Persistent Nightmares - Any tips?

[Michael569]

I'm working with someone who keeps having persistent nightmares returning to traumatic experiences of the past. 

And while we've improved other areas of their life, this one isn't improving much. They are already working with a psychotherapist but I feel like this needs a different approach but is beyond my scope of practice. 

Can you guys recommend any books or tips for someone going through this? 

Thanks!

[Schizophonia]

https://raypeatforum.com/community/threads/elevated-serotonin-5-ht-and-norepinephrine-ne-drive-nightmares-in-ptsd.49526/

Seems logical, I didn't use cypro but the benzodiazepines transform my sleep into a teleport until the next day.
The days following my nights are restless and I have nightmares, after cutting cold turkey from large doses of alprazolam I was actually able to sleep but I have horrible nightmares like being murdered, smelling "the smell death" etc.

GABA agonists are potent agonists of serotonin and all stimulatory neurotransmitters/modulators in general.

https://pubmed.ncbi.nlm.nih.gov/242201/#:~:text=Although central serotonin neurons are,indirectly to reduce serotonin activity.

https://pubmed.ncbi.nlm.nih.gov/6814196/#:~:text=In view of the fact,HTP in three regions of

People also report nightmares or at least dreaming faster after high choline intake or at least after taking substances that increase acetylcholinergic signaling.

Edited June 13, 2023 by Schizophonia

[aurum]

@Michael569

EMDR.

Bessel talks a lot about its ability to work with nightmares related to trauma in The Body Keeps The Score. Never dealt with these kind of nightmares personally, but in my experience EMDR definitely is effective and worth investigating.

[Jacob Morres]

No tips but I appreciate you thinking outside the box to help your client. Really shows you're committed to figuring out solutions.

Edited June 13, 2023 by Jacob Morres

[Michael569]

@Lila9 @Jacob Morres

10 hours ago, aurum said:

Bessel talks a lot about its ability to work with nightmares related to trauma in The Body Keeps The Score. Never dealt with these kind of nightmares personally, but in my experience EMDR definitely is effective and worth investigating.

thank you, I will look into this. Would you suggest recommendig the book to them? I haven't read it myself but heard great things about it. 

It seems to be that the true reason is the physical body is constantly on the run away from the emotional body that is trying to process trauma that happened to her during covid and the only time that happens is in the middle of the night which leads to all these nightmares. We're trying to work on that. Appreciate the response

@Schizophonia  thank you for the elaborate response. The issue I am facing is that she is on SSRIs which are messing up with her serotonin system already so yah it might be that it is not helping for sure. I can't do anything about that unless she decides to temper off and her psychiatrist needs to approve it. I've gone down that route with others and it is a messy process. ST John's Wort and Saffron could hold her psychologically during SSRi withdrawal but her doc needs to be onboard and they usually don't like to be. SSRI for life is easier. 

16 hours ago, Schizophonia said:

People also report nightmares or at least dreaming faster after high choline intake or at least after taking substances that increase acetylcholinergic signaling.

Having analysed her diet, the choline intake is pretty standard so not sure if this would have to do anything with it. 

 

[Schizophonia]

36 minutes ago, Michael569 said:

 

@Schizophonia  thank you for the elaborate response. The issue I am facing is that she is on SSRIs which are messing up with her serotonin system already so yah it might be that it is not helping for sure. I can't do anything about that unless she decides to temper off and her psychiatrist needs to approve it. I've gone down that route with others and it is a messy process. ST John's Wort and Saffron could hold her psychologically during SSRi withdrawal but her doc needs to be onboard and they usually don't like to be. SSRI for life is easier. 

Having analysed her diet, the choline intake is pretty standard so not sure if this would have to do anything with it. 

 

Which ? ?

Mirtazapine is apparently better for this problem because it is actually an antagonist of adrenalinergic receptors and certain 5-HT receptors implicated in anxiety, nightmares, and insomnia.
People with PTSD have more adrenaline and are sometimes prescribed beta-blockers in parallel with their usual treatment, precisely for the problems of nightmares, "flashbacks"...

https://wchh.onlinelibrary.wiley.com/doi/abs/10.1002/pnp.418

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4818733/

So yeah, maybe change the medication (not necessarily Mirtazapine) I guess.

