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    You'll Sleep When You're Dead

    When Anxiety Gives You Bad Dreams That Give You More Anxiety and Bad Dreams

    Written by Sarah Emerson

    Photo: new 1lluminati/Flickr

    My college commencement ceremony is in two hours. I’m screwed. Somehow, I’m three credits short and there’s no way I’m walking away with a degree. I desperately need to fix this, but I don’t know how.

    My heart slithers into my stomach. Stress has glued my jaw shut. Slowly but surely, I come to the realization that absolutely everything that could go wrong will go wrong.

    And then I wake up. Everything’s fine.

    This is an anxiety dream. I’ve had them every night for as long as I can remember, even before I knew I had an anxiety disorder. I can’t tell you what a good dream feels like, because I’ve never had one.

    What I can tell you is that I never feel genuinely rested, no matter how much sleep I get. My days are plagued with fatigue and a fragmented attention span that I’ve neglected to address for years out of fear of being diagnosed with another psychopathy.

    Like anyone who’s ever Googled an ailment, I was morbidly curious to find out if my condition was normal or if it was going to be the thing that ultimately kills me.

    It takes approximately six seconds into an online search to realize the internet dream realm is as large as it is filled with New Age mysticism. Wading through hypnotherapy, brainwave power music, subliminal sleep messages, and genuine suggestions to wake up and huff flowers in the middle of the night is a waking nightmare. It can be hard to see the science through the smudge sticks, so I called up some actual doctors to figure out what the hell is going on with me.

    Anxiety dreams, in their most elementary form, are bad dreams that cause the overwhelming feelings of panic and unease associated with waking anxiety. They’re very similar to nightmares, but instead of lurching you awake in a cold sweat, they sort of prod you into consciousness by jacking up your stress levels. Both occur during REM sleep, that critical period in which our most vivid and memorable dreams manifest.

    Bad dreams, which include anxiety dreams, are more common than most people know, clinical psychologist Dr. Michael Nadorff told me. On average, he said, more than half of all dreams that occur during REM sleep involve some form of negative emotion.

    I can’t tell you what a good dream feels like, because I’ve never had one.

    “A lot of people aren’t conscious of how many bad dreams they have because in order for a dream to encode into your memory, you need to actually wake up while it’s happening,” said Dr. Nadorff.

    When I told him about my own anxiety and persistent poor sleep, he said it wouldn’t surprise at all him if anxious people like me have the same percentage of bad dreams as people without the disorder. Anxiety doesn’t directly increase the frequency of our distressing dreams, he assured, but it does heighten their severity.

    I embarked on my own somewhat (very) unscientific survey and spoke to several other anxiety sufferers about their sleep, and was relieved to discover their experiences were nearly identical to my own.

    "They're usually either deeply disturbing, or very surreal but emotionally neutral. The disturbing dreams rarely bother me after I wake up. I think I'm used to them,” Motherboard writer Rachel Pick told me. “When I was a student, they'd be about school. Sometimes they're about my relationship, but that's rare. So the dreams are about whatever is currently making me feel most insecure in my waking life. They're pretty standard in plot—I fucked something up and people are pissed at me.”

    When I asked Gawker reporter Sam Biddle how an anxiety disorder affects his sleep, he also described having bad dreams 100 percent of the time, and on a nightly basis.

    “They’re always a variation on the same dream,” said Biddle. “I’m unprepared for school, or I realize I don’t have enough credits or have missed a class. Somehow, I’m extremely unprepared for school in a way that’s going to jeopardize my academic standing.”

    Graphic artist Renee Griffin definitely noted a pattern to her bad dreams. "Most of what I remember from my dreams involves a general sense of frustration—physical weakness, failing people I care about, the inability to complete something or be heard,” she said. “Mine don't tend to focus on real life anxiety triggers in a literal sense, but they are usually ordinary(ish) situations that get crazy frustrating."

    As for me, I almost exclusively cycle through the same two dream scenarios. Either I’ve failed to complete an important task for college, or I’ve mistakenly done something that’s mortally offended someone I care about.

    Dreams may feel extremely similar, but Dr. Nardoff insists we don’t actually replay them. “The dreams are definitely different, but they’re all dealing with the same underlying psychological theme,” he said.

    Furthermore, dreams aren’t as commonly connected to traumatic events as people tend to think—only one third of people who suffer from chronic bad dreams actually have a history of trauma, Dr. Nardoff said.

    Goodnight Gloom

    Anxiety sufferers most likely feel plagued by bad dreams because of a process in behavioral psychology called negative reinforcement, said Dr. Nadorff. Negative reinforcement, he said, is the act of avoiding or removing an unwanted stimulus to achieve a desired result.

    So, say you’re dreaming about your high school boyfriend dumping you in front of your class assembly while you’re clutching your failing report card in nothing but your underwear. Your brain knows all it needs to do is wake you up to force-quit the bad dream. The act is unconscious, but the more it happens, the more it becomes reinforced. And because you’re only going to recall a dream if you wake up in the middle of it, you’ll tend to exclusively remember the bad ones.

