Category: Nightmares

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Nightmare-Suicide Link Extends to Adolescents

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Read on to find out how you can help!

If you know or work with a deeply troubled teen, you might consider asking them about their dreams. If they report frequent disturbing dreams or nightmares, they are at a greater risk for suicide. The link between adult suicide and nightmare frequency has been well established, and a new study extends this correlation to young adolescents. The good news is that nightmares are treatable, and some very simple steps can make a meaningful difference.

In a recent study based in Montreal, Canada, Aline Gauchat and colleagues studied both the dreams and suicidal ideation of 170 children when they were 12 and again at age 13. Disturbed dreaming tends to lessen with age and did so in this sample. At the same time, the rate of suicidal ideation increased, and analysis of the data showed that the adolsecents who had suicidal ideation had significantly more disturbing and recurring dreams.

This is another piece of mounting evidence that when working with those with a potential risk of suicide (for example those with depression, borderline personality or a history of complex trauma) you should ask about nightmares as part of the screening process.

 

Why we should ask about nightmares

Dr. Michael Nadorff, who has conducted several studies linking nightmares and suicide, noted with dismay that in the past 50 years, we have not become any better at predicting suicide. Paying attention to dreams, in particular the frequency of disturbing dreams and nightmares, is one way to help determine who is most at risk.

The other important thing to note with respect to the nightmare-suicide link is that effective nightmare treatments are available. In his talk on nightmares at the recent (June, 2021) conference for the International Association for the Study of Dreams, Nadorff noted that of those with dangerously troubling dreams, only one person in ten might report this to a mental health professional. There are a couple of reasons for this: those with frequent nightmares don’t always realize that such dreaming is not typical. And very few people are aware that nightmares can be treated. People also hesitate to talk about their nightmares for fear of being judged for the dark images that haunt their sleep.

However, talking about nightmares, and getting treatment can have positive effects that extend beyond the simple reduction in the frequency and distress caused by disturbing dreams. In general, symptoms of depression and trauma dissipate, and although this has not been specifically studied, it is fair to suggest the risk of suicide drops significantly as well.

Instilling Hope

When asked what he thought made nightmare sufferers more likely to consider taking their own life, Nadorff said he thinks a lack of hope is a major contributing factor. For frequent nightmare sufferers, even sleep is not a refuge from their tortured thoughts. Those contemplating suicide report deep loneliness and a sense that they are a burden to those closest to them. He suggests intensive support for those whose risk of suicude is high, stressing that the periods of high risk are time-limited.

Treating the nightmares of those contemplating suicide is also something Nadorff recommends, though this idea has not taken hold very widely, at least not yet. But Imagery Rehearsal Therapy (IRT), lucid dreaming, and several other nightmare treatment protocols demonstrate that it can be fairly quick and easy to reduce nightmares and their related distress. In my survey of the nightmare literature, I have found that virtually all methods researchers tried seemed to help, and adverse effects seemed absent.

The common denominators in nightmare treatment include instilling hope by teaching those with nightmares that they are treatable and it is entirely possible to change their dream life for the better. The other key elements of treatment are to write, rescript or re-imagine a new ending to their nightmare, ideally one that gives them a sense of mastery over the challenge presented in their dreams. They can, for example, develop a superpower that enables them to escape or overpower their attacker. In my experience, the more richly imagined this new dream ending is, the more power it has to change subsequent dreams. If it sounds too simple, don’t be fooled… it can really be that easy to make a meaningful difference, possibly even save a life.

 

Some further resources:

Help for nightmare sufferers (free PDF) CLICK HERE

A short focused course on nightmare treatment for clinicians CLICK HERE

Are you a parent concerned about the frequency and intensity of your child’s bad dreams? Should you be concerned?
Learn more about Nightmare Relief for Everyone designed by nightmare expert Dr. Leslie Ellis, this self-paced user-friendly and accessible online course covers the very latest in science and research about what nightmares are, and what they’re not. Leslie offers some simple steps you can take to get some relief from nightmares and other nocturnal disturbances – both for yourself and for others, including your children.

 

References

Gauchat, A., Zadra, A., El Hourani, M., Parent, S., Renaud, J., Tremblay, R. E., and Seguin, J. R. (2021). Association Between Recurrent Dreams, Disturbing Dreams, and Suicidal Ideation in Adolescents. Dreaming 31(1), 32-43.

Nadorff, M. (2021). Invited talk for the International Association for the Study of Dreams (IASD) Online Conference, June 13-17, 2021.

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Can Your Apple Watch Stop Your Nightmares?

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For more than 30 years, retired combat Marine veteran Tim Bahr would have his sleep interrupted by a dozen or so nightmares every night. He clearly recalls the morning of August 5, 2017 because that was the first time in decades that he woke up from a full night of sleep and could not recall a single nightmare. Bahr was testing an early version of NightWare and has become a strong advocate for this new nightmare treatment.

Nightware, is a ‘breakthrough’ system that uses an Apple watch and iPhone to help reduce nightmares and their related distress. As you begin to have a nightmare, a gentle vibration from the watch wakes the wearer just enough to change the dream state, allowing the person to sleep on more peacefully. Bahr said the sleep data shows he is still having nightmares but the device ‘breaks’ them before they get to the most intense places, so he is blissfully unaware of them. He also says this does not replace therapy but it does enable him to work through his PTSD with a well-rested body and a clear mind. “I now wake up without that fog.”

Granted FDA approval in November 2020, Nightware is now available on a limited basis by prescription to those who suffer from nightmare disorder or nightmares related to post-traumatic stress disorder (PTSD). This is new order of nightmare treatment was granted ‘breakthrough device’ designation that allowed it to fast-track through the FDA approval process.

Recurrent, realistic nightmares that replicate traumatic events are a cardinal feature of PTSD. They cause considerable distress and impair sleep, and for many, these distressing dreams do not simply go away with time. There have been several effective nightmare treatments developed that involve some variant of nightmare rescripting – in which the dreamer invents and rehearses a new ending to their nightmare. Imagery Rehearsal Therapy (IRT) has the most supportive evidence, and many other, similar psychotherapy-based interventions have been developed over the past 20 years. Medications are often prescribed as well, most often Prasozin, but it was recently downgraded because in a recent study, it did not perform better than placebo. However, NightWare is a new and different kind of treatment that can augment other ways of helping reduce nightmare suffering.

