Ask the Experts: Nightmares

Ask the Experts...

Dear Burn Community,

Welcome to “Ask the Experts,” a burn community advice column. We know a strong support system is one of the most important factors in a successful recovery from a burn injury, so for this installment of our column, we focused on questions from loved ones looking for ways to support the survivor in their lives. While these submissions may be specific to a particular individual’s situation, all three questions are very common themes that many survivors and loved ones face on their journey.

Whether you’re a survivor, loved one, or burn support professional, we want to hear your questions and concerns—and nothing is off limits! Odds are, someone else is facing a similar challenge, and submitting your question can help them too. We want to tackle topics that matter to the burn community – and if we can’t answer your question or we know someone else who may be better able to help, we’ll tap other experts to share their knowledge. We want to know what's on your mind, from legal options to makeup techniques and everything in between.

Have a question? Submit your questions to resources@phoenix-society.org with the subject line "Ask the Experts."

Sincerely,

Lise, Samoana, Felicia

Question: Nightmares

Dear Experts,

I’m a year out from my injury and still have horrible nightmares. How long will my nightmares last, and how can I prevent them?

Jennifer

Response from Dr. Lise Deguire

Dear Jennifer,

I am sorry to hear you are having nightmares, which I’m sure are scary and upsetting. About 4% of adults experience nightmares, often related to their suffering from PTSD (Post-Traumatic Stress Disorder) (1). Unfortunately, burn survivors have a much higher rate of nightmares. 30% of burn survivors have nightmares even a year after their injury, and unfortunately, these nightmares can continue even ten years later (2). So, you are not alone.

This is not my specialty, so I reached out to sleep expert Dr. Jodi Mindell, who is the Associate Director of the Sleep Center at Children’s Hospital of Philadelphia. She offered these helpful suggestions:

1. Many people who have nightmares avoid sleep for fear of having another nightmare. Unfortunately, this habit backfires. When people avoid sleep, they end up having more REM sleep, which is the stage of sleep when dreaming occurs (called “REM rebound”). As a result, they experience even more intense dreams/nightmares (called “REM rebound”). It is important to keep regular sleep hours to minimize this rebound effect.

2. As previously stated, nightmares are frequently a symptom of PTSD. People with PTSD can benefit from psychotherapy, particularly psychotherapy with a clinician who can treat their trauma with cognitive behavioral therapy and specialized treatments such as EMDR.

3. There is a helpful technique for nightmares called “image rehearsal.” You can do it yourself, or a therapist can coach you to imagine your nightmare changing into a positive ending. For example, a nightmare about a fire could be re-imagined into a fire being extinguished by a cool rain. Practice this positive imagery repeatedly during the day. It can greatly reduce nightmares.

These are some general suggestions to consider, but I recommend you consult with your own therapist, who can assess you and help you find the best way to reduce your nightmares. Please know that help is out there, and you can be helped toward a better night’s sleep.

References:

1) Morgenthaler, T. I., Auerbach, S., Casey, K. R., Kristo, D., Maganti, R., Ramar, K., ... & Kartje, R. (2018). Position paper for the treatment of nightmare disorder in adults: an American Academy of Sleep Medicine position paper. Journal of Clinical Sleep Medicine, 14(6), 1041-1055.

2)Low, J. A., Dyster-Aas, J., Willebrand, M., Kildal, M., Gerdin, B., & Ekselius, L. (2003). Chronic nightmares after severe burns: risk factors and implications for treatment. The Journal of burn care & rehabilitation, 24(4), 260-267.

Dr. Lise Deguire graduated from Tufts University and earned her doctorate in clinical psychology from Hahnemann/Widener University. She is the author of her award-winning memoir Flashback Girl: Lessons on Resilience from a Burn Survivor. She is a blogger for Psychology Today and has appeared on NPR, NBC, ABC, FOX, Sirius XM, and numerous podcasts. Dr. Deguire writes a blog about psychological resilience issues and is a national keynote speaker. She lives in Bucks County, Pennsylvania with her husband, Douglas Behan, two wonderful daughters, and one rambunctious dog. Connect with her on Facebook, Twitter, Instagram, LinkedIn, or her website, LiseDeguire.com.