Do you have Nightmare Disorder?

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Nightmare

Nightmares maintain depression and PTSD.
Photo courtesy of Pixabay

Do you have bad dreams or is that a Nightmare Disorder?

We know there are connections between sleep, sleep disruptions and a number of mental illnesses. The connection between nightmares and Posttraumatic Stress Disorder (PTSD) is fairly well-recognized. Dreams related to your trauma is one of the symptoms of PTSD. What often goes unnoticed is just how connected poor sleep and having a mental or physical health issue can be.

Sleep disturbances can be both the result of and the cause of significant life problems. Many people ignore their bad dreams and nightmares. You shouldn’t. Disturbed sleep may be a warning that something much worse is on its way. Some of these issues can threaten your life and your sanity. Frequent nightmares increase the risk someone will attempt suicide. Drinking to shut off the nightmares increases the suicide risk even more.

Nightmare Disorder is included as a Mental Disorder in the DSM-5.

Nightmares fall along a continuum which runs from an occasional upsetting dream through frequent bad dreams that leave you feeling upset when you wake up, to those severe things like Nightmares and ends at the point of Sleep Terror Disorder where people wake up screaming. Sleep Terror Disorder along with Sleep Walking was combined in the DSM-5 getting the new name Non-Rapid Eye Movement Disorders, but that’s a topic that needs to wait for a future post.

Bad sleep is a symptom found in several other mental Illnesses so the sleep disorders get little attention from most Therapists. Given the human tendency to pretend there is nothing wrong with us until we hit the wall so to speak, it is not surprising a lot of sleep disorders go undiagnosed or get diagnosed as something else.

Nightmare Disorder is part of a group of conditions called Sleep-Wake Disorders.

Sleep-Wake disorders do not get diagnosed or treated by therapists of counselors all that often. Usually, sleep problems get one of two problematic treatments. They could be referred to a sleep disorder specialist who uses the International Classification of Sleep Disorders (ICSD-2) with its myriad subcategories. The other possibility is that sleep disorders are often taken as a symptom of a more common mental illness.

Poor sleep could be anxiety, depression or PTSD.

Nightmares or Bad Dreams can be a part of some anxiety disorders. Changes in sleep and appetite are key symptoms of depression. But just having bad dreams in and of itself does not automatically get you an anxiety or depression diagnosis.

Many nightmares are a part of Posttraumatic Stress Disorder (PTSD.)

Trauma- and Stressor-Related Disorders are such major factors in mental health that the Trauma- and Stressor-Related Disorders now have their own DSM chapter. Bad dreams and nightmares are one major factor in PTSD and other similar disorders that once you say you have bad dreams expect the professional to ask about any trauma history and any recent or current stressors.

If you have PTSD or another Trauma-Stress related issue nightmares are likely, but just because you have bad dreams does not mean you have PTSD. When I decide to write this post on Nightmare Disorder I looked up a hundred or so recent research articles on Nightmares and Bad Dreams. The largest part, a strong majority of those articles, were about Nightmares in people with PTSD. But there were a bunch of other mental health conditions that were connected to poor sleep also.

Nightmares and Bad dreams are connected to Borderline Personality Disorder, OCD, DID, GAD and aging.

That is only part of the list. OCD stands for Obsessive Compulsive Disorder, DID is Dissociative Identity Disorder and GAD is for Generalized Anxiety Disorder. Each of these diagnosis has related OCD like, Dissociative and Anxiety Disorders.

All these related disorders including bad dreams of one kind or another which makes me wonder if many people with one mental illness should also be getting a diagnosis of Nightmare Disorder. That and sleep disorders are one of the factors leading to the development of other mental health issues. In that vein, sleep disorders also greatly increase the risk of relapse in those with a substance use disorder.

What are the symptoms of Nightmare Disorder?

For the full text of the symptom see the official DSM-5 but here is my short, plain language version.

  1. Frequent, upsetting, bad dreams that really scare you.
  2. You can wake up quickly.
  3. These bad dreams are getting in the way of you living your life (family friends, job etc.)
  4. Drugs, alcohol or another mental illness are not the best explanation for why this is happening.

On top of these and a few other more specific criteria, Nightmare Disorder has a bunch of “specifiers” about when how often and how bad these dreams are.

A word of caution here. This is post is an effort to explain some kind-of complicated stuff. Diagnosis should not be a do-it-yourself project. There are a bunch of other Sleep-Wake Disorders that might also need to be ruled in or out. Some sleep problems are a sign of life-threatening physical conditions. You may also have some other mental issue or guess what?