The beauty of Nightware is that this wearable device poses minimal risk and has no side effects. When we have a nightmare, our body reacts as though the terrifying event is really happening – so our heart rate increases, our breath becomes rapid, and we can tend to thrash around a lot more. The Apple watch can detect heart rate and movement. Over the first week or so of wearing the device, the patented Nightware software creates a personalized sleep profile to enable it to detect when a person is likely to be having a nightmare. It will then send a signal to create a gentle vibration in the watch, enough to cause a shift in the dream state, but not enough to wake the wearer up… or if the signal is too strong and does wake the wearer, the watch will adjust the signal and make it softer.

NightWare was tested in 30-day clinical trial with 70 patients who were randomly assigned with the working app, or a placebo app that did not create vibrations. Both groups reported improved sleep quality, but those with the Nightware app reported greater benefit. A larger controlled clinical trial is under way in several Department of Veterans Affairs hospital sites. According to NightWare CEO Grady Hannah, the company was founded specifically to support the physical, mental and emotional health of veterans and active duty service members.

There are some caveats. The FDA suggests that Nightware should be used in conjunction with other treatments and under the supervision of a professional. And it’s not recommended for those who tend to sleepwalk, or become violent or act out their dreams because the device may increase this undesirable activity (called REM Behaviour Disorder). It also recommended only for those 22 years of age or older. Nightware is available by prescription only, and is currently limited to veteran and military individuals. To find out more about it, you can do go the company web site at nightware.com.

 

Dr. Leslie Ellis is an author, researcher and therapist who specializes in PTSD nightmare treatment. If you are interested in learning more about nightmares and their treatment, check out my Short Focused Course on Nightmare Treatment. Or go HERE for a free PDF for clients on ‘What You Can Do About Your Nightmares.’

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REM Rebound: Managing intensification of dreaming when sleep deprivation or substance use stops

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When you end a period of sleep deprivation or substance use, your dreams return, sometimes with a vengeance. Dr. Leslie Ellis explains how to understand and manage REM rebound.

While the global pandemic has been identified as a big factor in the recent increase and intensification of dreaming, a phenomenon called REM rebound may be the mechanism at work in some cases. REM sleep is so important that following a period of REM deprivation, our bodies will automatically make up for what it has missed. REM rebound is characterised by intense dreaming and a structural shift in the normal sleep cycle.

Sleep rhythm will return to normal once we have made up our REM sleep debt. This can take days or weeks depending on why, how long and how severely the sleep cycle has been disrupted. There is much in the literature about how to manage sleep problems associated with REM rebound, but very little in the way of help with what to do about all those troublesome dreams. Read on for some simple suggestions from a clinical dream and nightmare expert.

 

What is REM rebound?

First, we need a basic understanding of rapid-eye-movement (REM) sleep. This is the sleep stage most associated with dreaming. In a typical night, we have 4-5 REM sleep periods that gradually increase in length over the course of the night. In total, we spend about 90 minutes or more in REM sleep during a typical 8-hour night of sleep, with most of our REM concentrated toward morning. If we become deprived of REM, our bodies will drop into REM immediately upon falling asleep instead of moving through the progressively-deepening cycles of non-REM sleep that typically start our night. This is REM rebound, a natural increase in REM to make up for what was missed, often due to sleep deprivation or the kind of stress that leads to restless, broken sleep.

There is considerable research to support the notion that REM sleep and dreaming help to regulate emotional reactivity and to reframe negative experiences. REM sleep affects hormonal balance and sleep homeostasis. To return to the normal, restorative sleep patterns so important to all aspects of our health, we may need to go through a period of intense dreaming to allow our sleep rhythm to reset itself. My suggestion is to befriend this process. A first step is to understand that even our most frightening nightmares are trying to help us by balancing our emotional state and taking the charge out of challenging past and current life situations. We can work with them, not against them. More on this later.

 

Substance Use and REM Rebound

The most common cause of REM rebound is sleep deprivation, especially very early awakening that cuts off the second half of our sleep. REM rebound also happens when a person stops taking a substance that suppresses REM sleep. These include many commonly-used substances like antidepressants, alcohol, cannabis and benzodiazepines. Paradoxically, many of these substances are used to promote sleep – and while they can help you fall asleep, they disrupt normal sleep architecture, ultimately making the situation worse. (Newer sleep aids like zolpidem do not cause this problem.)

Sleep is critical to our emotional and physical health. Insufficient or poor-quality sleep is associated with poor emotional regulation, diminished ability to consolidate memory, a higher risk of psychiatric illnesses (depression, anxiety, PTSD), obesity, heart disease and stroke as well as increased risk of workplace and vehicle accidents. Clearly, getting a good night’s sleep is critical to all aspects of our health. Getting sufficient REM is intrinsic to this process.

The best way to overcome REM rebound is simple, yet it can also be a challenge for those with chronic difficulty sleeping well. You simply need to get enough good-quality sleep to make up the REM that your body requires. There are plenty of resources available on good sleep hygiene: things like a calming bedtime routine, limiting screen time, caffeine and alcohol before bed, and getting enough exercise are well documented and can help.

However, for some people, the intensely disturbing flood of dream imagery following the cessation of substance use can make it tempting to go back to taking the antidepressant medication or addictive substance they want to stop using. For those in this category, part of the answer is to befriend your dreams, especially those that have returned with great intensity following a period of silence. If you have intense, frequent and disturbing nightmares during the REM rebound period, making friends with these dreams may seem like an impossible task, but it’s not. Few people realize that nightmares are both treatable, and in many ways, also helpful in the emotional recovery process.

 

Changing Your Relationship With Your Dreams

Dreams and nightmares have been shown to temper emotional intensity. Studies suggest that when we dream about a disturbing scenario, we generally feel better about it than we did before. The big problem with nightmares is that they can be so intense, they wake the dreamer up, so they disrupt sleep rather than helping. A simple solution is to imagine the dream forward; just let it continue from where it left off until you get to a place that feels like more of a resolution. It doesn’t even have to be a triumphant solution, just one that carries the dream forward.

In my experience, this simple process can effectively stop or change a nightmare immediately. It can also take a few tries, and in some cases might require professional help. If you have PTSD or a history of trauma, a professional trained in working with nightmares can make the difference. There are many studies on a version of this method called Imagery Rehearsal Therapy (IRT) that show it often helps, and when it doesn’t, it causes no adverse effects. In other words, it’s worth a try.

