Sober Synthesis

Non-REM  (Slow Wave) Sleep

• Overall dreams are less frequent, briefer, simpler, and more logical.
• Norepinephrine (fight or flight neurochemical and hormone) is present. 

REM (Rapid Eye Movement) Sleep

• This stage usually starts 75-90 minutes after sleep onset, with each REM cycle increasing throughout the night. The first cycle typically lasts 10 minutes, with the final cycle lasting up to 1 hour. REM is when dreaming occurs.  
• Norepinephrine is generally absent, we are paralyzed during REM sleep.
• REM sleep is when emotions and emotional memories are processed and stored.

• We can process and adjust our emotional relationship to challenging and emotionally pleasing events that happened to us while we were awake. REM sleep can serve as our endogenous “therapy”.
• Drinking and/or using dreams are common in recovery.
• Causes of Bad Dream and Nightmares
  • Anxiety and stress are the primary causes of bad dreams and typical nightmares.
  • Bad dreams and nightmares increase with REM sleep deprivation, PAWS, some comorbid medical conditions, some medication side effects, chronic pain.
  • While nightmares and bad dreams both involve disturbing dream content, only a nightmare causes you to wake up from sleep.
    • Nightmares are more likely to contain threats to basic physical security and survival, while bad dreams are more apt to grapple with a broader range of psychological anxieties.
  • Nightmares increase before the mid sleep awakening cycle or morning awakening (norepinephrine is present). 
  • Frequent nightmares disrupt restorative sleep and may need behavioral and/or medical intervention.
  • There is some evidence that norepinephrine is not absent for people with active PTSD, reinforcing repetitive trauma dreams (the jump drive does not erase/altar allowing reprocessing).

Activities:

• Prioritize sleep hygiene.

Sylvia-Restorative Sleep – Sober Synthesis

• Ongoing sleep disturbance may be an indicator of a medical condition (e.g. sleep apnea). A sleep study may be helpful. 
• Mindfulness/meditation can be helpful for sleep onset as well as falling back to sleep after waking. Effective practices include Non-Sleep Deep Rest (NSDR) and Yoga Nidra. 
• Supplements (e.g. melatonin, magnesium threonate) may be helpful. Melatonin is not recommended for long-term use. Important to inform your physician of any supplements and/or vitamins you are taking.
• Medications may be helpful for acute sleep disturbance.
• Keep a sleep journal 
• To decrease repetitive bad dreams or nightmares
  • Image rehearsal therapy: Change the script of a repetitive nightmare or bad dream
  • Eye Movement Desensitization and Reprocessing therapy 
  • Exposure, relaxation, and rescripting therapy
  • Hypnosis
  • Lucid dreaming therapy
  • Other exposure and desensitization therapies
  • Comprehensive professional treatment for PTSD and/or moderate to severe mental health disorders may be needed.

Proposed Questions:

1. How have your dreams changed in recovery?
2. What changes in lifestyle have improved or changed your dreams?
3. What changes do you plan to make to improve your sleep and/or decrease bad dreams/nightmares?

Disclaimer

This summary is for general informational purposes only and does not constitute the practice of medicine or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed.