Some Words on: Nightmares and Restless Sleep on Psychiatric Medication

As for all states of distress, APA also has a fancy name for nightmares: nightmare disorder or dream anxiety disorder. It is known that everybody has nightmares from time to time. They are believed to be caused by our mind trying to process conflicts, fears and stressful life events. In other words: nightmares are a healthy and necessary phenomenon that helps us deal with our issues and move on. Yet, when unsettling dreams become so frequent and so intense that they disrupt our sleep patterns and affect our mental and emotional balance during the day, they no longer help us to cope, but they add to our problems. Not only do nightmares leave an ugly aftertaste and cloud our mood. Deprivation of restful sleep can exacerbate already existent psychoses. Sleep, and in particular restful sleep, are a vital component of mental health.

Although it is meant to improve symptoms of mental illness, psychoactive medication commonly causes sleep disturbances, including nightmare disorder. In general, psychotropic drugs will affect your sleep cycles in one or the other way, for whatever acts upon your mental functions during your waking hours, logically also does so when you are asleep. Both my antidepressant (Sertraline) and my anti-psychotic (Quetiapine) list nightmares as a frequent side-effect, along with other sleep abnormalities, such as insomnia or excessive sleepiness. So far, I have gotten away with only the nightmares.

Ever since I got on psychoactive medication, I have had hardly one night without unsettling dreams, and this is not an exaggeration. The topics are nauseatingly repetitive. Being far from home at a place I perceive as threatening and fearing not to be able to leave, is a classic. Typically, in my dream I am anxious to leave that place before the onset of winter with its cold and darkness. A variation of this scenario is my having to travel to a threatening place. Luckily, my dream-Self has learned by now to just say “I am not going. I have a right to be where I feel safe and happy.”. Often, these dreams are coupled with scenes of confrontations between me and relatives whom I am also in conflict with in real life. Typically, they would attempt to tear down my self-confidence or force me into life choices I feel strongly opposed to. Before I moved in with my partner four months ago, I also used to dream I was living in a house that was crumbling. Cracks would appear in the walls, or big chunks of plaster would fall off them. In those dreams, it was understood that the structure could collapse and crush me any minute. I believe I can see clearly which fears all these nightmares spring from. My interpretation is that, after having seen my existence and my personal autonomy disintegrate during my psychotic break, my psyche is still fearful of it to possibly happen again. Over the last years, I have returned to a good life. In fact, I would say my life is now happier than it has ever been before. To me, it seems only logical that my not-so-subconscious is afraid of losing it all again.

Plane crashes are another frequent dream. I am actually afraid of flying, so the source of this scenario is also quite obvious. The origin of other nightmares is less evident. An interesting one is the vision of a cataclysmic volcanic eruption or simply a nearby active volcano that scares the crap out of me, but apparently out of nobody else. In my dreams, I regularly find myself in groups of enthusiastic people who absolutely want to climb up to the crater, while I am desperately trying to convince them not to. In reality, I do live in the proximity of three volcanoes, but I have never witnessed an eruption. I realize such an event is a possibility, but it is not something that occupies my conscious mind. So far in my life, I have scaled five volcanoes and slept at the foot of another three without being overly concerned about it.

A few posts ago, I had already mentioned that I am beginning to have less intense nightmares than has been usual for me over the last four years. And finally, last week, I got a break from my nightly horror-marathon. I actually dreamt something pleasant! I will abstain from going into details, but the sweet afterglow of that dream stayed with me throughout the day. It has been a while since this last happened to me. I am quite delighted! Placing the dream in the context of my current life situation, I have to assume a huge part of the improvement is certainly due to my moving into a new, lovely home with my partner and us both making healthy changes to our lifestyle. And although I have only just started to wean off my medications, I also hope the reduction of my medication dose to have something to do with the improved quality of my sleep. Could it be that my brain was too numbed down to process topics of conflict and therefore brought them up again and again through my dreams, similar to a broken record that can’t get past a certain content, but replays it in an endless loop? Could the dose reduction have begun to reactivate those parts of my psyche, allowing me to finally deal with and eventually overcome the unresolved issues? I cannot know for sure, but it is a hypothesis that I find logical.

