tag:theconversation.com,2011:/africa/topics/nightmares-29370/articlesNightmares – The Conversation2023-05-26T12:26:57Ztag:theconversation.com,2011:article/2015272023-05-26T12:26:57Z2023-05-26T12:26:57ZA little-understood sleep disorder affects millions and has clear links to dementia – 4 questions answered<figure><img src="https://images.theconversation.com/files/527576/original/file-20230522-6205-s3h5qy.jpg?ixlib=rb-1.1.0&rect=7%2C0%2C5103%2C3410&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Past age 50, men are much more likely to have REM sleep behavior disorder than women.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/caucasian-man-sleeping-royalty-free-image/92305206?phrase=50+year+old+sleeping&adppopup=true">Jose Luis Pelaez/Stone via Getty Images</a></span></figcaption></figure><p><em>A little-known and poorly understood sleep disorder that occurs during the rapid eye movement, or REM, <a href="https://www.cancer.gov/publications/dictionaries/cancer-terms/def/rem-sleep">stage of sleep</a> <a href="https://www.scientificamerican.com/article/acting-out-dreams-predicts-parkinsons-and-other-brain-diseases/">has been garnering attention</a> for its role in foreshadowing neurodegenerative brain diseases such as <a href="https://www.nia.nih.gov/health/parkinsons-disease#">Parkinson’s disease</a> and <a href="https://www.alz.org/alzheimers-dementia/what-is-dementia/types-of-dementia/dementia-with-lewy-bodies">dementia with Lewy bodies</a>. The disorder, known as <a href="https://my.clevelandclinic.org/health/diseases/24465-rem-sleep-behavior-disorder-rbd#">REM sleep behavior disorder</a>, or RBD in the medical field, affects around 1% of the general population worldwide and <a href="https://www.uptodate.com/contents/rapid-eye-movement-sleep-behavior-disorder/print">about 2% of adults over 65</a>.</em> </p>
<p><em>The Conversation talked with <a href="https://uvahealth.com/findadoctor/Anelyssa-D%27Abreu-1891243507">Anelyssa D'Abreu</a>, a neurologist who specializes in geriatric neurology, to explain what researchers know about the condition’s links to dementia.</em></p>
<h2>1. What is REM sleep behavior disorder?</h2>
<p>Every night, you go through four to five sleep cycles. Each cycle, lasting about 90 to 110 minutes, has four stages. That fourth stage is REM sleep. </p>
<p>REM sleep only comprises <a href="https://www.ncbi.nlm.nih.gov/books/NBK526132/#">20% to 25% of total sleep</a>, but its proportion increases throughout the night. During REM sleep, your brain rhythms are similar to when you are awake, your muscles lose tone so you are unable to move, and your eyes, while closed, move quickly. This stage is often accompanied by muscle twitches and fluctuations in your respiratory rate and blood pressure.</p>
<p>But someone with REM sleep behavior disorder will act out their dreams. For reasons that are poorly understood, the dream content is usually violent – patients report being chased, or defending themselves, and as they sleep they shout, moan, scream, kick, punch and thrash about. </p>
<p>Injuries often result from these incidents; patients may fall from bed or accidentally harm a partner. Some 60% of patients and 20% of bed partners of people with this disorder <a href="https://www.uptodate.com/contents/rapid-eye-movement-sleep-behavior-disorder/print">sustain an injury</a> during sleep. </p>
<p>Appropriate testing, including <a href="https://sleepeducation.org/patients/sleep-study/">a sleep study</a>, are needed to determine if a patient has REM sleep behavior disorder, as opposed to another disorder, such as <a href="https://www.ncbi.nlm.nih.gov/books/NBK459252/#">obstructive sleep apnea</a>. This is a disorder in which breathing is interrupted during sleep. </p>
<p>REM sleep behavior disorder can occur at any age, but symptoms usually start with people in their 40s and 50s. For those younger than 40, antidepressants are the most common cause of REM sleep behavior disorder; in these younger patients, it affects biological males and females about equally, but past age 50, it’s more common in biological males.</p>
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<figcaption><span class="caption">If you suspect you have REM sleep behavior disorder, see a sleep specialist or neurologist.</span></figcaption>
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<h2>2. What causes REM sleep behavior disorder?</h2>
<p>The disease mechanism is not well understood. In some cases of REM sleep behavior disorder, a clear cause cannot be identified. In other cases, the disorder may be caused by something specific, such as <a href="https://www.ncbi.nlm.nih.gov/books/NBK459252/#">obstructive sleep apnea</a>, <a href="https://www.mayoclinic.org/diseases-conditions/narcolepsy/symptoms-causes/syc-20375497#">narcolepsy</a>, psychiatric disorders, use of antidepressants, autoimmune disorders and brain lesions, which are areas of damaged brain tissue.</p>