In general, getting to know more about your dream world and what it’s trying to tell you will set you up for a more positive relationship with your dreams. I have written extensively about this, and will post a list of resources in the references below. My main message, having worked for decades with the dreams of those recovering from trauma and addiction, is that your dreams are trying to help you, not hurt you. Dream lovers welcome the flood of nocturnal images that characterize a REM rebound. If you are someone who has stopped the use of a REM-suppressant substance, for whatever reason, be prepared for the dreams that will come to you, and find a way to welcome them. Also know that the condition is temporary and if you can stay the course, your normal sleep rhythm will return.

 

Dr. Leslie Ellis is the author of A Clinician’s Guide to Dream Therapy, and an expert in dreamwork and nightmare treatment. Her web site (www.drleslieellis.com) contains many resources about how to work with dreams and nightmares.

 

Resources:

There Are No Bad Dreams – a Ted-like talk about nightmares.

Nightmare relief, free PDF: What you can do about nightmares

For clinicians: A Short Focused Course on Nightmare Treatment

Live Oct. 13 (and recorded) Live workshop on Nightmares and the Nervous System

Blog post: Whether and how to work with traumatic nightmares

Blog post: Whether and how to work with traumatic nightmares

 

Selected references for this article:

Ellis, L. (2019). A clinician’s guide to dream therapy: Implementing simple and effective dreamwork. New York: Routledge.

Feriante J, Singh S. (2020). REM Rebound Effect. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560713/

Krakow, B. and Zadra, A. (2006). Clinical management of chronic nightmares: Imagery Rehearsal Therapy. Behavioural Sleep Medicine, 4(1), 45-70.

 

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Jungian dreamwork basics from John van Eenwyck at the Jung Platform Summit

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Jung wrote vast amounts of material about dreams, so much that to approach the topic can be intimidating. In the first lecture for the free dream summit now taking place on The Jung Platform, John van Eenwyck pares this enormous topic down to a few helpful ideas about how to work with your dreams.

The first thing van Eenwyck says is that we don’t really know what dreams are. This echoes Jung’s idea that we should approach each dream as if it were a totally unknown object. In particular, we cannot assume we know anything about the meaning of the dream images of someone else. That said, Jung saw dreams as complementing waking consciousness by presenting the opposite of our day-world view. For example, a priest who lives an exemplary life dreams of dark, sinful behaviors at night. Our dreams often pick up on our shadow, or our unlived life.

To engage with your dreams, you need to record not only your dreams, but also their context. We all know that keeping a dream journal involves writing down our dreams, ideally as quickly as possible after dreaming them, and in as much detail as you can recall, because otherwise dreams often slip away. Van Eewyck also suggests that before going to sleep, we jot down a few lines about the main events or what occupied our thoughts during that day. This way, we can relate the dream content to the events of the previous day, the so-called ‘day residue.’

He also suggests we avoid editing our dream material. Write down everything that you can about your dreams upon waking – from having no dreams that you can recall, to recording vague sensations or emotions, and from small dream snippets all the way to epic dream stories. When we do this over time, we build an archive of our dream life, something we can refer back to.

To work with another’s dream, we might first look at the setting: who or what is in the dream, and where does the dream take place? Then we can ask into the dreamer’s associations; what the dream elements mean to the dreamer is far more relevant than what we, as the dreamwork, may think a dream image means. After this, we can engage in amplification of the dream, looking at what stories and myths might relate to the dream, and then checking with the dreamer to see if anything resonates for them.

Lastly, the biggest takeaway for van Eenwyck is Jung’s suggestion that we dream the dream onward. This is particularly true for nightmares because by definition, we wake from them in the middle of the action, before the dream has reached a resolution. He provides a poignant example of Ruby, a client who had severe Lupus and was given six months to live. In her frequent nightmares of a pursuer who planned to rape and kill her, Ruby would work with van Eenwyck to dream the dream on to a better place. The last time she had this dream, she turned toward her would-be killer and it was a 9-year-old boy looking for help to find the way home. She did help the boy, and not only did the nightmares cease, but she also experienced a lifting of the severity of the disease, and lived for many years beyond what her doctors predicted.

Was this spontaneous remission due to the dreamwork? Or did the dream reflect the unexpected turn for the better in her health? Like so many things about dreams, we can’t know for sure. Van Eenwyck concludes that we don’t waste too much energy looking for definitive ideas about dreams, but instead to enjoy them. He concludes, “The essence of dream analysis is play.”

Join me and 11 other dreamworkers Jan. 14-17 for a free dream summit exploring the fascinating world of dreaming. Look for my talk on why and how to use dreams in clinical practice on Jan. 16 at 11am PDT.

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Dreams of Bereavement: How Your Dreams Help You Grieve

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Bereavement dreams are common and they help us through the grief process. Surprisingly, dreams following the loss of a beloved person or pet are mostly positive.

Earlier this summer, already made more cruel by the distress and dislocation brought on by the pandemic, I lost my beloved cat Shadow, a massive Maine Coon that was so majestic he seemed almost mythical. He was an outdoor cat who made the rounds of the neighborhood and had many admirers. He left one day never to return…. except in my dreams.

While I still help out hope that he was just holed up in someone else’s home being showered with affection, I was also very concerned, especially when I was shown that a prowling cougar crossed the path of my neighbor’s security camera. In my dreams, Shadow came every night at first, sleeping in the crook of my knees as was his habit. But this dream-Shadow was a glossier, shinier version, the picture of radiant health.

As the summer wore on with no sign of him, I began taking down the posters and admitting to myself that I may never see him again. He still returned in my dreams, but he was increasingly distant and a more faded, tattered version of himself. It was as though he was moving on, and I guess, so was I. Admitting to myself that it was highly unlikely I would see him again, I even got another cat (who is never allowed out except on a leash). It feels as though the dreams helped me, especially the early ones – as though my cat was coming back to reassure me.

Dreams following the death of a loved one, be it a pet or a person, are quite common. They are not always comforting, but they do seem to move the grief process forward. A woman who I did some dreamwork with told me of her dreams after the death of her father, which was a shock made more difficult by the fact that because of her family religious tradition, she was not allowed to see the body and pay her final respects. She told me her father would come often in dreams, with no apparent idea that he was deceased. He would talk to her in these dreams as though all was well, and she would have to live through the fact of his death over and over again every night. Was this helpful? Her feelings about this are decidedly mixed. But she did feel that the dreams helped her overcome the shock of the loss, and to accept its reality.