Whether or not you consider weaning off your medications, you can – and should – attempt to improve the quality of your sleep. Actually, some speak of “sleep hygiene”. Taking measures of sleep hygiene is recommendable for everyone, even “healthy” individuals. The equation is simple: the more restful your sleep is, the better you feel all over – mentally and emotionally – and the better your cognitive functions are. If you are tormented by insomnia or by nightmares to a point that you perceive sleep as an unpleasant duty, try the following:

  • Establish regular sleeping habits. Try going to bed and getting up approximately at the same time every day, and allow yourself at least seven hours of rest. Even if your sleep gets interrupted during the night or you can’t fall asleep in the first place – stick to those seven hours and get out of bed at the established time. Eventually, your organism will recognize this resting period as its opportunity for distension and revitalization.
  • Create an optimal sleep environment in your bedroom. Make sure your mattress is comfortable and your pillows allow you to rest your head without straining your neck and upper back. Switch off all the lights and, if possible, do not keep any electronic devices in your bedroom. Use curtains or blinds which block street lights and the morning sun effectively. Try out if you prefer complete silence or soft noises like the gurgling of a small fountain or the regular ticking of a clock. Make sure temperatures in your bedroom are moderate. Neither excessive heat nor cold will help you sleep.
  • Avoid caffeinated beverages, stimulant medication or other energizing substances during the late afternoon and evening. Funnily, although alcohol can make you feel drowsy in the beginning, it is a major sleep disruptor because it messes with your sleep cycles. Same as for stimulating substances, take care not to have booze right before going to sleep. Personally, I know some people who actually have a cup of coffee or even espresso right before going to bed. They insist it helps them sleep. If you are one of that kind, fair enough, but probabilities are that you react to caffeine like most other mortals do – by staying wide awake. To be on the safe side, stay away from coffee and maybe have a glass of hot milk or soothing herbal infusion before going to sleep.
  • Just before going to bed, give yourself 30 minutes of time out. Spend them on a relaxing activity: meditation, reading, cuddling with your pet, chatting with your partner, watering your plants or just putting things in place around the house. Give yourself an opportunity for winding down and cleansing your mind and emotions at the end of every day. Studying for an exam or watching an action movie and then hitting the hay immediately is not a good idea. Just like a train can’t come to a dead halt, you need to gently let your mind come to rest.
  • Eat at least two hours before going to sleep. Going to bed with a full stomach is almost certain to make you toss and turn. If your schedule doesn’t allow for this, prepare a light snack rather than a full meal in the evening.
  • Exercise! Any type of workout, especially if performed several times a week, will not only help you burn off calories, but it will also improve your mood significantly. It is not necessary to do anything extreme or spectacular. Yoga and long walks are perfectly fin. Of course, if you wish to go for something more intense, feel free! Regular exercise will help you find a more restful sleep and balance your mood. Just remember that, if you exercise intensely in the evening, you need to come off your adrenaline rush before going to bed, so don’t hop right from the treadmill into bed. Maybe do a short yoga routine, have a nice warm shower or engage in some activity you find soothing.
  • Follow a healthy diet. Prefer whole, fresh foods to highly processed ones. Processed foods are typically rich in all the wrong things: sugar, fat, sodium, artificial sweeteners, preservatives, colorants. At the same time, they are almost devoid of vital nutrients and contain very little dietary fiber, which you need to cleanse your intestines. Thinking you can make up for your dietary deficiencies by taking supplements is a wrong assumption. Cover as many nutritional necessities as you can through your food intake. My partner and I, for example, are going low carb and mainly eating vegetables, lean meats, soy and dairy products. We have also developed the habit of drinking vegetable smoothies every morning. They taste great, and depending on which veggies and fruits you combine you can obtain different flavors, colors and nutritional benefits. We use kale as a main ingredient, and from there we just improvise according to what we have at home: spinach, strawberries, beets, celery, raspberries, carrots, apples, lettuce, and so on. Be creative, it’s your call to design your own liquid salad!

As you can see, there is a lot you can do for your sleep quality, even if you choose to stay on psychiatric medication for now. Try any or all of the above measures before asking your prescribing doctor for tranquilizers or sleeping pills. Adding medication to your treatment plan may seem like a quick fix. Yet, it only delays your getting to the root of your problems, compromises your liver and will make it even more difficult for you to ever wean off your medications. When you’re lost in the jungle, don’t add more trees. Consider taking further medication as the very last resort, or as an emergency solution to treat acute insomnia or psychosis temporarily.

Last, but not least, make sure you have the support of those living under the same roof with you. You can make your room as dark and as quiet as you like, but if your roommate insists on having noisy reunions or listening to loud music during the evenings, you will have a hard time finding sleep. Whoever you share your space with – family members, your partner, friends or fellow patients – explain to them why and how you wish to improve your sleeping habits. You might even be able to make them join in! Everybody needs restful sleep, and certainly everyone enjoys it. Personally, I find it extremely helpful that my partner and I are on the same page in terms of looking after our health. We share the same diet, do yoga together and follow the same sleeping schedule. Doing all of these things together is also a beautiful occasion for bonding. We research and discuss new food recipes, try out different yoga routines and have a small chat before going to sleep. Incorporating healthy habits into our lifestyle has been a wonderful contribution to a harmonious relationship and a happy home.

I would love for you share your own experiences with nightmares or other sleep disturbances, and with measures you have taken to overcome them. Feel free to comment. I will read through everything you send me and publish it here on my blog. Looking forward to hearing from you!

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