    People with anxiety are also more prone to sleep disorders like insomnia, which is linked to bad dreams, sleep physician and instructor at Harvard Medical School Dr. Ina Djonlagic told me.

    There’s “a correlation between sleep quality and how we process traumatic experiences,” she added, which may help to explain why bad dreams, insomnia, and real-life anxiety can sometimes seem so hard to divorce.

    But as personal health websites are eager to tell you, bad dreams and nightmares can easily turn into serious medical disorders. The American Academy of Sleep Medicine loosely recommends that seven hours per night is best for adults, but the reality is everyone requires different amounts of rest. Your body will tell you what it needs. “It’s a spectrum,” said Dr. Djonlagic, “and there are certainly people who need less sleep, but there are a lot who need more.”

    Still, if bad dreams are making you avoid sleep, or preventing you from being able to fall back asleep, you run a higher risk of developing any number of disorders associated with chronic unrest.

    On the less fatal end of the spectrum, regularly skimping on sleep can lead to REM rebound; a response mechanism where your brain prioritizes REM sleep, forcing you to have it earlier and for a longer amount of time. But because REM sleep is such a key player in the occurrence of bad dreams, having more of it means—you guessed it—more bad dreams.

    “Sleep changes the cellular structure of the brain. It appears to be a completely different state."

    More seriously, chronic undersleep can also result in cognitive disorders like working memory problems and the inability to multitask, said Dr. Djonlagic. She often finds that people who aren’t getting enough regular sleep complain about being more forgetful, mentally fatigued, and have difficulty with visual discrimination exercises.

    One recent NIH-funded study out of the University of Rochester Medical Center even suggests that sleep deficiency might be a corollary of neurodegenerative diseases such as Alzheimer’s. The study’s authors observed that sleep allowed cerebrospinal fluid (the liquid that comes out during a spinal tap) to rapidly flow through the brains of sleeping mice. When the mice were awake, however, spinal fluid barely flowed at all.

    “Sleep changes the cellular structure of the brain. It appears to be a completely different state,” said the paper’s lead author Dr. Maiken Nedergaard.

    The brains of people with Alzheimer’s have too much of a damaging protein called beta amyloid between neurons, so the study also examined whether the movement of spinal fluid during sleep helped to flush out these molecules after having been injected into the brains of mice. Surprise, surprise, it did. While this study hasn’t been replicated on humans yet and certainly isn’t definitive, it does leave the door wide open for further investigation into the effects of a good night’s rest. At the very least, it’ll make you reconsider the true meaning of the phrase “sleep it off.”

    The Science of Better Sleep

    For those of us who would like some semblance of normal sleep, there are two forms of clinical treatment that have seen the highest rates of success; a blood pressure medicine called prazosin, and image rehearsal therapy.

    Researchers have observed positive results using prazosin to minimize sleep disorders in people with PTSD. Prazosin is a drug that works by stemming the flow of norepinephrine—a stress response chemical our bodies create during “fight or flight” situations—which doctors think contributes to nightmares. When norepinephrine rushes out of the central nervous system it can disrupt REM sleep, subsequently increasing the chances of having bad dreams.

    Image rehearsal therapy is another technique that’s recommended for people who have frequent and recurring negative dreams. Treatment requires the patient to visualize a specific bad dream, write it down, and alter it in any way that makes it less negative. This exercise should be repeated several times a day for five to ten minutes. With practice, the person should be able to cognitively displace the old, bad dream with a new, more positive one. Sort of like incepting yourself.

    Some therapists in the slightly controversial school of Jungian psychology find fault with image rehearsal therapy, however, because they see the repression of a patient’s dreams as a repression of their unconscious self. According to them, using cognitive behavior techniques to alter the outcome of your bad dreams means depriving yourself of the opportunity to work through some deep-seeded issues. I say to each their own, listen to your gut, whatever floats your boat, etc etc.

    Unfortunately, prescription anti-anxiety medications, while effective in helping many people regulate their waking symptoms, are unlikely to do much for inhibiting bad dreams, said Dr. Nadorff.

    Because anxiety and bad dreams are processed in different areas of the brain, patients usually need to address the two disorders separately, even if they’re symptomatically the same, Dr. Nadorff added. If you’re not not treating the sleep disorder in addition to the psychopathy, “you’re not going to see much remission and you’ll have higher rates of relapse.”

    Most people won’t think to see a doctor about their bad dreams and nightmares, he added, because for many it can be an embarrassing condition. A lot of poor sleep-sufferers don’t even realize that effective clinical treatment exists, but having even one nightmare per week is enough to make an appointment with a physician or therapist.

    After talking to actual doctors about my own anxiety dreams, I don’t feel good, but I do feel better. I’m open to trying both prazosin and image rehearsal therapy, but ultimately I’ll probably try to find a better way to contain my anxiety with the help of a therapist.

    After all, we humans spend about one-third of our lives sleeping, and all of it shouldn’t be bad.

    You’ll Sleep When You’re Dead is Motherboard’s exploration of the future of sleep. Read more stories.