Trauma Induced Stress and The Impact of Nightmares
Robert J. Palasciano
Like many of you survivors, the quality of my night’s sleep rules the quality of my days. We don’t dream like everyone else. The traumatic events we’ve experienced have somehow changed the way we dream. So here’s what twenty three years of experience has taught me about chronic nightmares. Nightmares so powerful, that they literally transform how we feel, what we think, and who we are.
First, it’s important to understand the differences between a normal human sleep cycle and the sleep cycle of an individual suffering from chronic Trauma Induced Stress. The purpose of normal sleep is as uncertain as it is complex. There are several stages in a healthy human sleep cycle. The most important of these stages is Rapid Eye Movement or REM. There seems to be a biological and a psychological need for REM sleep, although it’s not really known why. A common belief is that our brains use REM sleep to process through our emotions in the form of dreams. A healthy REM sleep cycle normally occurs every 90 to 120 minutes, and lasts for about 20 to 40 minutes.
When we experience healthy REM sleep, we feel more rested and refreshed the next morning. It’s known that healthy REM sleep has two phases: phasic and tonic. It’s also known that when we experience healthy REM sleep, certain physiological events take place. In the phasic stage, our extremities may display slight twitching movements. However, during the tonic phase, our bodies experience selective sleep paralysis of the major muscles, or REM atonia. This perfectly normal part of healthy sleep allows our involuntary functions, like heart rate and breathing to continue. Simultaneously, it protects us from physically acting out in our dreams and injuring ourselves, and those sleeping beside us.
We’re not sure exactly how the brain produces REM atonia. We do know that during this particular stage of sleep, the production in the brain of the chemical neurotransmitters histamine, serotonin, and norepinephrine are significantly reduced. These neurotransmitters are responsible for relaying chemical messages in the brain. It’s believed these reduced levels of neurotransmitters are responsible for this selective paralysis of the large muscle groups.
Like many of you suffering from the effects of Trauma Induced Stress, I’ve been experiencing unhealthy sleep patterns for more than twenty years. I’m not a doctor, but what I have learned from my doctors and my experience has taught me volumes about the condition we face. I’ve spent two decades and tens of thousands of dollars on classical and holistic treatments, as well as prescription drugs. One of my goals was to learn the causes of horrific recurring nightmares, and how to quell them. So after more than twenty years, I finally have some answers and some well-deserved relief.
When we experience healthy REM sleep, the production in the brain of the chemical neurotransmitter norepinephrine is greatly reduced. But as I’ve learned from my doctors, this is usually not the case for those of us suffering from nightmares triggered by chronic Trauma Induced Stress. First, you need to understand that norepinephrine is not only a neurotransmitter; it’s also a kind of hormone. Norepinephrine is like the hormone adrenaline, which we know supercharges us when we’re frightened or excited. This is thought to be the reason our dreams aren’t pleasant or even neutral, but rather always nightmares of blood, gore, and death.
Before I experienced Trauma Induced Stress and woke up from a bad dream, it was over. After returning to sleep, the bad dream didn’t come back or continue. However, after my brutal shooting, near death, and 77 day stint in the hospital, nothing about my dreams was ever the same. I suspect that Trauma Induced Stress may also be turning your dreams into fighting for your life nightmares.
If you’re like me, your nightmares don’t end when you wake up from them. After we fall back asleep the nightmare either replays or simply continues from where it left off. I’ve gone so far as to get out of bed and watch TV or take a shower in the middle of the night. But no matter what I did to try and break the cycle of nightmares, they just kept rolling on. It’s like my mind wasn’t stopping the dream but only temporarily pressing the pause button, only to press play again when I fell back asleep. It’s believed the unusually high levels of norepinephrine/adrenaline in the brain during the tonic stage of REM sleep may be responsible. This is why our brains don’t cycle past the nightmares and why we’re stuck in a bloody death loop that plays over and over.
While healthy sleep patterns induce REM atonia of the major muscles, those of us suffering from terrifying nightmares caused by Trauma Induced Stress aren’t so fortunate. We lack this natural event, and we physically act out in our nightmares, putting ourselves and the ones we love in harm’s way. I regret to say that over the years, my wife Maria has accidentally been on the receiving end of my punching and kicking during nightmares. This is an unacceptable problem that must be solved. We can no longer put our loved ones at risk, and I believe a solution is in sight.
Yet another complication of our adrenaline filled nightmares is, it makes us feel the physical and emotional pain of our terror for hours or even days after we wake up. It’s believed that stress hormones, especially adrenaline, are the key to imprinting strong memories. That’s why you remember so vividly, your wedding day, the first time you rode a bicycle, or closing that big deal at work. As well, it’s also the reason you’ll never forget every detail of the death of a loved one or a blow-out fight.
You can so easily remember exactly how you felt, what you saw around you, even what it smelt like. The amazing thing is, these memories stay with you forever and it’s all because of adrenaline. The same belief is also true of our nightmares. When we dream with adrenaline filled nightmares, the emotional and physical response is so intense and vivid, that even in a wakeful state, we continue to feel the effects for hours and even days later.