[integral]

Is she living in a secure environment? I had a ex gf whos trauma was healed during our dating she would have constant night terrors reliving the trauma for years and would wake up in the middle of the night calling me. What helped was a change in environment and meeting her security needs, if we think about it from Maslow's hierarchy. Took about 6 months after she moves house, reduced contact with toxic people and surrounded herself with healthy ones. 

From personal experience with sleeping issues but not with reoccurring dreams is that eating heavy foods to close to bed time or taking supplements like B-complex, vitamin C or Ashwagandha any time during the day can cause vivid dreams (disturbance) at night. So if she is taking anything its better to experiment avoiding them to see if that helps. She could also be sensitive to coffee if she is drinking that every morning or evening. Also if she has any gas build up in her digestion track the pressure in the intestines stresses the system and keeps the body with high cortisol during the night causing sleeping issues. 

With anti-depressants when I met my current gf she was taking them, so I immediately worked with her to start the gym and reduce the dosage slowly over a 2 months until she was off of it. Because of the high she was getting from our new relationship and life style changes she got off of them with 0 withdrawals, at some point she just stopped taking them with out following the proper reduction protocol because she was high on life lol. 

Edited June 14, 2023 by integral

[Michael569]

2 hours ago, Schizophonia said:

Which ? ?

Mirtazapine is apparently better for this problem because it is actually an antagonist of adrenalinergic receptors and certain 5-HT receptors implicated in anxiety, nightmares, and insomnia.
People with PTSD have more adrenaline and are sometimes prescribed beta-blockers in parallel with their usual treatment, precisely for the problems of nightmares, "flashbacks"...

https://wchh.onlinelibrary.wiley.com/doi/abs/10.1002/pnp.418

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4818733/

So yeah, maybe change the medication (not necessarily Mirtazapine) I guess.

at the moment escitalopram as that seems the be the first one that does not make her gain weight and cause headaches - still not ideal. I don't prescribe pharmacology so its outside of my scope to change them. That's a psychiatry work. 

She definitely has PTSD problem but somehow I think more meds aren't the solution here. Beta-blockers, in UK are prescribed mostly for hypertension, you would struggle to get a prescription for mental health. Basically, she has been put on meds and sent home...that's a standard approach from the NHS. 

I think if she could go off, 5-HTP or SJW would be the way forward (alongside other tools) 

1 hour ago, integral said:

Is she living in a secure environment? I had a ex gf whos trauma was healed during our dating she would have constant night terrors reliving the trauma for years and would wake up in the middle of the night calling me. What helped was a change in environment and meeting her security needs, if we think about it from Maslow's hierarchy. Took about 6 months after she moves house, reduced contact with toxic people and surrounded herself with healthy ones. 

I totally believe this can be achieved and if I had a 100% free hand in this (untied by the NHS) , could follow her around for 24-hrs a day and control her environment and guide her through mindfulness therapy, she'd probably be off in 2 months but there are limits to what can be achieved through online communication. Your girlfriend was lucky to have a stage Yellow dude around Most people are not so lucky, I think her bf is stage orange guy who does not himself lead the best type of lifestyle. 

1 hour ago, integral said:

From personal experience with sleeping issues but not with reoccurring dreams is that eating heavy foods to close to bed time or taking supplements like B-complex, vitamin C or Ashwagandha any time during the day can cause vivid dreams (disturbance) at night. So if she is taking anything its better to experiment avoiding them to see if that helps. She could also be sensitive to coffee if she is drinking that every morning or evening. Also if she has any gas build up in her digestion track the pressure in the intestines stresses the system and keeps the body with high cortisol during the night causing sleeping issues. 

She is taking both of those vits already along with Omega 3s, magnesium (all self-prescribed) , I'm a bit worried to put her on any herb as these things interact with meds a lot and has has already gone through an episode of serotonin syndrome in the past. 

yah coffee is a good call, she said it does not impact her but I don't believe that. Reduction is caffeine is one my goals with her. 