Your bad dreams may be a normal reaction to some stress in your life right now.

Drinking alcohol to quiet bad dreams is a really bad idea. The amount it takes to knock you out is very close to the amount that will kill you. Especially do not mix alcohol with prescribed sleep or anxiety meds. You can work with your doctor on meds for bad dreams but when the meds wear off the dreams can get worse.

If you are having sleep disruption, bad dreams, nightmares, night terrors or related sleep problems, talk with your doctor or other professional and see if medication, therapy or some other treatment might be helpful to you. Don’t put it off. Even normal sleep issues if left untreated can eventually impair your physical or mental health.

You might want to take a look at other posts on:

Sleep

Dreams and Nightmares 

Stay tuned, more on sleep’s connections to mental health, wellness and recovery are coming.

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

Excess Medications – Poor Sleep linked to Dementia and Alzheimer’s?

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Sleepwalking

Sleep Walking.
Photo courtesy of Pixabay.com

New research is linking a lot of factors with cognitive decline.

Came across some interesting research recently about factors that may be increasing people’s risk of cognitive decline.  Both excessive medication and sleep problems appear to be risk factors for memory and thinking problems. We are a long way from any final answers when it comes to cognitive decline but some of this research is so convincing that I wanted to share it with you.

Poor sleep in the first few hours of the night, the time when memories and thoughts are processed and stored appears to be connected to eventual dementia. Low levels of oxygen also increased this risk.

There is a brief article on this research at PSYBLOG

One study does not make for final answers. This study was on only Japanese men and done in Hawaii. It made the connection between the poor sleep, low oxygen, and dementia but did not find a connection to the subsequent development of Alzheimer’s. The source for the research? Published in Neurology.

So is the answer to this poor sleep and cognitive decline to put more people, seniors in particular, on sleep medications? Not really.

Turns out that many seniors are being badly over medicated. The older you get the more likely it is that a doctor will prescribe sleep medications or anti-anxiety medications. The increase in anti-anxiety meds is troubling as research has told us that many seniors become less anxious not more so as they age.

The National Institute of mental Health published an article titled – Despite Risks, Benzodiazepine Use Highest in Older People.

This article reported on research into the prescribing of Benzodiazepines for older adults. The older you get the more likely it is that your doctor will prescribe a benzodiazepine for either poor sleep or anxiety. As you age you are more likely to be prescribed higher doses, for longer periods of time.

Most of these Benzodiazepines were prescribed by primary care doctors rather than by psychiatrists. Now here is the problem with that.

Taking lots of Benzodiazepines appears to increase your risk of developing Alzheimer’s. The more you take the higher the risk. Take these meds for 180 days or more and your risk of developing Alzheimer’s DOUBLES, or so this one study tells us.

The text of this article as published is on PubMed.

There is another reason to be concerned about this high use of Benzodiazepines among seniors. That is the interaction between Alcohol and Benzodiazepines. We know from the experiences in the substance abuse treatment field that as we age the body’s ability to remove chemicals from your body declines. Any drug use by the elderly is risky. Just because the drugs are prescription ones does not eliminate the risks.

We also know that a large part of drug overdose deaths is the result of the interaction of alcohol and Benzodiazepines. People are tempted to use alcohol to sleep and when this is done to excess the result is poor sleep not improved sleep.

What is the solution?

Please do not suddenly stop taking prescribed medications based on this blog post or any other online source. If in doubt talk with your doctor. Do all you can to manage your health concerns, get that diabetes or heart condition under control. Lose weight, all those other health things you know you should do. No pill is a substitute for a healthy lifestyle.

Consider all those things that we loosely refer to as “sleep hygiene.” There are lifestyle changes that can help you sleep better. Also if emotional problems are impacting your sleep or causing you anxiety or depression, consider counseling or therapy for those mental health issues. You do not need to be “mentally ill” to benefit from counseling.

Science has not given us a cure for cognitive decline just yet, that may never happen. It is possible to do everything right and still develop some cognitive loss. But until we have a better answer to this problem do all you can to reduce the risks and get more mileage out of that brain of yours.

P. S. There have been a couple of broken links in these posts recently. Who knew that links could be so fragile? If you find a bad link please let me know and I will attempt to fix it.

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

What does my dream mean?