Sometimes, the terror in my nightmares doesn’t resign itself to killing just me. My nightmares have relentlessly horrified me by brutally slaying of each of my family members, including my wife Maria, and each of our three children. Please understand that after a survivor wakes from dreaming such atrocities, the feelings of deep emotional loss of a loved one can stay with us for days. My most recent nightmare of this nature involved the shooting death of my daughter Jessica. When she died in my arms, I was helpless to save her. I remember waking up from it and continuing to feel all the visceral emotions of her loss. When I saw her the next morning, I hugged her again and again.
The memory of her death in my nightmare was so filled with norepinephrine; it felt as real to me as if she’d actually died. So for the next two days I felt and acted as if she was gone, even though she was right in front of me. All of this caused because my supercharged nightmare was full of this powerful stress hormone, norepinephrine. Yet, amid this seeming never-ending torture we barely endure for years, there exists a bastion of hope.
Since my nightmares of death have plagued me, I’ve searched for any relief I could find. Keep in mind that our nights rule our days. So when we experience chronic nightmares of dying, it can inhibit our minds from functioning rationally and calmly in a waking state. We become unable to cope with even the smallest stressors. Every sound and voice becomes magnified many times over, forcing us to retreat to the quietest room in the house. Every simple task triggers mental confusion and frustration as well as physical shaking and elevated heart rate and breathing. In short, we feel useless.
Over the years, many doctors treated me for this stress related condition, including the symptoms of nightmares, but with little success. However, several years ago I met Dr. Jack Katz, an experienced psychiatrist specializing in anxiety conditions, and my symptoms began to change for the better. He understood that many of the drugs other doctors prescribed for me only made my symptoms worse in the long run. His approach was gentler and less experimental. For the first time, I felt I was in the right place. As it turns out, I was.
Dr. Katz has regularly treated me for eight years now. With each new year it feels like small parts of the ‘old Rob’ are coming back. Most importantly, it’s easier for me to laugh and to enjoy my family again. While Dr. Katz is still uncertain when I’ll be able to return to work for, he’s proven to be an invaluable resource in my challenge against this worthy adversary.
In August of 2011, Dr. Katz suggested that I consider taking a prescription drug which has proved to reduce the frequency and magnitude of chronic nightmares for individuals suffering from this trauma condition. Dr. Katz understood my conservative philosophy on taking any drugs, let alone more drugs. But he suggested that if this drug could ease my nightmares, I might be able to reduce my other nighttime medications. I thought that sounded like a good plan.
Dr. Katz described the drug as an older high blood pressure medication, which had recently become popular to ease the frequency and intensity of chronic nightmares, at a dose of between 1mg to 13mg per day. He pointed out that when taken before bedtime, this medication worked by greatly inhibiting the body’s response to norepinephrine (adrenaline). This resulted in reduced frequency and intensity of chronic nightmares. He told me he’d recently learned about this medication’s astounding and positive side-effect at a medical conference and asked if I’d be willing to include it into my regime.
He made it clear that because the medication is an anti-hypertensive, it would lower my blood pressure. As a result, I should be cautious of rising out of bed quickly as my blood pressure might drop causing lightheadedness. After I fully understood the risks and benefits, I agreed to start at a low dose and work my way up to the target dose in a few weeks. After all, what choice did I have? With my nights already filled with screams, blood, guns and death, anything had to be better. For me it was a choice between the lesser of two evils, and I chose the drug called Prazosin or Minipress.
I’ve suffered from the lasting effects of nightmares on and off for more than twenty years, and almost constantly from between 2004 to 2011. Dr. Katz suggested a conservative initial dose of 2mg before bedtime for the first two weeks. By the third week and with no noticeable side effects, he increased my dose to 4mg before bedtime. By the end of the first month the frequency and intensity of my nightmares improved somewhat. Yet, I couldn’t rely on these preliminary results as I often experience a normal and systematic waxing and waning of nightmares over time. By the fifth week, Dr. Katz increased my dose to 6mg at bedtime. By the end of the eighth week, there was a consistent and marked improvement in the frequency and intensity of my nightmares. To me, these were significant results, yet I remained cautiously optimistic.
It’s now been four years since I started taking Prazosin to reduce my nightmares. In all, my personal results are significant. I have fewer and less intense nightmares over all. Recently though, my nightmares increased again and Dr. Katz raised my dose of Prazosin to 8mg at bedtime. He indicated that Prazosin may become less effective over time, requiring a higher dose. The adjustment did the trick and while my nightmares continue still, they are generally fewer and less intense.
To put this into perspective, it feels like a victory after a twenty five year-long battle against a superior force equipped with unlimited resources. And I have Dr. Katz to thank for it. I believe my association with Dr. Katz is a part of the providence that has led me to the path of enlightenment. I encourage all of you to listen and watch for the signs that will present you with your own path in the right direction. Remember however, that your journey toward a better place requires sacrifice. The question remains, are you up for the challenge?
From Anger To Enlightenment, A Survivor’s Story of Faith © FromAngerToEnlightenment@gmail.com