Terror in the night

Research suggests that up to 20 per cent of adults experience some form of sleep disorder, including nightmares. Deirdre Cashion talks to sufferers and discovers how this condition can be managed.

It’s a familiar if not rare experience for many of us – waking with a sudden dart in the dead of night, heart pounding, pulse racing, brainwaves flooded with flashback images and an overwhelming sense of anxiety and confusion permeating our rousing consciousness.

While more common in children, adults can also suffer from persistent nightmares or night terrors from time to time. It’s a condition that can be very debilitating for those, whose sleep is regularly interrupted by spurious things that go bump in the night.

“It’s normal to have nightmares and bad dreams to a certain degree,” according to Dr Elaine Purcell, consultant in sleep disorders’ medicine at the Mater Private Hospital. “But if it becomes very persistent and distressing, then it can be an issue and might need to be addressed.”

The terms nightmare and night terror are often used interchangeably but they are quite different. We commonly understand nightmares simply as bad dreams, coming out of REM (Rapid Eye Movement) or dreaming sleep but night terrors derive from deep sleep and manifest in a much more physical way.

“Night terrors occur where the adult seems to awaken suddenly from sleep; they’re panicked, pale and sweating; they look like they’re terrified but they can’t hear what you’re saying and they can’t interact with you,” explains Dr Purcell. “They are actually still asleep, even though they look awake and they won’t have any memory of it the next morning.”

Rachel Sorohan (24) works in PR and is from Donaghmede, Dublin. She suffers from bouts of sleep paralysis, every second month or so. The first episode occurred over two years ago.

“The best way to describe it is, it’s like having a nightmare – you’re in a bad dream and you try to wake up but you can’t. It’s as if your mind wakes up before your body and you’re frozen stiff in the bed. It’s really scary.”

The condition is frequently accompanied by terrifying visions as Rachel knows only too well.

“I’ve often felt somebody was there pressing down on my chest or a presence hovering over me. The first time it happened I thought I was a demon possessed and I asked my Mam to get the holy water,” she recalls.  “In one night terror, I remember crawling into my Mam’s room trying to get away. Just as I got there to open the door, my ankle was pulled and I was dragged back in. Then all of a sudden I just woke up.”

Sleep paralysis occurs during disturbed REM sleep, when Mother Nature deliberately paralyses the body to prevent it from acting out the dreams and injuring itself.

“Sufferers can wake in the middle of dreaming sleep and their body just lags behind their brain for a couple of seconds,” explains Dr Purcell. “They feel they’ve woken up but the body still thinks it’s in dreaming sleep so it’s still paralysed. It usually only lasts for a few seconds but it can be extremely frightening,” she says.

Rachel’s paralysis phase can vary in length. She estimates the longest one at about 60 seconds and admits that it does play on her mind the following day.

“You’re thinking why it happened, how it happened and you just have to put it down to dreaming. Sometimes, you’d have a feeling of dread going to sleep the next night and you’d even sleep with the light on,” she confesses.

But Rachel finds that a rose-scented room spray, incense and some relaxing music helps her to ease into a restful slumber. She also tries to manage her stress levels and makes sure that she maintains a regular sleeping pattern.

“If I was getting them twice a week, it’s something that I would have to do something about,” she says. “It’s scary but it’s manageable.”

Unlike Rachel, third year nursing student, Elisha Reilly (26) from Portarlington, Co Laois has quite literally run into a cul de sac in attempting to manage her broken dreams.

“Lately, the nightmares are fairly similar,” she says. “I’m running away from something and fighting. A lot of the time I’m dreaming about zombies coming after me. But it’s not just zombies – it could be a murderer or it could be the CIA. There is another dream where I turn to fight and I’m trying to hit someone but there’s no force behind it as I’m really, really weak.

“There’s no clear motive in the chase. All I know is that I have to get away from them but sometimes I develop superpowers and I can jump over hedges, over walls and I run really fast to get away from them. But if it does come to a fight, I can’t do anything,” she says.

Elisha lives alone and is estranged from her family. She has very little support to draw on.  The nightmares occur several times a week, intensifying to the point that they now constantly wake her up, something that never used to happen. They strike at any hour of the night but she deliberately avoids looking at the clock as it’s an unwelcome reminder of the little time left, before she starts her long commute from Portarlington to Dublin City University in Glasnevin.

“With a nightmare, it’s a dream screaming at you to pay attention,” explains psychoanalyst and well-known RTÉ broadcaster, Michael Murphy. “It’s speaking in a symbolic language and toning up the fight or flight responses to deal with a real emergency or event which is on the way. Paradoxically, Elisha’s dream is an interesting one because often what we flee from can bring us some good.”

Mr Murphy believes that psychoanalysis is a very effective way of dealing with nightmares and night terrors, by drawing on an extensive body of psychological theory and using his skills to understand or direct them.

“The principle core of the psychoanalyst’s work is to listen,” he says. “I would ask the client to first of all recount the dream. I’d listen very carefully to what they’re saying, note exactly as they say it and feed that language back, so we can discuss what’s going on. I would discuss the situation. Where is it taking place? Is it in the street, in an office? It might begin in a derelict house – that is a metaphor, explaining how they are inside at the moment.

“Where are they situated in the dream? Are they participating or are they just looking on? And the various people in the dream, who are they? Do they exist in real life?”

Mr Murphy could work with clients over multiple sessions to go through the unfolding drama of the dream, looking at its core turning point and how it could apply in their lives.

“People who are particularly anxious will have more nightmares than others but as the work progresses, the nightmares cease in intensity,” he says.

Quite apart from the disruptive nightmares, Elisha also suffers from night terrors, with her pet hate, spiders, taking the starring role.

“I’ll wake up and there’s a spider in front of me. I’ll throw the covers off me and I’ll be convinced that it’s there and I could end up being awake for the rest of the night. I’m afraid to go back asleep as I’m absolutely convinced there’s something there,” she says.

“If an adult suddenly develops night terrors out of the blue, you have to wonder if there’s some other sleep disorder underlying it,” says Dr Purcell.

“The most common disorders are restless leg syndrome – where the legs kick excessively during sleep, or sleep apnoea (abnormal pausing in breathing and snoring). We would have to do an overnight sleep study in the laboratory, where we read the patient’s brainwaves as they sleep to see what’s going on.”

There is very limited access to sleep disorder treatment in the public health system. The sleep clinic in the Mater Private is the only one in the country that deals with all sleep disorders, for young and old. Dr Purcell believes it’s a very under-served area that needs to be “fostered and encouraged”.

Elisha hasn’t been able to figure out the trigger for her nightmares and she always feels tired the day after the night before.

“I’ll be honest. I do have quite a bit of stress in my life at the minute – financial, family and work stress. That’s probably is contributing to it. It’s getting worse and more frequent. I do think about it quite a bit and it does affect my sleep. You can’t expect to have a restful night’s sleep if you’re on edge in your dreams,” she says.

So where does Elisha go from here? For the moment at least, a good night’s sleep is something she can only dare to dream about.

Tips for a good night’s sleep

1. Maintain a two hour winding down routine before bed – no phone, no TV, just relaxing activities.
2. Keep a regular sleeping pattern, trying as far as possible to go to bed and get up at the same times each day.
3. Exercise during the day. Exercise aids sleep but don’t do it too close to bedtime as it can inhibit the ability to sleep.
4. Avoid caffeine and alcohol as they can really interfere with sleep quality – that goes for tea and green tea too which are caffeine-rich.
5. Get sufficient sleep each night – eight hours are recommended.

This article appeared in the Irish Independent on March 13, 2013.