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TO SLEEP, PERCHANCE TO SCREAM
Mary G. Barry, MD
Louisville Medicine Editor editor @ glms. org
" I don’ t see any American dream; I see an American nightmare." – Malcolm X
I
am not sure whether to blame the supermoons or the national trials and tribulations of November, but lately I have noted a mini-epidemic of nightmares in my patients. At least three of them timed the onset to the Hunter’ s Moon, which is the full moon of October( following the Harvest Moon in August / September). The Hunter’ s moon this mid-October was a supermoon, for the moon had come very close to the earth, and so it was particularly bright and large and this year, a glowing gold.
As I write this, I look forward to the Frost Moon, another super-close moon, occurring mid-November. Most moon names in the U. S. come from the tribes of the eastern seaboard, the Iroquois and Algonquin and Mohawk peoples, among many others, whom colonial settlers from the British Isles met first. Some of these called it the Beaver moon, because dam-building reached a peak before winter set in. The first real frost is forecast for the exact day of that moon.
What my patients( and I, and anyone who has ever had nightmares) would like is a forecast for when and what nightmares might visit us, as well as an understanding of what they mean. They are far more common in the young, waning by the age of voting( at least in former times). We do know they occur in REM sleep, mostly closer to morning than bedtime. They happen more when we are sleep-deprived. They are far more likely after trauma, which carries always the physical and emotional components. Accidents, injuries, near-misses and life-changing events like the deaths of loved ones, major losses, national and natural disasters do not make for easy sleep. Those with PTSD from any cause suffer far more than others from nightmares: over 90 percent of survivors of rape or sexual assault have them. A large majority of those who return from combat, and civilians caught up in war, have nightmare flashbacks, intense and recurring nightmares of particular combat actions, explosions, dangers and the deaths and woundings of their comrades.
For those living peacefully at home, nightmares happen more often if we eat late, especially an acid-reflux generating meal, or any food we tend to digest badly. They happen more if we have scared ourselves with books or movies, when we are delinquent in a task, facing an exam or if we have just had a very bad day.
Many medications can cause nightmares, especially those that are sedating: sleeping pills, benzodiazepines, antihistamines, centrally acting blood pressure medicines,
Parkinson’ s meds and anticonvulsants – the list is very long. Beta blockers of the older ilk are calming to the brain and the heart, and taking them in the morning can prevent changes in one’ s dreams. Pravastatin was on the market 30 years or so before enough after-market reports generated a warning to doctors to ask patients about nightmares with this medicine( especially since the original FDA approved labeling specified bedtime dosing, which is no longer the case for any statin: any time is fine). Calcium channel blockers are on the list, and tricyclic antidepressants, which are nearly all sedating, and other families of antidepressants, and interestingly, sympathometics like albuterol. That one I don’ t understand, but over the years I have found that to be a dose-limiting effect for multiple patients. Sleep apnea is not linked to nightmares, because people sleep so lightly and wake so often, until they are found, and treated( if they use the treatment, another matter entirely).
Alcohol, opiates, marijuana, cocaine etc.- all the drugs of abuse – and the suffering of addiction, both while using and withdrawing – all cause nightmares.
Those of us who are scaredy-cats in general have more nightmares than the brave.
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