Another issue is that she exercises an insane amount of time and has a bit of an adrenaline addiction in that way, I think and that's something that we also need to fix by getting her to slow down. 

1 hour ago, integral said:

ith anti-depressants when I met my current gf she was taking them, so I immediately worked with her to start the gym and reduce the dosage slowly over a 2 months until she was off of it. Because of the high she was getting from our new relationship and life style changes she got off of them with 0 withdrawals, at some point she just stopped taking them with out following the proper reduction protocol because she was high on life lol. 

like I said, she is lucky to have a dude next to her who can lead her through that that's an inspiring story! 

[integral]

2 hours ago, Michael569 said:

She is taking both of those vits already along with Omega 3s, magnesium (all self-prescribed) , I'm a bit worried to put her on any herb as these things interact with meds a lot and has has already gone through an episode of serotonin syndrome in the past. 

yah coffee is a good call, she said it does not impact her but I don't believe that. Reduction is caffeine is one my goals with her. 

Another issue is that she exercises an insane amount of time and has a bit of an adrenaline addiction in that way, I think and that's something that we also need to fix by getting her to slow down. 

Its a easy experiment to stop taking all the stimulants for a week and seeing if that helps? Avoid B-complex, vitamin c (raises serotonin), herbs, coffee? 

 

2 hours ago, Michael569 said:

like I said, she is lucky to have a dude next to her who can lead her through that that's an inspiring story! 

?Maybe there's a job opportunity there, holisticboyfriends.com

[The0Self]

I used to have nightmares a lot. I have diagnosed narcolepsy and very often get sleep paralysis. I would procrastinate going to sleep every night. The sleep paralysis was painful too — felt like what I can only describe as phantom limb syndrome across the entire body. Eventually it cleared up for the most part fairly randomly but it happened at the same time as what I would call “growing up.”

Edited June 14, 2023 by The0Self

[Michael569]

47 minutes ago, integral said:

s a easy experiment to stop taking all the stimulants for a week and seeing if that helps? Avoid B-complex, vitamin c

Might be worth the shot

5 minutes ago, The0Self said:

I used to have nightmares a lot. I have diagnosed narcolepsy and very often get sleep paralysis. I would procrastinate going to sleep every night. The sleep paralysis was painful too — felt like what I can only describe as phantom limb syndrome across the entire body. Eventually it cleared up for the most part fairly randomly but it happened at the same time as what I would call “growing up.

That's interesting. She does report having sleep paralysis quite a bit. Has anything helped with that while you were in the mids of it? Somehow I feel that her SSRIs might be making this worse but I can't prove it. 

[Superfluo]

Talking about it with a psychotherapist is not enough.

From a psychological perspective, I'd suggest:

- The Completion Process, by Teal Swan

- Parts Work (Teal Swan has a video on it)

- Inner Child Work/Visualization (basically visualizing an emotion as the inner child and taking care of/listening/accepting/understanding it)

These techniques let you be in control of what happens.

I have other posts on healing, check my signature.

[Osaid]

Increase sleep quality, make sure sleep isn't being interrupted and that the sleep schedule isn't weird. 

IME, if the sleep is interrupted a lot or if it is low quality, it increases the amount of dreams and makes them more vivid as well. You end up phasing in and out of a lot of weird dream states.

With a certain sleep schedule, I was able to enter sleep paralysis with about a 80% success rate. I was sleeping from 6pm -11pm and then sleeping again at 3am - 4am. So make sure that there isn't any awkward schedules like that going on.

 

[Israfil]

11 hours ago, Schizophonia said:

Which ? ?

Mirtazapine is apparently better for this problem because it is actually an antagonist of adrenalinergic receptors and certain 5-HT receptors implicated in anxiety, nightmares, and insomnia.
People with PTSD have more adrenaline and are sometimes prescribed beta-blockers in parallel with their usual treatment, precisely for the problems of nightmares, "flashbacks"...

https://wchh.onlinelibrary.wiley.com/doi/abs/10.1002/pnp.418

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4818733/

So yeah, maybe change the medication (not necessarily Mirtazapine) I guess.

Do you study psychiatry? You seem to know a lot about meds.

[aurum]

12 hours ago, Michael569 said:

thank you, I will look into this. Would you suggest recommendig the book to them? I haven't read it myself but heard great things about it. 

It might be worth a read if they are open to it and curious about trauma in general. It’s kind of a long read though, and the majority of it is not about EMDR.

To get an experience of EMDR, they are likely better off just seeing a therapist or trying virtual EMDR (https://www.virtualemdr.com/)

[Schizophonia]

11 hours ago, Israfil said:

Do you study psychiatry? You seem to know a lot about meds.

Yes, but self-taught.
But I am much more comfortable in endocrinology than in psychiatry, and my advice does not ultimately replace the recommendations of a good specialist.

[Michael569]

15 hours ago, Superfluo said:

- The Completion Process, by Teal Swan

- Parts Work (Teal Swan has a video on it)

- Inner Child Work/Visualization (basically visualizing an emotion as the inner child and taking care of/listening/accepting/understanding it)

thanks, yes I think she needs a deeper work. I do not know a lot of therapists who would do this type of work (well, 2 on this forum but not sure if they are still practicing) - it is really difficult to find a good therapist in this area. She would definitely benefit from IFM but I believe there is such thing as having too many therapists. Right now she has: NHS psychiatrist, NHS GP, private psychotherapist + me. But she definitely needs to go deeper. 

 

16 hours ago, Osaid said:

ncrease sleep quality, make sure sleep isn't being interrupted and that the sleep schedule isn't weird. 

IME, if the sleep is interrupted a lot or if it is low quality, it increases the amount of dreams and makes them more vivid as well. You end up phasing in and out of a lot of weird dream states.

With a certain sleep schedule, I was able to enter sleep paralysis with about a 80% success rate. I was sleeping from 6pm -11pm and then sleeping again at 3am - 4am. So make sure that there isn't any awkward schedules like that going on

Thanks, I agree with these points. Her sleep is all over the place, it is something we are working on, mainly it is being disrupted by her nightmares hence the existence of this thread. Good to know about the sleep paralysis. 

13 hours ago, aurum said:

o get an experience of EMDR, they are likely better off just seeing a therapist or trying virtual EMDR (https://www.virtualemdr.com/)

Thank you, I will recommend this to her as a potential tool to look into. 

[Israfil]

8 hours ago, Schizophonia said:

Yes, but self-taught.

Give me all your sources or your feet will turn green.

[Schizophonia]

2 hours ago, Israfil said:

Give me all your sources or your feet will turn green.

Mostly :
-Meso RX
-Ray peat forum (especially the posts of some people like Haidut, Travis, RedSun...).
-And especially blogs and/or videos of personalities who seem relatively reliable to me (Denise Minger, Haidut, Danny Roddy, sometimes carnivores like Dr Chaffee, Dr Robert Kiltz, Dr Ken Berry, even Bart Kay even if he mostly spends his time to contradict vegans in an aggressive and sarcastic way lol).
I was also interested in certain vegans in terms of nutrition (McDougall, Dr Greger), but that did not interest me more than that because beyond my disagreement / my reproaches, they have above all an epidemiological approach and it does not interest me.

I don't know too many personalities for endocrinology except maybe Dr Rand Mcclain on youtube, none for psychiatry, most of the videos or blogs are of doctors or university professors, that's good but I don't retain their name ha ha.

I don't have a university education and my approach to these areas is more like collecting information here and there according to my concerns and my free time.
So I don't really have an endocrinology book (apart from perhaps Seignalet's book, if you are interested in immunology/allergenicity, nutrition, the relationship between the two and the chronic diseases that can result from it etc) or stuff like that to advise you which could alone give you serious bases in endocrinology, psychiatry or other, if that was what you asked for. 

Edited June 15, 2023 by Schizophonia

[LSD-Rumi]

@Michael569 I think there is a treatment, in which she tries imagining the nightmare and then changing the outcome of it, and then keep repeating this multiple times a day until it is gone.

She also must learn to face her fears. She should do some Flooding therapy and desensitization.