DOCTORS’ LOUNGE
Like my sister, I learned the hard way as a
child that I cannot watch any show or movie
where a person is in danger. I have had the
same two nightmares since childhood (one
involving Zulus, from the Michael Caine
film, and one involving Nazis, all of whom
are murderously closing in). Being hunted
to the death is in fact the most common
theme of nightmares. Being unprepared,
being late, being exposed, being unable to
move or speak: these too are common, and
researchers believe have to do with REM
activity in the amygdala, a very “old” part
of our brains, sending signals to the pons
that render us (helpless in the grip of sleep)
paralyzed.
But why the moon? In fact, why would
the full moon unleash these nocturnal demons? There are various theories. A Swiss
researcher Dr. Christian Cajochen and his
Basel group, who said they got the idea for
the study while having a nice pint in the
pub, proved in repeated monthly monitoring that the full moon shortens deep
sleep by 30 percent, reduces melatonin and
caused their subjects to report uneasy as
opposed to restful sleep. He postulated that
we evolved with an inner sense of the lunar
cycle, what he called “the lunar hand on the
body’s clock.” Other scientists have blamed
shifts in Earth’s magnetic field, which is constantly bombarded by solar winds (pulses
of highly charged particles). The magnetic
field protects us from these massive particle
bursts. Every 27.3 days the moon completes
her orbit, moving through Earth’s “magnetic
tail” during the full moon. The moon has no
magnetic field to protect her from the solar
winds. Thus, her surface that faces the Earth
during the full moon phase is bombarded by
the Earth’s deflection of these solar forces.
That deflection in turn “rebounds” onto our
magnetic tail, and some people theorize that
these forces affect the pineal glands of rats.
Rats stand in for people in nearly all
preclinical drug trials. We may be, in this
instance, as one with the rat kingdom, since
al l our pineal glands secrete melatonin.
Preventing nightmares – other than not
eating chili at midnight, or taking certain
meds – has been studied extensively also,
primarily in the service of helping those
who suffer from PTSD. A type of cognitive therapy called Imagery Rehearsal has
been validated in multiple settings. One is
taught to rewrite the script of the inciting
trauma while still awake, to re-imagine a
whole different ending, to retrain one’s way
of thinking about that specific trauma. Pa-
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tients report improved sleep once they have
practiced this for several months.
Prazosin, an old alpha blocker drug (there
are many alpha-1 receptors in both the vascular smooth muscle and the CNS) has been
found to prevent nightmares rather well
in many studies funded by the VA. It has
also been useful as preventive treatment for
substance abuse. Young vets with combat
PTSD take large doses, and those avoiding
alcohol or other substances start at much
lower doses, since it can drop blood pressure and cause significant orthostasis. The
efficacy is high and the dose remains stable
over years without need for escalation.
Finally, what dreams mean has been debated for as long as humans have lived on
Earth. I do not pretend to interpret. Yet I
can identify with James Joyce in this matter:
“History,” Stephen said, “is a nightmare
from which I am trying to awake.”
Dr. Barry practices Internal Medicine with
Norton Community Medical Associates-Barret. She is a clinical associate professor at the
University of Louisville School of Medicine,
Department of Medicine.
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