<p>In both situations, REM sleep behavior disorder <a href="https://molecularneurodegeneration.biomedcentral.com/articles/10.1186/s13024-021-00501-z#">may be associated with synucleinopathies</a>, a group of neurodegenerative disorders in which aggregates of the protein α-synuclein accumulate in brain cells. The most common of these neurodegenerative disorders is Parkinson’s disease. Others are <a href="https://www.alz.org/alzheimers-dementia/what-is-dementia/types-of-dementia/dementia-with-lewy-bodies">dementia with Lewy bodies</a>, <a href="https://www.ninds.nih.gov/health-information/disorders/multiple-system-atrophy">multiple system atrophy</a> and <a href="https://doi.org/10.1016%2Fj.mayocp.2019.03.009">pure autonomic failure</a>. REM sleep behavior disorder may precede these diseases or occur at any time during the disease process. </p>
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<figcaption><span class="caption">People with REM sleep behavior disorder can injure themselves – and their bed partners.</span></figcaption>
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<h2>3. What are the links between the sleep disorder and dementia?</h2>
<p>REM sleep behavior disorder may be <a href="https://doi.org/10.1016/j.nbd.2020.104996">the first symptom of Parkinson’s disease or dementia with Lewy bodies</a>. It is observed in 25% to 58% of patients diagnosed with Parkinson’s, 70% to 80% of patients with dementia with Lewy bodies and 90% to 100% of those with <a href="https://www.nhs.uk/conditions/multiple-system-atrophy/#">multiple system atrophy</a>.</p>
<p>In a long-term study of 1,280 patients with REM sleep behavior disorder who didn’t have <a href="https://my.clevelandclinic.org/health/diseases/22815-parkinsonism#">parkinsonism</a> – an umbrella term that refers to brain conditions, including Parkinson’s disease, that cause slowed movements, stiffness and tremors – or dementia, researchers followed participants to find out how many would develop these disorders. After 12 years, 73.5% of those with REM sleep behavior disorder had developed a <a href="https://doi.org/10.1093/brain/awz030">related neurodegenerative disorder</a>.</p>
<p>Some of the factors that independently increased the risk of developing a neurodegenerative disorder were the presence of irregular motor symptoms, abnormal dopamine levels, loss of sense of smell, cognitive impairment, abnormal color vision, erectile dysfunction, constipation and older age.</p>
<p>REM sleep behavior disorder may also be observed in other neurodegenerative disorders such as Alzheimer’s disease and Huntington’s disease, but at much lower rates. The association is also not as strong as that observed in the synucleinopathies.</p>
<h2>4. Does an early diagnosis help?</h2>
<p>For most neurodegenerative disorders, there is a phase that may last for decades in which brain changes are taking place but the patient either remains asymptomatic or develops symptoms without the full expression of the disease. RBD, in that scenario, is an early sign of those disorders. This provides an opportunity to study how the disease progresses in the brain and to develop therapies that could either slow this process or prevent it from happening. </p>
<p>At this time, there are no approved therapies to prevent the onset of these neurodegenerative diseases in those with REM sleep behavior disorder. There are, however, medications such as melatonin and clonazepam that may improve the symptoms. We also recommend measures to avoid injury, such as removing breakable objects from the room, protecting windows and padding floors. </p>
<p>Patients who are affected by REM sleep behavior disorder may choose to participate in research. Proper treatment of the disease can help prevent injury and improve quality of life.</p><img src="https://counter.theconversation.com/content/201527/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anelyssa D'Abreu receives funding from ARDRAF </span></em></p>REM sleep behavior disorder is characterized by acting out dreams, which may include shouting, kicking and punching during sleep.Anelyssa D'Abreu, Associate Professor of Neurology, University of VirginiaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2050782023-05-11T16:14:30Z2023-05-11T16:14:30ZSleep paralysis: why modern horror is fascinated by old superstitions of troubled slumbers<figure><img src="https://images.theconversation.com/files/524490/original/file-20230504-25-zxnqo8.png?ixlib=rb-1.1.0&rect=1%2C0%2C1230%2C971&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The Nightmare by John Henry Fuselli, 1781.</span> <span class="attribution"><a class="source" href="https://en.wikipedia.org/wiki/The_Nightmare#/media/File:John_Henry_Fuseli_-_The_NightmareFXD.jpg">Wikepedia</a></span></figcaption></figure><p>You wake up in the middle of the night. The room is dark except for the faint glow of the moon through your window. But something’s wrong. A weight presses down on your limbs, digs deep into the flesh of your stomach, and squeezes the air from your lungs. You try to move, but you can’t – all you can do is tentatively open your eyes.</p>
