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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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