Mental Illness: Nightmares & Insomnia

This post is meant to provide a brief overview on symptoms of mental illness and then insight into living with the symptom. It should not be used as a diagnostic tool, but if you relate to what you read, it may be time to have a conversation with a mental health professional. 

Nightmares and Insomnia are part of the human experience. Almost everyone will experience these at some point in their life but people with mental illness may experience chronic nightmares or insomnia, meaning it is a long standing continuous symptom. 

Sleep is an important part of your overall health and disruptions to it can generate their own sets of issues as well as making other mental illness symptoms worse.

Insomnia can be a symptom (secondary insomnia) or a sleep disorder on its own (primary insomnia) that makes it hard to fall asleep or stay asleep. Most adults need seven to nine hours of sleep a night and will experience short term insomnia at some point in their life- typically due to stress or illness. Natural changes during aging may also results in insomnia. Chronic insomnia is insomnia that lasts for three months or more typically due to another illness or disorder.

What Causes Insomnia?

Insomnia can have many causes. 

• Genetics
• Stress
• Irregular person schedule due to work, school, or travel
• Poor Sleep habits
• Heart burn
• Mental Illness
• Nightmares
• Medication
• Sleep Disorders
• Sleep Apnea
• Caffeine
• Nicotine
• Alcohol
• Aging
• Changes in activity level

How many people have insomnia?

According to the Cleveland clinic - roughly 1 in 3 adults

When do I get help for insomnia?

• Sleepiness during waking hours that is hard to resist
• Microsleeping during the day, especially if during work or while driving

How is Insomnia treated?

• Developing good sleep habits
• Setting a sleep schedule
• Having wind down time
• Being comfortable
• Limiting device usage
• Being mindful of eating/drinking before bed
• Exercise
• Medication
• Sedative Drugs
• Hypnotic Drugs
• Antidepressants
• Melatonin
• Some herbal supplements
• Mental Healthcare

Nightmares are not just "bad dreams", they are dreams that can lead to emotionally disturbing feelings such as fear, anxiety, or terror. They can generate physical symptoms like a racing heart, sweating, or rapid breathing. Chronic nightmares can be a symptom of different types of mental illness or a disorder of their own. Nightmares can be the cause of insomnia.

Nightmares are not the same as night terrors. Night terrors mainly affect children who may physically act out with screaming, shouting, thrashing about early in their sleep cycle. Typically the child will not recall they had a night terror.

Nightmares affect adults and children but lead to strong feelings which will be recalled later. They tend to happen later in the night during REM sleep.

How often do people "normally" have nightmares? (Source: www.psychologytoday.com/us/conditions/nightmares )

• Women tend to have nightmares more often than men
• 6% of adults report nightmares at least once a month
• Between 1% and 2% of adults have nightmares more often than once a month
• Less than 1% report frequent nightmares that disrupt daily function

How are Nightmares treated?

• Creating a healthy sleep routine with good sleep hygiene 
• Creating a safe, healthy sleep routine that includes practices such as relaxing, reducing screen time, and sleep journaling may help
• Treating any underlying issues (i.e. substance abuse, physical health concerns, etc.)
• Certain health conditions are comorbid with nightmares such as cancer, Parkinson's disease, and coronary heart disease
• Substance abuse may also result in nightmares
• Therapy
• Therapy to address trauma, stressors, or anxiety that is reoccurring in nightmares may reduce the frequency of nightmares
• Medication (used for persons with PTSD, anxiety or depression) 
• Some medications can cause nightmares so adjusting those may reduce the nightmares
• Medication can be prescribed to treat nightmares

Note: There is a documented link between nightmares and suicide risk. You can read more here: https://www.apa.org/monitor/2024/10/science-of-nightmares

"Nightmares are one of my longest standing PTSD symptoms. The first truly awful one I can remember happened the night of my fifteenth birthday. I can still remember it vividly twenty years later.

I have chronic nightmares. The vast majority of my dreams that I can recall are nightmares and I have had multiple a night for as long as I can remember. The severity ranges from almost comical (still scary while dreaming) to horrific gore that makes me wake up and vomit. I have been too scared to fall asleep at times because I knew I hit a trigger and the nightmares were coming for me.

They are consistently so violent that my long time therapist told me I should never take prescription sleep aids because she was concerned I would be a danger to myself or others if it caused me to sleep walk while having nightmares. She did suggest I try melatonin or Unisom to help me fall asleep to see if I couldn't manage more sleep around the nightmares.

Over the years I have tried several different ways of managing my nightmares, some more successful than others. I spent most of my late teens and early twenties working myself into exhaustion then sleeping with headphones on. I spent my mid twenties working a lot and then using exercise or sleep to push myself into a deep sleep that went past dreaming. 

Sleeping in sunlight seems to consistently result in dream free sleep so I often nap in my car on my lunch break or sleep in a hammock in the sun when the weather is nice.

Part of my medication journey as an adult in my thirties is trying out prazosin for the nightmares. It helps in that while I still have nightmares they don't seem to "stick" very well. I can wake up from them and fall back asleep without it triggering anxiety or insomnia. It is easily the best and most sleep I have gotten since the nightmares started when I was a teen. I still have them and I still have insomnia but that is once or twice a week instead of every night. I am starting to have and remember regular dreams now which is novel to me still. Its still not the normal amount of sleep that most people get and I still have a lot of nightmares but it is still an improvement.

To be completely honest, the sleep deprivation between insomnia and nightmares amplifying some of my other symptoms was one of the primary reasons I decided I should not go through with a pregnancy or care for a newborn. I just couldn't see a world where I could be trusted if my already fractured sleep was even more scarce. I realize that may seem like an extreme choice to some people and many of my loved ones still don't understand, but luckily my therapist and OBGYN both took my concerns seriously and helped me get the sterilization procedure I wanted. The older I get, the happier I am with my choice. I will dedicate a whole other post to that decision but if you know you aren't able to function then seek medical professionals that take you seriously."

- D.M.