<p>A shadow of twisted, gangly limbs writhes above you. A looming head moves closer to your face. And just as your paralysing terror threatens to burst you open, the monster retreats and you regain control over your limbs. You wake up. It was just a dream. Hopefully.</p>
<p>This is what it feels like to suffer from sleep paralysis, which is termed a <a href="https://royalpapworth.nhs.uk/our-services/respiratory-services/rssc/patient-information/symptoms/odd-behaviour-night">parasomnia</a>, and characterised by the sensation of a crushing weight accompanied by hallucinations of a malevolent presence. We now know that it has a scientific explanation: paralysis is a natural part of sleeping that wears off before morning, but some of us wake up while it’s still in effect.</p>
<p>The history of the phenomenon, however, is one of suspicion and witchcraft. While our modern superstitions have dwindled, <a href="https://www.nhs.uk/conditions/sleep-paralysis/#:%7E:text=Sleep%20paralysis%20happens%20when%20you,insomnia">sleep paralysis</a> is having a renewed grip on our imagination through a trend in recent horror movies.</p>
<h2>Hag-ridden</h2>
<p>Until <a href="https://www.history.com/topics/renaissance/renaissance">the Renaissance</a> promoted scientific evidence over religious superstition, it was commonly believed that troubled sleep was caused by malevolent witches. Many of the old names for sleep paralysis align with this idea: being “hag-ridden”, for instance, or of being attacked by a bewitched horse known as the “<a href="https://www.scarystudies.com/mare-demon-mythology/">mara</a>”, from which we get the term “nightmare”.</p>
<p>As such, bedroom rituals were as much about defending against witches as they were about winding down for sleep. People would wear necklaces of coral, or hang a fossil known as a <a href="https://www.bgs.ac.uk/discovering-geology/fossils-and-geological-time/belemnites/">belemnite</a> over their beds, to protect them from being crushed by witches in their sleep. Stables, too, were adorned with talismans to guard horses from being possessed by witches intent on using them to trample sleeping victims.</p>
<p>It has been 330 years since the infamous <a href="https://salem.lib.virginia.edu/home.html">Salem witch trials</a>, where 19 people were hanged on suspicion of being in league with the Devil. More than 200 accusations were made, and the court records are now digitised and held with the Virginia library.</p>
<p>When writing my book, <a href="https://www.amazon.co.uk/Night-Terrors-Troubled-Sleep-Stories/dp/1785787934/ref=tmm_hrd_swatch_0?_encoding=UTF8&qid=&sr=">Night Terrors</a>, I accessed these papers, and recognised that many of the accusations described encounters with “witches” aligned to prevalent ideas of the cause of sleep paralysis. In the <a href="https://salem.lib.virginia.edu/n13.html#n13.13">testimony of Richard Coman</a> against Bridget Bishop on 2 June 1692 , he describes Bishop opening the curtains at the foot of the bed, and lying upon his body and crushing him so that he could not speak or move. Bishop was the first to be executed.</p>
<p>During the time of the Salem witch trials, however, a more rational explanation was being discussed in terms of scientific discovery that situated sleep paralysis firmly within the body of the sufferer. Belief in witchcraft, at least in terms of troubled sleep, started to dwindle.</p>
<h2>Sleep paralysis in film</h2>
<p>There seems to be renewed interest in witch-trial superstitions in modern horror films. Recently, a variety of protagonists face monsters and demons while in that most vulnerable of spaces: the bed. In the 2014 film <a href="https://www.theguardian.com/film/2014/oct/23/the-babadook-review-chilling-freudian-thriller">The Babadook</a>, directed by Jennifer Kent, Amelia (Essie Davis) watches in paralysed horror as the film’s titular monster skitters across her bedroom ceiling. Her mouth is agape in a silent scream as the Babadook drops like a spider on top of her.</p>
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<p>Similarly, in <a href="https://www.theguardian.com/film/2021/oct/31/last-night-in-soho-edgar-wright-review">Last Night in Soho</a>, Thomasin McKenzie’s protagonist, Eloise, becomes pinned to her bed by the ghostly hands of murdered men. Other films are even using sleep paralysis as the monster, such as <a href="https://www.theguardian.com/film/2015/oct/08/the-nightmare-review-sleep-paralysis">The Nightmare</a>, a horror documentary depicting the parasomnia, and Andy James Taylor’s short film, <a href="https://www.youtube.com/watch?v=4h4fKtEQ8K0">The Nocnitsa</a> in which a young woman is haunted by a shadowy presence creeping up her bed while unable to move.</p>
<p>It’s becoming increasingly noticeable – and there are a few reasons to explain the trend. Each presentation of sleep paralysis in film confuses the boundary between the hero and the “hag”, with the latter often being a product of the imagination and representing psychological turmoil.</p>
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<p>In other words, the protagonist’s emotional troubles are made manifest through their sleep paralysis demons. Another factor is that it brings the monster of classic horror films into a much more personal and domestic space. It presents the idea that the villains we face in our sleep are of our own making.</p>
<p>Perhaps the most prevalent reason, though, is that sleep is now over-analysed and too firmly rooted in neuroscience and discussions of sleep “habits” and “hygiene”. Cultural discussions of sleep have moved so far away from the creepy and the mysterious that it is now the role of horror films to remind us of the grip that troubled sleep used to have on our imaginations.</p>
<p>Sleep is now scrutinised under a harsh clinical light – but horror stories are increasingly restoring a more historic sense of darkness.</p><img src="https://counter.theconversation.com/content/205078/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Alice Vernon does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A raft of horror films remind us of the grip troubled sleep once had on our imaginations.Alice Vernon, Lecturer in Creative Writing and 19th-Century Literature, Aberystwyth UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1998222023-02-27T06:08:40Z2023-02-27T06:08:40ZBad dreams in children linked to a higher risk of dementia and Parkinson’s disease in adulthood – new study<figure><img src="https://images.theconversation.com/files/510869/original/file-20230217-328-czjqb3.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C6240%2C4156&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/scared-african-american-boy-embracing-bear-2081792098">Pressmaster/Shutterstock</a></span></figcaption></figure><p>Can children’s dreams foretell events that will happen nearly 40 years into the future? Yes, according to the results of my latest study published in The Lancet’s <a href="https://doi.org/10.1016/j.eclinm.2023.101872">eClinicalMedicine</a> journal.</p>
<p>More specifically, it showed that children who experience regular bad dreams and nightmares between the ages of seven and 11, may be nearly twice as likely to develop cognitive impairment (the core feature of <a href="https://www.nhs.uk/conditions/dementia/symptoms/">dementia</a>) by the time they reach age 50. And they may be up to seven times more likely to be diagnosed with <a href="https://www.nhs.uk/conditions/parkinsons-disease/">Parkinson’s disease</a> by age 50.</p>
<p>For some background to these startling findings, in 2022 I discovered that middle-aged and older adults who experience frequent bad dreams and nightmares could be more than twice as likely to develop <a href="https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(22)00370-4/fulltext">dementia</a> or <a href="https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(22)00204-8/fulltext">Parkinson’s</a> in the future. </p>
<p>Given that a large proportion of people who experience regular nightmares as adults also report having had regular nightmares <a href="https://ajp.psychiatryonline.org/doi/10.1176/ajp.137.10.1197?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed">when they were children</a>, this made me wonder whether having lots of bad dreams during childhood might predict the development of dementia or Parkinson’s disease later in life.</p>
<p>To find out, I used data from the well-known <a href="https://en.wikipedia.org/wiki/National_Child_Development_Study">1958 British birth cohort study</a>, which follows the lives of all children born in England, Scotland and Wales during the week of March 3–9, 1958. </p>
<p>When the children were aged seven (1965) and 11 (1969), their mothers answered a range of questions about their health, including whether they had experienced bad dreams in the previous three months (yes/no).</p>
<p>I grouped the 6,991 children based on how regularly they experienced bad dreams at ages seven and 11: “never”, “occasional”, or “persistent”. I then used statistical software to determine whether the children with more regular bad dreams were more likely to develop cognitive impairment or be diagnosed with Parkinson’s by the time they turned 50 (2008).</p>
<p>The results were clear. The more regularly the children experienced bad dreams, the more likely they were to develop cognitive impairment or be diagnosed with Parkinson’s disease.</p>
<p>Remarkably, compared with children who never had bad dreams, those who had persistent bad dreams were 76% more likely to develop cognitive impairment and were 640% more likely to develop Parkinson’s. This pattern was similar for both boys and girls.</p>
<p>These results suggest that having regular bad dreams and nightmares during childhood may increase the risk of developing progressive brain diseases like dementia or Parkinson’s disease later in life. They also raise the intriguing possibility that reducing bad dream frequency during early life could be an early opportunity to prevent both conditions. </p>
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<p>Further studies will be needed to confirm whether bad dreams and nightmares truly cause these conditions. </p>
<p>The frequency with which we experience nightmares as children is to a large degree determined by our <a href="https://onlinelibrary.wiley.com/doi/10.1002/(SICI)1096-8628(19990820)88:4%3C329::AID-AJMG8%3E3.0.CO;2-E">genetics</a>. And one gene known to increase our risk of having regular nightmares (<a href="https://www.biorxiv.org/content/10.1101/836452v1">PTPRJ</a>) is also linked to increased risk of developing <a href="https://www.nature.com/articles/s41398-021-01677-0">Alzheimer’s disease</a> in old age. So it’s possible that nightmares and progressive brain diseases are both caused by a shared set of genes.</p>
<p>My hunch is that both theories could be true. That is, nightmares and progressive brain diseases are linked by shared genetics, as well as through nightmares directly causing brain diseases by disrupting the <a href="https://pubmed.ncbi.nlm.nih.gov/24199995/">brain-restoring elements of sleep</a>.</p>
<h2>Don’t be alarmed</h2>
<p>Although these findings sound alarming, put in their proper context, they shouldn’t be. Of the roughly 7,000 children included in my study, only 268 (4%) had persistent bad dreams according to their mothers. Among these children, only 17 had developed cognitive impairment or Parkinson’s disease by age 50 (6%). </p>
<p>So it is likely that the vast majority of people who have persistent bad dreams in childhood are not going to develop early-onset dementia or Parkinson’s.</p>
<p>However, the risk of developing progressive brain diseases increases substantially in old age. Being aware that bad dreams in childhood may signal a higher risk of dementia or Parkinson’s later in life suggests that there could be a window of opportunity to implement <a href="https://www.nhs.uk/conditions/dementia/dementia-prevention/">simple strategies</a> to lower those risks. And for young people with frequent distressing dreams that persist over time, <a href="https://www.mayoclinic.org/diseases-conditions/nightmare-disorder/diagnosis-treatment/drc-20353520">getting help for nightmares</a> might be one such strategy.</p>
<p>The next step for my research is to use <a href="https://en.wikipedia.org/wiki/Electroencephalography">electroencephalography</a> (a technique to measure brainwaves) to look at the biological reasons for bad dreams and nightmares in children. </p>
<p>In the longer term, the aim will be to use this knowledge to develop new treatments for all people troubled by bad dreams and nightmares. The ultimate goal is to improve their <a href="https://www.sciencedirect.com/science/article/abs/pii/S0165032722012447">sleep quality and mental health</a> and reduce their chance of developing dementia or Parkinson’s disease later in life.</p><img src="https://counter.theconversation.com/content/199822/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Abidemi Otaiku does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Children who had persistent bad dreams were over six times more likely to develop Parkinson’s disease than children who never had bad dreams.Abidemi Otaiku, NIHR Academic Clinical Fellow in Neurology, University of BirminghamLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1983662023-01-23T21:15:26Z2023-01-23T21:15:26ZHorror and anguish are playing out on repeat following the latest mass shooting – and the mental health scars extend far beyond those directly affected<figure><img src="https://images.theconversation.com/files/505949/original/file-20230123-7861-4i7gf6.jpg?ixlib=rb-1.1.0&rect=26%2C142%2C5909%2C3737&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The mass shooting at a dance studio in Monterey Park, Calif., is the latest in an endless string of gun violence tragedies.