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Dreams

Dream On!
Photo courtesy of Pixabay.com

Ever wondered what you dream meant?

Dreams

Dreams
Photo courtesy of Pixabay.com

Many readers email me about what their dream may mean. They want answers and hope I can provide them. Dreams can provide useful information for your awake life. Over simplistic interpretations can be harmful. I have written previously about some common drug using dreams that clients have reported to me and what I and they thought these dreams meant.

Dreams about relationships and life events seem, to me, to be open to a lot more possible interpretations than the common drug use dreams I wrote about in those posts.

Dream interpretation used to get more attention.

First I will offer some thoughts on the topic of dream interpretation, then some suggestions for interpreting your particular dreams.

There was a time when interpreting dreams was a large part of what people in the psychology field did. The key concept in dream interpretation was the Freudian interpretation of mental processes and the role that was ascribed to the unconscious. Jung wrote about the collective unconscious and there are “depth” psychologists today that work in this area.

Interpreting dreams went out of fashion.

Somewhere along the line the study of normal psychology and the study of mental health and mental illness, sometimes called “abnormal psychology” were divorced.

Today the predominant model for treatment of mental illness or improving mental wellness is cognitive behavioral therapy. Rather than looking for answers to life problems in the place of an unknowable and uncontrollable unconscious most therapy and counseling looks at very visible processes like learning and cognitive distortions. The emphasis is on things you think and believe, that are unhelpful, not on things your unconscious mind is making you do.

Most of the cognitive interventions, like reframing and challenging faulty assumptions are relatively straightforward. Interpreting dreams is far more subjective and less certain. While interpreting dreams and exploring your unconscious can be personally rewarding it is not the sort of brief, medically necessary, intervention a lot of insurance companies will pay for.

Personally, I have some dreams. Some of those are a bit disturbing and others are happy memories, so yes I may look at them. I find I need to be careful in interpreting my dreams and feel you should be careful with anyone who offers you a quick interpretation of your dreams. Especially be suspicious of those popular books that list a whole lot of things and if you dream of a lake it means one thing and if you dream of a river it means something else.

One thing does not always have one definite meaning for everyone. I am told that Freud, that believer in all things sexual, once replied that sometimes a cigar is just a cigar. He was, according to some reports, highly addicted to tobacco, so dreaming of cigars makes sense in a drug using context.

Dream meanings are very personal.

Your past life experiences, in real life and vicariously in movies and books can color your dreams. For example, back in High School, I raised some birds, Pigeons, and parakeets, if I dream about those birds it may have one meaning for me and quite another one for a person who was bitten by a bird and as a result is frightened of birds. The important thing is what does this dream mean to you?

Most of us have far more dreams than we remember. Even people who say they do not dream seem to enter dream states when hooked up to machines during sleep studies. Ever had a dream, awakened and ran for the bathroom and when you got back to bed could not remember that dream? The majority of us forget more dreams than we remember. Some people forget almost all of their dreams.

It is the very unusual or frightening dreams that get remembered. If you keep a pad by the bed and write the dream down upon awakening you will discover you are having and remembering a lot more dreams.

From a cognitive perspective, we think that during dreams memories are taken out, processed and then restored. There are opportunities for memories to undergo some alteration as in Lucid dreaming an intervention proposed to help with dreams that maintain PTSD symptoms. 

Things that happen in dreams do not have to follow logic or even the laws of time and space. So you may, in your dream, step out a door and be in another country. So you saw something in your dream, someone did something or something happened to you or a person close to you what does that mean?

Dreams have layers of interpretation.

Recently I read a book on dream interpretation by Jeremy Taylor, Where water runs up hill; he suggests that dreams have many layers of meaning. So the dreams about the parakeets many just be about a fond memory of childhood but it might also have to do with existential things like living, having children and eventually dying, or it might have another meaning altogether.

What he suggests we should do is look at the dream, talk with others you trust about the dream and then look at possible interpretations. What do you think it means at a superficial level, what it could mean at a deeper level and so on. Some of these meanings will not make much sense and some will really speak to you.

So if you comment or use the “contact me” form, I can offer you a possible meaning to two for what you ask about, but I make no pretense that mine is the “correct” interpretation. If when someone tells you that your dream might mean a particular thing and you feel in your gut, your felt-sense, intuition, that this is correct, that meaning is probably part of your truth.

Hope this brief explanation of dreams from purely my perspective might be helpful.