Dr. Joshua Black studies dreams of grief and loss. He recently investigated the question: “Why are some dreams of the deceased experienced as comforting, while others are distressing?” In his study (2020) with 216 participants whose partner had died, he and his colleagues found that bereavement dreams appear to serve at least three distinct functions: they can assist with processing trauma; they can serve to maintain a bond with the deceased; and/or they can help regulate emotion. Taken together, these functions may “actively facilitate adjustment to bereavement.”

Black became interested in grief when he had a visitation from his father 3 months after his death. His dad had died suddenly, plunging Black into grief he described as numbness, as if all the color had drained from the world. In the dream, his dad had an uncharacteristic lightness about him. In an interview, Black (Bell, 2020) said, “It was the first time I saw him peaceful.” In the dream, he got to tell his dad he missed and loved him and after that, all the color in his world returned. This ultimately led to Black’s decision to research grief dreams rather than follow his plan to teach elementary school. In his dissertation (2018), he studied who dreams of the deceased and why, and found that the desire to maintain continuing bonds is a factor that was not previously considered, and that attachment styles may play a role in who dreams of lost loved ones.

Among Black’s other findings, one of the most surprising is that dreams following loss are not only common, but overwhelmingly positive. After the loss of a spouse, 86% will dream about them over the following year, while 78% will dream of their lost pet within 6 months of their death. More surprising is that 92% of those dreaming of deceased partners will have positive dreams, compared with 44% negative dream content. With pets, fully 91% will have positive dream content.

Black said initial grief dreams tend to offer reassurance, just as Shadow did with me. He was glossy and felt so alive and present it was as if I could reach out and touch him. When these dream figures keep returning, it brings a sense of continuity of connection. And toward the end of life, lost loved ones often come to help ease the life-death transition. So while grief dreams can be painful, most often they help us through the pain of loss.

 

Some further resources:

Help for nightmare sufferers: CLICK HERE

A short focused course on nightmare treatment for clinicians. CLICK HERE

 

References

Bell, K. (2020). The Dream Journal Podcast, Sept. 26, 2020 episode with Dr. Joshua Black. Retrieved from ksqd.org/grief-dreams-with-dr-joshua-black

Black, J. (2018). Dreams of the deceased: Who has them and why. Dissertation, Brock University.

Black, J., Belicki, K., & Emberley-Ralph, J. (2019). Who dreams of the deceased? The roles of dream recall, grief intensity and openness to experience. Dreaming, 29 (1), 57-78.

Black, J., Belicki, K., Piro, R., & Hughes, H. (2020). Comforting Versus Distressing Dreams of the Deceased: Relations to Grief, Trauma, Attachment, Continuing Bonds, and Post-Dream Reactions. OMEGA – Journal of Death and Dying.

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New Study Examines Complex Relationship Between Nightmares, Suicide and Depression

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A recent study refutes the research which shows nightmares are indicators of increased risk of suicide. A group of Swedish researchers (Hedström et al., 2020) studied a group of more than 40,000 participants with an average follow-up of 19 years and found the rate of suicide linked to depression was not worsened by nightmares. Their study “revealed no significant effects of nightmares on suicide incidence,” but rather that depression was more prevalent among those who suffer from nightmares.

The conclusion the authors reach regarding the nightmare-suicide link is so at odds with what has been reported in several studies, I asked Dr. Michael Nadorff, an expert in this area, to comment. He wrote:

The study, in my opinion, was clearly underpowered which is why they are saying there was no effect despite nightmares more than doubling suicide risk even after controlling for depression, anxiety, hypnotic use, and a bunch of other factors.  Uncontrolled frequent nightmares put participants at more than five times greater risk.

Despite some methodological flaws, Nadorff and other reviewers noted that this paper offered much that was worthy of note. For example, Hedström and colleagues found that treatment of both depression and nightmares is warranted when these conditions co-occur. The researchers concluded that nightmare treatment “may provide additional therapeutic benefit.”

Other findings of interest related to suicide and depression: women are overrepresented among those who report depressive symptoms, and are more often smokers with lower levels of physical activity, and they suffer more insomnia symptoms. However, in the large sample, it is men who were more likely to commit suicide. Of the 69 suicide deaths reported in the sample over the 19-year follow-up period, 64 percent were men and 36 percent were women. There was a 12-fold increase in suicide risk associated with depression, and the researchers found that the presence of nightmares did not increase that risk.

Still, increasing nightmare frequency predicts greater likelihood of depression: “The odds of depression during follow-up was higher among those who suffered from nightmares than among those who did not.” Therefore, while nightmares do not appear to directly increase suicide risk, the study finds that “nightmares may reflect pre-existing depression.”

The researchers recommend nightmare treatment for several reasons: The distress caused by nightmares, especially when this is severe enough to compromise functioning and well-being, is linked to anxiety and depression. The effectiveness of nightmare treatment has been well documented. So as part of treatment for those with both nightmares and other diagnoses, the direct treatment of nightmares can help reduce some of the distressing symptoms.

Another interesting note is that a recent study shows that the propensity for nightmares may be genetic, but that nightmares in and of themselves do not indicate a predisposition for mental illness. The recent study by Ollila and colleagues (2019) on the genetics of nightmares showed that psychiatric illness predicts nightmares, but that nightmares do not predispose a person to psychiatric problems.

 

Hedström AK, Bellocco R, Hössjer O, Ye W, Lagerros YT, Åkerstedt T. (2020). The relationship between nightmares, depression and suicide, Sleep Medicine: X, https://doi.org/10.1016/ j.sleepx.2020.100016.

Ollila HM, Sinnott-Armstrong N, Kantojärvi K, et al. (2019). Nightmares share strong genetic risk with sleep and psychiatric disorders. BioRxiv 836452; doi:https://doi.org/10.1101/836452.

