Nightmares & Sleep

I'm pleased to announce the recent posting of my first YouTube interview with integrative sleep psychiatrist Dr. Nishi Bhopal, MD, during which I discuss the relationships between nightmares, trauma, and sleep.

I am all about taking a functional medicine approach to problems. This emphasizes the notion of treating the root cause of a presenting problem and thus requires a thorough and carefully conducted initial assessment. Why is this important? To me, it means that we are developing a true understanding of a problem which informs us of the type of treatment that is going to be the most lasting -- and therefore it will be the most effective and efficient one.

In this video with Dr. Bhopal I dive deeper into a functional medicine approach to treating nightmares. Meeting the DSM criteria for a Nightmare Disorder requires that you experience a recurring dream at least 3 nights per week that causes you significant distress and/or impairment in your day-to-day functioning. Important distinction to make: nightmares are different from night terrors in that with nightmares you tend to wake up generally remembering what you dreamt about. With night terrors you do not typically recall dream content but rather your bed partner is the one witnessing you acting out your dreams verbally and/or nonverbally. Fun fact, nightmares typically happen during REM sleep, or the rapid eye movement stage of sleep which is known to serve the purpose of consolidating memories and processing emotions. Night terrors occur during non-REM sleep, specifically stage 3 also known as delta or slow-wave sleep -- the deepest stage of sleep that helps us feel refreshed when we wake up.

Spoiler alert: from my anecdotal experiences with patients presenting with a primary concern of nightmares, a careful analysis has revealed that, believe it or not, nightmares are more often secondary to a primary underlying concern of either undiagnosed/untreated sleep apnea, trauma/posttraumatic stress reactions, substance dependence/withdrawal (especially cannabis), or a combination of these. Take a look at my interview with Dr. Bhopal to learn more about these important rule-outs and the different treatment approaches for each.