Enjoy your dreams but seek help for disturbing nightmares.

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

Sleep and Mental Illness connection

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

sleep

Child sleeping.
Photo courtesy of Pixabay.com

Does poor sleep cause mental illness or does mental illness keep you from sleeping?

There is a huge connection between mental health issues and insomnia. This fact has been recognized for a long time and its recognition has been built into most of the diagnostic codes.

Some recent studies are making mental health professionals question if have gotten the connections right. Could be there are more connections between sleep and good mental health than we thought.

Sleep disturbances are a diagnostic feature of Major Depressive Disorder. Typical depression includes the inability to sleep. Depression with atypical features is characterized by excessive sleeping. Clients might describe this as hibernating in bed. But depression is not the only mental illness in which sleep features play a role.

Bipolar disorder requires a period of mania or hypomania for diagnosis. One key feature of the “mania spectrum” is needing less or very little sleep and being able to function on reduced sleep. I don’t recall ever reading about a “mania spectrum” but the variability of the way clients report manic-like symptoms is making me think that there is a continuum of manic symptoms just like the continuum of other disorders.

There are specific sleep disorders but as a counselor and therapist, I don’t believe I have ever been called on to work in that area. Most sleep disorders are seen as more medical problems. It is only when a lack of sleep or excessive sleep begins to affect someone’s overall mental health that we counselors get to talk with them.

One health concern has become that increasing weight, the epidemic of obesity it has been called, can cause poor sleep. So we need to wonder if inactivity, excess calories and weight gain are harming our mental as well as our physical health.

There is also a connection between poor sleep and Posttraumatic Stress Disorder (PTSD.) Nightmares, as well as daytime intrusive memories, are considered symptoms of PTSD. We probably should observe a distinction between bad dreams and nightmares. With bad dreams, people do not awaken until the morning and may or may not have detailed memories of the dream. Sometimes others around them are aware they had a bad dream even if the dreamer is not aware.

Nightmares are much nastier creatures. They are characterized by strong negative emotions and frequent “awakenings” from the dream. People who have nightmares are much more likely to remember them because they keep waking up.

We also know that having nightmares will prolong the symptoms of PTSD. In a previous post, I wrote about the way in which nightmares play a role in maintaining PTSD symptoms. Nightmares and dreams, good or bad dreams are strongly connected to spiritual, religious and cultural values. Some people also see nightmares as warnings about the future and as a source of intuition. Given that past experiences are a basis for dreams and that what happened in the past may happen again, dreaming about worries would seem to be a normal phenomenon.

What if we have this all backwards? Could a sleep disruption be a cause of mental illness rather than a symptom or a maintenance factor?

One study of veterans of the Iraq war looked at the relationship between insomnia and PTSD. Now this is just one study so the results are preliminary and more studies may not get the same result, still, the results were surprising.

What they found was that for these veterans the insomnia came BEFORE the PTSD symptoms. Insomnia 4 months after returning from deployment predicted the development of PTSD symptoms at 8 months post-deployment (Wright, Et al., 2011.) It seems likely that an increase in anxiety resulting from being in a risky situation could cause sleep disruptions and the result, much later, would be episodes of mental health problems.

Their suggestion and there was a lot more to this study was that sleep functioned as an emotional regulator. So insomnia may be both a symptom of, and a cause of, mental illness. An increase in insomnia predicted who would develop depression as much as three years later.

Good self-care, including a healthy diet, exercise, and good sleep hygiene has long been an integral part of relapse prevention in substance abuse. We are also seeing that relapse prevention is an important part of mental health recovery.

What if sleep changes could be an effective predictor of mental health relapse? In what ways might we be able to improve our sleep and thereby improve our mental health?

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

What are Lucid Dreams? Do Lucid Dreams cure Nightmares?

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Dreams and Nightmares

Dreams and Nightmares
Photo courtesy of Pixabay.com

Can Lucid Dreams cure nightmares?

Lucid dreams are dreams in which the dreamer knows that they are dreaming but does not awaken. Experienced Lucid dreamers are able to control the content and direction of the dream.

Lucid Dreams have been the subject of discussion for centuries. Various Lucid Dream techniques and dream practices are a part of Dream Yoga and Tibetan Buddhist practices but were largely dismissed by western practitioners. In recent years hard scientific evidence that Lucid Dreaming is occurring has been accumulating.