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No need to fear the Old Hag: Sleep Paralysis briefly explained

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Locals will warn you never to sleep on your back in Newfoundland, or risk a visit from the Old Hag. She steals in on the night fog just as you are falling asleep. She is an apparition that crawls up from the foot of your bed and sits on your chest so heavily you can’t breathe or move. Sometimes she may try to seduce you, other times, to kill you. These terrifying experiences are so common in Newfoundland, they have become the subject of a tv series aptly called Hag. They are also the subject of research into the relationship between sleep paralysis and folklore.

There is a physiological explanation for sleep paralysis. And there are good reasons these peculiar events feel like visitations by the Old Hag or some other kind of apparition. Sleep paralysis episodes are not limited to Newfoundland and in fact, are fairly common worldwide and throughout human history: roughly 8 percent of us will experience one in our lifetime, and some will have recurrent episodes. Students and psychiatric patients have a much higher prevalence of about 30 percent, likely because it is more common in people who are sleep-deprived and stressed. Sleep paralysis is not a nightmare, but rather a form of sleep disturbance, a parasomnia.

Sleep Paralysis is normal: terrifying but harmless

The most important thing to know is that sleep paralysis is normal. Having an episode doesn’t mean you are losing touch with reality or being visited by the ghost of an old sea witch. These legends, in various guises, have been around since Sumerian times as a way to make sense of those frightening occasions when we wake up paralyzed, unable to move from the neck down. What you may not realize is that we all experience sleep paralysis every night, but for the most part we dream our way right through it.

During the REM sleep cycle most rich in dreaming, our body releases a chemical that makes our voluntary muscles go limp. It’s our body’s way of protecting us from thrashing around as we fight our dream dragons. In fact, it’s more of a problem if the paralysis doesn’t happen – this leads to REM sleep behaviour disorder, the dangerous propensity to physically act out one’s dreams, and it can be a precursor to Parkinson’s disease.

If you suffer from sleep paralysis, it helps to know that this is just your mind waking up from the state of dreaming before your body, when it should be the other way around. Or your body drifting right into REM sleep, and your muscles going lax before your mind has truly shut down for the night. This can happen for various reasons, mostly to do with insufficient or irregular sleep, and most often it is a benign physiological event. Terrifying but harmless.

It also helps to know that sleep paralysis episodes are short, typically lasting about 20 seconds. It may feel like much longer if you are frozen in fear as the Old Hag bears down on your chest. If something like this happens again, try to take some long deep breaths and wait for the images and sensations to subside. Remind yourself that it won’t take long. If you also experience banging noises or flashes of light, this is another parasomnia with the colorful name of  exploding head syndrome. This is equally harmless and tends to last just a few seconds, so wait it out and try not to be alarmed!

Not everyone experiences sleep paralysis as an evil old hag. There are many variations of experience, and these fall into three main categories. First is the experience of an intruder, a malevolent felt presence that is sometimes visible and/or audible, but not always. The second type is called incubus, and this is experienced as a supernatural assault, a sense of being smothered, or of a great weight on the chest. These two types are well-known and often combined.

A third kind of sleep paralysis involves unusual bodily experiences (or vestibulo-motor phenomena) such as flying, out-of-body experiences or false awakenings, and some of these can be experienced as blissful. However, the vast majority of reported episodes of all three types of sleep paralysis are terrifying. Understandably, most people who wake up unable to move, and with a sensation of being trapped in their own body, react with fear. The fear itself may exacerbate the sensations of shortness of breath and chest pressure, as these are common features of panic.

What can you do about sleep paralysis

This is an area that has not been studied very well; there have been no formal clinical trials testing treatment. However, since sleep paralysis is correlated with disrupted or insufficient sleep, an obvious step is to observe good sleep hygiene: go to sleep and wake up at consistent times, no caffeine before bed, and avoid sleeping on your back. Sleep paralysis is also associated with hypertension, hypersomnia, sleep apnea and alcohol use. Not surprisingly, it is common in shift workers and others with disrupted sleep schedules.

Therapeutic interventions may be warranted if sleep paralysis is frequent and distressing enough to warrant the diagnosis of recurrent isolated sleep paralysis (RISP). Some anti-depressant medications can help, as can psychotherapy and psychoeducation, especially if it is underlying anxiety or depression that is contributing to the condition. Having a basic understanding of sleep paralysis can help; the knowledge that such episodes are normal and will end soon can make the event itself less scary.

Taking control

During an episode, you might be able to take charge of the dream state as one would in lucid dreaming. It is possible to realize that while you may not be in control of your body at the moment, you do have some control over your subjective experience. Try to remain calm and as curious as you can – this is a chance to observe yourself in the dream state. After an episode, or as a way to lessen the intensity of a future episode, you can try a version of imagery rescripting. This can set you up for a better experience should the Old Hag revisit. The idea is simply to re-imagine the experience, letting it become a different story, possibly with a different character or ending, and this may seed a more benign future encounter.

A caveat: much of the above is based on clinical literature. There are many other ways that people make sense of ‘Old Hag’ experiences that differ from this view. Some are culturally determined, and others are based on the beliefs formed through direct experience. There are those who welcome this altered state of consciousness. My desire in writing this is simply to help and inform, so use what you find valuable and leave the rest.

If you are interested in learning more about nightmares and their treatment, sign up for my short, focused online course. Because I feel this material is important to disseminate, the course is always open, is self-paced, and currently discounted during the virus crisis. Please ask your clients if they have nightmares, and let them know they are treatable. CLICK HERE for a free PDF for clients: What You Can Do About Your Nightmares. Or check out our Short Focused Course on Nightmare Treatment using THIS LINK.  

References

Cheyne, J.A. (2005), Sleep paralysis episode frequency and number, types, and structure of associated hallucinations. Journal of Sleep Research, 14: 319-324. doi:10.1111/j.1365-2869.2005.00477.x

Cox A. M. (2015). Sleep paralysis and folklore. JRSM open, 6(7), 2054270415598091. https://doi.org/10.1177/2054270415598091

Sharpless B. A. (2016). A clinician’s guide to recurrent isolated sleep paralysis. Neuropsychiatric disease and treatment, 12, 1761–1767. https://doi.org/10.2147/NDT.S100307

Solomonova, E. (2018). Sleep Paralysis: phenomenology, neurophysiology and treatment. In: Fox, K & Christoff, K. (Eds). The Oxford Handbook of Spontaneous Thought: Mind-Wandering, Creativity, Dreaming, and Clinical Conditions. New York: Oxford University Press.

