strain, after a shock or a loss, and with some medicines, and they become a problem only when they come often enough to make sleep itself a thing to dread.

Other frights of the night

Some night frights are not nightmares. A night terror strikes early in the night, out of the deepest sleep: the sleeper sits up or screams, the heart races, they are hard to wake and confused when woken, and in the morning they remember little or nothing. Night terrors belong mostly to childhood and are usually outgrown; the clinic's advice is to keep the child safe and not to try to wake them.

Sleep paralysis, waking unable to move, sometimes with a figure in the room, is harmless and passes. Acting out dreams, shouting, striking out or leaping from bed while dreaming, especially in later life, is something else again, and a reason to see a doctor. Nightmares that replay a real event closely, again and again, belong with a doctor or therapist too.

Reading an occasional nightmare

An occasional nightmare can be read like any dream, as a mirror. Leave the writing until morning light; in the small hours everything looks darker than it is. Find its central image and its ruling feeling, and ask what in waking life now carries that fear: what is pursuing, what is collapsing, what is out of control. Often the answer is a worry already known, given a sharper shape.

Imagery rehearsal

For nightmares that keep coming, sleep clinics use a method called imagery rehearsal, developed by Barry Krakow and his colleagues. Its idea is that a nightmare that returns night after night has become a habit of the sleeping mind, and that a habit can be retrained. The steps are simple. First, choose one nightmare to work on; the usual advice is to begin with one that is not the worst and not one that replays a trauma, which is better worked on with a therapist.

Then change the nightmare in any way you wish. Krakow deliberately does not say what kind of change to make, and trusts the dreamer to choose: it can be large or small, a new ending, a different place, the danger gone, a helper arriving, or the whole dream made dull. Write the new version down. Then, once a day, while awake and calm, spend some minutes picturing the new dream as vividly as you can, commonly between five and twenty, and do not rehearse the old one.

Work on one or two nightmares at a time, and keep the daily rehearsal going for some weeks. The aim is that the old dream, no longer rehearsed, fades or changes of its own accord.

Pleasant imagery first

Before rehearsing a changed nightmare, the method has people practise pleasant imagery, picturing a calm or happy scene in detail and with all the senses, so that the skill of imagining is built on easy ground. Krakow teaches those for whom any imagery brings up distress to notice the distressing image, and then to choose to move away from it to a new and pleasant one. If imagining at all stirs strong fear, the work should go on with a therapist.

After waking from one

When a nightmare wakes you, orient first: put on a soft light, feel your feet on the floor or your back against the bed, look around the room and name a few ordinary things in it. Breathe slowly, letting each breath out last longer than the breath in. A sip of water helps some people. Remind yourself that it was a dream and that you are safe.

Then turn the mind to something gentle before trying to sleep again: a calm place, a pleasant memory, or the changed version of the dream if you have one. If sleep has not come after twenty minutes or so, get up and do something quiet in dim light until you feel sleepy, and then go back to bed.

Calming the nights

Nightmares grow in tired, strained and irregular nights. Regular hours, enough sleep, less alcohol in the evening and a quiet hour before bed all help; alcohol in particular can bring on vivid, broken dreaming in the second half of the night. Some medicines bring on nightmares as a side effect, and a doctor can review them, but a prescribed medicine is never stopped without advice.

Facing the dream from inside

Some dreamers learn to recognise a recurring nightmare from inside it, as a lucid dream, and then to face the figure and ask what it wants, or simply to remind themselves that they are dreaming and safe. That can help, and the art of lucid dreaming describes it. For frequent nightmares, though, the clinic's method comes first, and lucid techniques that break sleep only add to the trouble.

When to ask for help

Ask a doctor or therapist for help if nightmares come most nights, if they replay something that happened to you, if they make you afraid to go to sleep, or if they leave you exhausted or shaken by day. There are treatments that help many people, imagery rehearsal among them, and therapies for trauma that work on the dreams at their root. A nightmare, however vivid, is a dream of the sleeping mind. It foretells nothing, and it can be changed.