The goal in Lucid Dreaming is to manipulate the dreams so as to solve problems and reduce distressing elements of the dream. If the dreamer can recognize that they are dreaming they can become an active participant in the dream, creating and acting out events in the dream they wish would occur.

In a previous post, I wrote about how Nightmares can Maintain PTSD, most treatment for nightmares has involved talking about or rewriting dreams while awake. Lucid dreaming creates an opportunity to work on altering distressing dreams as they occur by taking actions to alter the course of the Lucid Dream.

Lucid Dreaming was used effectively in one 2006 study to reduce the frequency of nightmares.

While therapy has been applied to interpreting dreams and to coping with distressing elements of dreams after they occur, lucid dreaming is a tool for altering the dream as it is in progress.

Becoming aware that you are dreaming has also been used by artists and people seeking to improve their creativity by increasing the ability to move visions in the dream world into the awake world.

Most dream content is lost in the morning as soon as the dreamer moves or begins their morning rituals. Learning to recognize that you are dreaming and to continue to hold and process the dream upon awakening can increase the amount of the content of your dream the conscious mind retains.

Keeping a notebook by the bed and writing down all you can of the dream immediately upon awakening helps keep the dream from evaporating upon rising.

Experienced Lucid dreamers can review previous dreams and return to finish a previous dream. Lessons learned while dreaming can then be retained and applied to the waking life.

Researchers have found that things seen in the dream state will be believed even when they defy the laws of physics as we know them. While asleep the dreamer is willing to believe what they see, but upon awakening, they are quickly aware that what they saw in the dream is not possible. In the dream state seeing, really is believing.

Related to Lucid Dreaming is the phenomenon of False Awakening.  In False Awakening the dreamer dreams they have awakened but the dream continues. This continues until the dreamer realizes this must still be a dream or until they really do awaken.

Related Posts include Sleep Paralysis and Trauma Steals your Sleep.

Have you been able to recall your dreams? Have you ever tried to participate in the dream and alter the course of events? If you have had a Lucid dreaming experience or a false awakening please leave a comment.

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

Does sleep paralysis cause or is it caused by mental illness?

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

More on Sleep paralysis.

Sleep paralysis.
Photo courtesy of pixabay.

Remember this is written from a therapist’s point of view. If there is any chance that you or someone you know has a medical problem, have it checked out by a doctor first. But if the doctor finds nothing medically wrong with you that does not mean you are going crazy. It might mean that you can benefit from some counseling to help you better cope with stress.

Many people who experience sleep paralysis, hypnogogic hallucinations or “exploding head syndrome,” think they are going crazy or fatally ill. Knowing that these are explainable phenomena and have simple treatment can reduce the concerns. Sleep Paralysis and many related sleep problems are often triggered by stress. More stress, good or bad stress, and the chances of an attack increases.

People who become fearful of another occurrence of Sleep Paralysis can “prime the pump” and increase the risks of a second bout in the same way people who experience panic attacks begin to worry about having another episode.

If clients describe these events as dreams the doctor is likely to reassure them that it is normal. Patients who explain these events as demons, spirits or believe they actually saw a supernatural being are likely to be prescribed a psychiatric medication. Antipsychotics, antidepressants and anti-anxiety medications (Benzodiazepines) are all believed to increase the incidence of Sleep Paralysis and Hypnogogic Hallucinations (Gangdev, 2004.)

Other things that have been reported to increase the risks of having an episode of Sleep Paralysis include being physically ill, such as having the flu, watching or experiencing emotionally upsetting events, such as having an argument.

If the paralysis or hallucinations only occur when going to sleep and waking up they are most likely sleep-related and not the result of a mental illness. Gangdev, in his article, asked the question: “It is possible that a small proportion of patients diagnosed with schizophrenia who experience hallucinations may actually be experiencing escaped REM-related dream activity during the wakeful state?”

There is a significant overlap between sleep paralysis and Narcolepsy. Narcolepsy includes not only sleep paralysis but hypnogogic and hypnopompic hallucinations, daytime sleepiness and Cataplexy (sudden unexplained loss of muscle tone.)

Sleep Paralysis without any cataplexy or daytime sleepiness is not considered to be associated with Narcolepsy and is referred to as Isolated Sleep Paralysis (ISP.) Penn reported that 16 % of medical students reported at least one episode of sleep paralysis. That makes me think that long hours and sleep deprivation may be a major cause of many of these events.