Are you a parent concerned about the frequency and intensity of your child’s bad dreams? Should you be concerned?
Learn more about Nightmare Relief for Everyone designed by nightmare expert Dr. Leslie Ellis, this self-paced user-friendly and accessible online course covers the very latest in science and research about what nightmares are, and what they’re not. Leslie offers some simple steps you can take to get some relief from nightmares and other nocturnal disturbances – both for yourself and for others, including your children.

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Turning Toward Our Nightmares: How This Paradoxical Move Helps Us

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The surprising thing about nightmares is that there is nothing to fear. This is not to dismiss them. They feel absolutely real, and our heart-pounding response to them is also very real. But as frightening as the characters and situations nightmares depict may be, the dreams themselves are like paper tigers, playing out on the screen of our imagination. Believe it or not, they are trying to help us, not hurt us. The broad consensus among nightmare therapists and researchers alike is that dreams help us regulate our challenging emotions, and that nightmares are part of the natural recovery process from trauma. So rather than avoid them — the understandable response to something that scares us — we need to turn and face them.

Curiosity, an alternative to fight or flight

How we turn and face the fears represented in our dreams truly matters. For inspiration, consider the example of black blues musician Daryl Davis who spent 30 years befriending members of the Ku Klux Klan. Person by person, through one-on-one conversations, Davis changed a relationship of hate and fear to one of mutual understanding. The more we know about the so-called ‘other’ the harder it is to hate and fear them. In the process befriending the ‘enemy’, Davis convinced more than 200 KKK members to give up their robes. This same act of turning toward the other with respect and open-mindedness is what I advocate doing with our dreams.

I suggest taking particular interest in the dreams that scare us because they hold the greatest potential for expanding our personal capacity and understanding. When I invite my dreamwork clients to explore their dreams in experiential ways, they are often surprised at what they find. They begin to understand, via direct experience that the monsters in their dreams are represented in such a way because the image is colored by their own perception of it. We tend to fear what we don’t know. As soon as we enter into relationship with something, the dynamic begins to change.

Consider Mary’s dream. In it she is standing on a beach and sees a tsunami coming. She tries to run and there is a sense that she is never going to make it up the slope in time. The wave is coming too fast, and will certainly bury her in its mountain of water. So she decides instead to turn toward it. When she does that, turns toward the powerful ocean and calmly holds her ground, it becomes a harmless wave that dissipates at her feet.

Also consider the dream of ‘Flora,’ a refugee who fled her native Congo due to political persecution. She had a recurring dream that a group of men with guns circled her and were going to kill her because they thought she possessed incriminating information. Like the classic dreams of post-traumatic stress injury, this dream was almost an exact replay of what actually happened to her. She was confronted and froze in terror, unable to speak. In therapy, she was invited to dream the dream forward; she stood and faced her attackers and found her voice. This empowering action changed her relationship to the dream, took away the charge. The nightmares that had been plaguing her for years simply stopped.

This idea of changing the ending of our nightmares is not a new one. Carl Jung was the first to suggest we engage with our dreams by ‘dreaming the dream on.’ Nightmare rescripting has now become the main method for clinical work with traumatic nightmares, and while it doesn’t always work as well as it did for Flora, it has been shown mostly to help and even when it doesn’t, it causes no harm.

Working with childrens’ dreams

The same technique can be used for helping children with nightmares, which is a good thing because kids have much more frequent nightmares than adults. You might offer a child this example from the movie Shrek: Donkey was initially terrified of the dragon, but when he turned and looked at her more carefully, and noticed her long, fluttering eyelashes, his feelings changed from fear to love. Cue the voice of Eddie Murphy saying, ‘Oh! I didn’t you were a girl dragon.’ And in that moment, everything changed.

Children are still immersed in the world of their imagination, so dream rescripting comes quite naturally to them. They can readily imagine their bed turns into a magic carpet that takes them up and away from danger. Or even better, like Donkey, they can turn toward their dream dragons and make friends with them. This is far more effective than telling them their dream is not real, because as we all know, the amazing thing about dreams is how very real they feel when we are in them. Telling them it’s ‘just a dream’ dismisses their experience without mending it.

A caveat. The underlying feelings need attention and this can take time.

While it is true that turning toward our dream dragons with curiosity and as much friendliness as we can muster is very often helpful, it is not a panacea. Dreams are a part of our emotional regulation process. Nightmares that we turn toward will help us understand and face our fears, and when we come to terms with the intense feelings they represent, our dreams will reflect a calmer landscape. This can happen immediately, but more often over weeks or months. It will take longer if the effects of trauma are ongoing, or the dream reflects a major loss and the grieving process is current.

The point is, no matter how long it takes, it is better to turn toward your dreams and the emotions that ride in on their waves than to ignore or dismiss them. In dreams, as in life, it is the things that we engage with actively and with open curiosity that can evolve and change. Ultimately, the message is a hopeful one. If turning toward the ‘other’ can transform the hate of hundreds of former KKK members, then surely we all can tame our dream dragons. Maybe, like Donkey, we can even fall in love.

 

If you are interested in learning more about nightmares and their treatment, sign up for my short, focused online course. Because I feel this material is important to disseminate, the course is always open, is self-paced, and currently discounted during the virus crisis. Please ask your clients if they have nightmares, and let them know they are treatable. CLICK HERE for a free PDF for clients: What You Can Do About Your Nightmares. Or check out our Short Focused Course on Nightmare Treatment using THIS LINK.  

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Four Reasons to Work with Dreams… and at the risk of being dramatic, they can even save lives!

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By Dr. Leslie Ellis

The following is an excerpt from the first chapter of my recent book which outlines 4 excellent reasons to work with dreams. This list is aimed at psychotherapists, but holds true for all dreamers! So, why work with dreams?

They point to our most salient emotional concerns

It may seem that we don’t need dreams to do this, but that we are always well aware of our most pressing emotional concerns. However, human consciousness is not always straightforward or consistent, and people can be very good at unwittingly deceiving themselves. In fact, one of the most popular forms of therapy (cognitive-behavioral therapy or CBT) was founded on the premise that our mind leads us astray and distorts our experience in a number of ways. One example is rationalization, a habit of talking ourselves out of our feelings using ‘rational’ arguments, such as, “I’m not sad that she left; I didn’t really love her anyway.” We can often fool our conscious mind, but such a person may dream of losing something of great value and wake up crying. If they pay attention to their dream, they will realize that they are in fact very sad about the loss of their relationship. Dreams are like that very good friend who is willing to be honest with us even when what they have to say is not easy to hear.

Dreams can also provide therapy clients with a way to introduce important yet deeply personal topics in the course of therapy, subjects they may want to bring up but are reluctant to do so due to fear, embarrassment or cultural norms that discourage personal revelation, even in therapy. A researcher (Goelitz, 2007), who works with clients preparing for death, found that dream work brought the focus of the session to the deeper emotional concerns rather than the more typical discussions about physical symptoms and treatment. She noted that the dream work helped her clients feel less alone and better prepared for death. She was convinced that these discussions would not have taken place had they not been facilitated by a dream.

Dreams bypass our defenses and speak the truth

Dreams tell the truth, even when such truth is uncomfortable and defended against in everyday awareness. During sleep our prefrontal cortices, responsible for, among other things, rational thought and executive functioning, mostly shut down for the night. During dreaming, our internal editor, and our moral authority also go to sleep. That’s why our dreams can sometimes be bizarre and why normally taboo subject matter such as explicit sexuality and violence can often appear in our dreams. At times, it seems as though our dreaming consciousness is trying to get our attention by delivering its content in the most flamboyant or dramatic way possible. It helps to know that dreams are often metaphorical, not meant to be taken literally. For example, I had a dream that I was eating horseshit and kind of enjoying it even though I was well aware of how disgusting this would seem to the people around me. I laughed to myself when I understood the dream’s message might have to do with a lecture I had listened to a few days’ prior that I found highly entertaining and yet filled with ideas I considered completely far-fetched.  Because I liked the person, I was trying to remain open to their ideas, trying to take in and digest the material, but having trouble doing so. The dream captured the complexity of my feeling about the situation with economy and humour.

There is considerable clinical evidence to suggest that dreams carry emotional truth that is often difficult for the dreamer to assimilate. One of the major benefits I have seen in working with dreams is that it can help clients to see and truly experience an unconscious aspect of their personality or behaviour that is not congruent with how they see themselves or want to be. For example, a client I will call Michael had a dream that he was walking on a beach and came across a group of people sitting in a circle, and his cousin was there with them smoking a crack pipe. Michael had a strong judgement about this, as smoking crack was something he would never do. But if, as some theories suggest, characters in a dream represent aspects of ourselves, then Michael was like his dream-cousin in some way. In the dream-work he did, I asked him to ‘be’ his cousin on the beach, and when he imagined this, he felt an attraction to the pipe, and then a dawning of awareness that this feeling of addiction was familiar to him as it coloured the dynamic of his relationships with the women in his life. He was flooded with shame and a heartfelt desire to change which fueled transformation in his relationship and many other aspects of his life.

 

Dreams can bring a new and wider perspective on a situation that is stuck

History provides many good examples of how a dream can bring a creative new perspective. The person who invented and patented the first lock-stitch sewing machine solved the main challenges to developing a reliable machine because a dream pointed to the solution that had long eluded him. Elias Howe, who eventually became the second-wealthiest man in the U.S., came up with the novel idea of putting the hole in the ‘wrong’ end of the needle from a dream of a spear fight between warring native tribes. In the dream, some of the warriors’ spears punctured the fabric of the tents, snagged loops of thread and pulled them back through with the tips of their spears. Dreams are the sources of many great inventions, including the periodic table and Einstein’s theory of relativity. For someone who has studied a subject deeply but who has become stuck in a fixed way of looking at the problem, dreams can bring the fresh creative inspiration that was elusive. Sometimes ‘sleeping on it’ can bring unexpected and creative answers.

Dreams are embodied, and present us with an internally-generated world that is detailed and appears very real to all of our senses. This total immersion brings us in touch with the magical quality of dreaming. A dream is a richly-detailed world that is experienced as entirely real while the person is dreaming it. Even for those who experience lucid dreaming and become aware they are dreaming while in the midst of it, the experience feels very real. This aspect of dreams is what makes them so compelling, and such a useful tool in therapy for assisting clients in stepping out of their ordinary way of experiencing or seeing things. A dream can bring a broader perspective, a new way of seeing, a shift from ordinary consciousness, or habitual ideas, a step toward change.

 

Dreams provide diagnostic information and can show clinical progress

There are many ways that dreams can provide diagnostic information about clients, although the subject is a complex one because dreams can be cryptic. According to Oliver Sacks (1996) dreams are, “directly or distortedly, reflections of current states of body and mind.” Neurological disorders can alter dreaming processes in quite specific ways, and these can vary from person to person. Sacks gives the example of a patient with an occipital angioma who knew that if his dreams turned from their usual black and white to red, he was about to have a seizure. Some other examples Sacks offered are loss of visual imagery in dreams as a possible precursor to Alzheimer’s, and recovery dreams presaging remission from multiple sclerosis. Sacks hypothesized that the dreaming mind is more sensitive than the waking mind to subtle changes in the body, and so appears prescient because it picks up subtle early cues.

In some cases, this premonitory aspect of dreaming can even be life-saving. Famous dreamworker Jeremy Taylor offered the example of a woman from dream group that met regularly who dreamt of a purse of rotting meat. The dream was so disturbing to her and the other group members, the woman felt unsettled enough to have a diagnostic pap smear which turned out to be negative. She insisted on further testing which revealed she had a particularly aggressive form of uterine cancer that would have killed her had she not caught it in time. At the time of the dream she had no symptoms and was about to go on a trip – she credits the dream and the dreamwork for saving her life.

Not only can dreams be indicative of potential health changes for better or worse, they can also be used to track clinical progress. Tracking shifts or progress via dreams can be an easier task for therapists than using a dream to make an initial diagnosis because it is often easier to spot incremental change in the pattern of dreaming than to decipher something completely new. It takes some time to get to know the unique world of each dreamer, and paying attention to a series of dreams will make it clearer when something significant has changed. For example, in my research into the nature and treatment of recurrent PTSD nightmares (Ellis, 2016), specific kinds of changes in dreams that had been recurring repeatedly, sometimes for years, appeared to coincide with trauma recovery. This observation is supported by research that sampled 94 trauma survivors and found the closer their nightmares were to replicating the actual trauma event, the higher their level of related distress. For trauma therapists who track dreams, the progression from concrete to less realistic, more imaginative dreaming can be seen as a sign of clinical progress.”