Sleep Paralysis is far more common in African-Americans and in one study of Nigerian subjects more than half had experienced ISP. It is also common in Japanese Subjects.

People who have a Sleep Paralysis event find it helpful to get up move about and make sure they are fully awake before attempting to return to bed. People who do not get out of bed have an increased risk of having multiple episodes of sleep paralysis in the same night. Sleeping flat on your back looking up at the ceiling (supine position) is much more likely to cause a Sleep Paralysis experience than sleeping on your side.

Knowing that episodes of Sleep Paralysis and Hypnogogic Hallucinations are relatively common and most often harmless can help someone cope with these experiences.

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

Sleep Paralysis – What causes it? Is it related to PTSD or demons?

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

Sleep paralysis.
Photo courtesy of Pixabay.com

Is Sleep Paralysis related to PTSD or the supernatural?

Imagine awakening suddenly in the middle of the night. Sitting on your chest is a demon; there are ghosts, dead people or spirits standing around your bed. You try to scream but nothing comes from your throat. You would run if you could but your legs won’t work. You are awake and paralyzed. Looking up at the demons you are helpless to do anything beyond saying a silent prayer inside your head. You are experiencing Sleep Paralysis.

Sleep Paralysis is one of those unusual problems. This condition is especially terrifying to someone who has the disorder.  If you have a belief in the supernatural you may dread falling asleep.

Sleep Paralysis has long been more the province of legends and the supernatural than included in the area of mental health. This experience has been connected to many other worldly phenomena. Similar experiences were described during the Salem witchcraft trials.

Today we have a scientific explanation that satisfies some, some of the time, but are we sure?

In Sleep Paralysis you can see, move your eyes and breathe, but the rest of your body is unable to move.  Some episodes of Sleep Paralysis last seconds. The average is six minutes. Occasional an episode of sleep paralysis will last longer than 6 minutes or on rare occasion’s hours.

Many people with Sleep Paralysis, up to 30% also have a history of Panic Attacks. It is more common among those with PTSD or anxiety disorders. Sleep Paralysis is also most common among those with minority status, especially African-Americans (Sharpless et al 2010.)

Other researchers have suggested that dissociation may be related to the old or “Lizard brains” freeze response to threat or danger. The same mechanism might explain the inability to move despite overwhelming terror found in Sleep Paralysis. Fear and anxiety may both cause and be the consequence of Sleep Paralysis.

Sleep paralysis is more common with overtired or sleep deprived individuals. It is also associated with taking Antidepressants, Benzodiazepines and some other medications. Ohayon et al., 1999 (Cited by Sharpless) also suggested a relationship between SSRI’s and Sleep Paralysis but Sharpless did not find a connection.

Sleep paralysis can occur when falling asleep or when awakening from sleep. Its main characteristic is not being able to move for an extended period of time. This condition occurs naturally during REM sleep but we don’t know we are becoming paralyzed when we are asleep.

The episodes of paralysis while awake are most often accompanied by very vivid hallucinations. The more vivid the hallucinations the more terrifying the Sleep Paralysis. Sometimes the person will experience hearing sounds. Even when experiencing the full symptoms of Sleep Paralysis, both the visions and the inability to move, many people describe the experience as a “dream” (Fukuda et al, 2000.)

If the hallucinations occur when falling asleep they are called Hypnogogic. Hallucinations that occur when awakening are called Hypnopompic.

Sleep paralysis may be connected with a physical disorder such as Narcolepsy. Reports suggest that those who hear sounds are most likely to also have narcolepsy. Sleep paralysis has also been associated with Migraines. If this occurs more than once or causes significant distress it is wise to seek medical attention.

Sleep paralysis is more likely to occur when someone has moved to a new location, is under stress or has consumed an excessive amount of alcohol.

Mental health practitioners, therapists, and counselors are mostly concerned with two relationships between sleep and mental health. Is the problem with sleep caused by a mental illness? Symptoms of depression include changes in sleep and appetite. Depression can be seen as the cause of a sleep problem.

Sometimes sleep issues can create symptoms that are diagnosed as mental illness. Nightmares play a role in maintaining depression and PTSD.

Beyond those two alternatives, most other sleep issues are in the providence of medical doctors. There are plenty of sleep problems that are in the International classification of sleep disorders that are not directly included in the DSM.

The following are past posts on connections between sleep and mental health issues.

Getting Rid of Nightmares that Maintain Depression and PTSD

Trauma Steals Your Sleep 

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