 

Dr. Leslie Ellis offers online courses in personal and clinical dreamwork, and is opening a dreamwork certification program in 2020. For more information see www.drleslieellis.com or join her email list  if you want to receive blog posts, and training opportunities.

 

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Treating Complex Trauma: Straddling Two Worlds

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A brief review of Trauma and the Soul: A psycho-spiritual approach to human development and its interruption by Donald Kalsched (Routledge, 2013)

In his book Trauma and the Soul, Kalsched (2013) asks us to stand between two worlds – with our embodied sense of all the trauma that is present in ourselves and in the world, but also with the richness that is our personal, immediate and infinite current existence. He poses the question, “How do we manage to live a full life between these two worlds?” (p. 2).

Kalsched believes that any complete view of the personal self “must include its infinite reach and spiritual potential as well as its finite limitations.” In fact, in working with the deep ravages of complex trauma, it is the depth of connection with one’s soul that is often the saving grace and the “ultimate source of transformation in psychotherapy.”

He notes that many of those who experienced early childhood trauma describe “a blurring of the boundaries between ordinary and non-ordinary reality… that is inaccessible to better adapted people” (p. 3). But one of Kalsched’s primary messages is that these inner protectors from the spirit realm often turn into inner persecutors. How to overcome this phenomenon, not often talked about, is the focus of Trauma and the Soul.

The archetypal world is there to catch trauma survivors when they fall

It is well understood that when a difficult situation exceeds a person’s ability to cope with it, they split off a part of themselves as a form of protection, and in doing so, often step into a vast transpersonal world. Dissociation drops the trauma survivor into a mysterious world that Kalsched argues is not simply the result of ‘splitting’ but is also a doorway into an archetypal world that is “already there to catch them” (p. 4).

To view these extraordinary experiences as metaphor for personal experience collapses the two worlds… “between which our lives are normally suspended.” To assume it is all bounded by personal experience is to lose something essential, and in the case of survivors of extreme trauma, to discount their personal experience as merely imagination. This does not mean that we should overvalue the magical world many trauma survivors inhabit as they often need to be “talked down from their celestial scaffolding… and reconnected to life.” But Kalsched stresses that “often the early story of the trauma survivor is a mythological story before it is a personal one.”

What current neuroscience of infancy shows is that dissociation due to trauma or neglect will fragment experience, storing it in implicit memory only. Kalsched suggests these fragments gather up archetypal images from the collective unconscious because there has not yet been a developmental step that differentiates into a personal self. So early trauma survivors find access to and expression of their story more easily through myth, dreams and metaphor.

The body is the access point for this material, and focusing remains one of the best ways I know to gain access to this metaphysical layer. Focusing is an inner process that gently opens a person up to their embodied, implicit knowledge. The process of accessing, and expressing what a trauma survivor embodies can move the material from the transpersonal to be woven into their personal story. To pathologize this process and label it as a form of psychosis is unhelpful, possibly harmful – though the ultimate goal is to enable the client to straddle both worlds while remaining in solid contact with what is real and present… at times a tricky balancing act.

Kalsched makes a careful distinction here. He states that “the spiritual world is real, and following trauma it is recruited for defensive purposes” (p. 5). He believe that the angels and demons that help or haunt survivors are not only the derivatives of a defensive process, something that would not exist otherwise.

In viewing the archetypal realm as its own form of reality, Kalsched does not dismiss the visible world or the importance of our new understanding of the role of attachment and early relationship. He said these developments keep trauma work “relevant and grounded. In fact, they even hold out the possibility of restoring the embodied soul to our field” (p. 8). I suspect the reason he devotes more attention to the invisible world is that it is too often ignored, and in trauma work, this is an oversight. He writes that the infinite and eternal world of spirit “is often potentiated by early trauma and so a complete story of trauma must include its perspective.”

Trauma is defined as anything we are unable to bear consciously. Children are especially vulnerable because they have not yet developed any way to metabolize abuse or neglect, and so their nascent sense of self would be shattered if it were not for our ability to split or dissociate to “save a part of the child’s innocence and aliveness, preserving it in the unconscious… and surrounding it with an implicit narrative that is eventually made explicit in dreams” (p. 11).

Newfound hope that healing is possible

Kalsched found that such dreams contained a pattern, a dyad of child or animal and its protector, often a diabolical figure that would appear just as the client was making progress in therapy – getting close enough to relational feelings to trigger a defensive response. In 1996, Kalsched wrote about this ‘self-care’ system without much hope, but he has since incorporated techniques informed by attachment and neuroscience (ie Schore, Badenoch, Bromberg). “As a result, I have been able to witness how the seemingly-intractable resistances of the self-care system can transform, and the defensive system can even release its prisoners” (p. 13). This work is not easy and involves the full relational participation of the therapist to bring about “the co-creation of an entirely new inter-subjective reality.”

Kalsched was fascinated with what is preserved when a traumatized child splits off and hides away an essential part of themselves. He originally called it the “imperishable personal spirit” and now calls it simply the soul. He called the “main epiphany” of Jung’s work the discovery of “the divine child, patiently awaiting his conscious realization” (1912, para 510). Kalsched points out that there is a sacred dimension we can discern from “the psyche’s symbolic process – if we learn how to attend to it in our dreams” (p. 15).

Kalsched echoes the popular sentiment that early trauma is relational trauma and this can only be healed in relationship. He stresses that such a healing relationship must be of a particular kind that looks both outward and inward. It can bridge dissociated self-states in a manner not unlike the ‘good-enough’ infant-mother dyad made famous by Winnicott. It can weather “the stormy affects that are generated as the soul re-enters the body, until re-connections are made between affect and images, between the present and the past, between the inner child and its caretakers. Such a relationship holds the hope that both inner and outer transitional space may open once again, that connections in the brain can slowly be re-wired, and that archetypal defenses will release us into human inter-subjectivity and ensouled living” (p. 21).

He adds that “therapy for the soul comes in many forms” in addition to therapy or parent-child relationship, including encounters with animals, art, ideas, music… there is no formula or system that applies universally. “This theory can never be systematic or scientific because the soul and spirit are mercurial realities, quixotic, ineffable and can never be pinned down… If we were wise, we would probably keep silent about the soul and learn to listen” (p. 22).