</span> <span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/CaliforniaShooting/adecd28f335647b9a565166a7d3e540f/photo?Query=monterey%20park%20shooting&mediaType=photo&sortBy=&dateRange=Anytime&totalCount=79&currentItemNo=36">AP Photo/Jae C. Hong</a></span></figcaption></figure><p>Yet another <a href="https://ktla.com/news/local-news/monterey-park-shooting/suspect-dead-2/">community is stricken with grief</a> in the wake of the horrific shooting at Monterey Park, California, on Jan. 21, 2023, that left <a href="https://www.washingtonpost.com/nation/2023/01/23/monterey-park-mass-shooting/">11 people dead and 9 more wounded</a>. Families and friends of the victims, as well as those who were injured, are no doubt gripped with grief, anguish and despair. </p>
<p>In addition to those who are experiencing direct loss, such events also take a toll on others, including those who witnessed the shooting, first responders, people who were nearby and those who hear about it through the media.</p>
<p>I am a <a href="https://scholar.google.com/citations?user=UDytFmIAAAAJ&hl=en">trauma and anxiety researcher and clinician</a>, and I know that the effects of such violence reach millions. While the immediate survivors are most affected, the rest of society suffers, too.</p>
<h2>First, the immediate survivors</h2>
<p>It is important to understand that no two people experience such horrific exposure in the same way. The extent of the trauma, stress or fear can vary. Survivors of a shooting may want to avoid the neighborhood where the shooting occurred or the context related to shooting, such as grocery stores, if the shooting happened at one. In the worst case, a survivor may develop post-traumatic stress disorder. </p>
<p>PTSD is a debilitating condition that develops after exposure to serious traumatic experiences such as war, natural disasters, rape, assault, robbery, car accidents – and, of course, gun violence. Nearly 8% of the <a href="https://www.ptsd.va.gov/understand/what/ptsd_basics.asp">U.S. population deals with PTSD</a>. <a href="https://www.ptsd.va.gov/professional/treat/essentials/dsm5_ptsd.asp">Symptoms include</a> high anxiety, avoidance of reminders of the trauma, emotional numbness, hypervigilance, frequent intrusive memories of trauma, nightmares and flashbacks. The brain switches to fight-or-flight mode, or survival mode, and the person is always waiting for something terrible to happen. </p>
<p>When the trauma is caused by people, as in a mass shooting, the impact can be profound. The rate of PTSD in mass shootings may be as high as <a href="https://doi.org/10.1176/ajp.151.1.82">36% among survivors</a>. Depression, another debilitating psychiatric condition, occurs in as many as <a href="https://theconversation.com/syrian-refugees-in-america-the-forgotten-psychological-wounds-of-the-stress-of-migration-96155">80% of people with PTSD</a>.</p>
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<a href="https://images.theconversation.com/files/505951/original/file-20230123-24-5g23yh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Two women embrace each other, one with a tear-stained face, at a daytime gathering to honor the victims killed in the ballroom dance studio shooting in Monterey Park, California." src="https://images.theconversation.com/files/505951/original/file-20230123-24-5g23yh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/505951/original/file-20230123-24-5g23yh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/505951/original/file-20230123-24-5g23yh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/505951/original/file-20230123-24-5g23yh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/505951/original/file-20230123-24-5g23yh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/505951/original/file-20230123-24-5g23yh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/505951/original/file-20230123-24-5g23yh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Jolie Slater, right, and Beth Paz, from Lake Avenue Church, embrace each other at a gathering held to honor the victims killed in the Jan. 21, 2023, ballroom dance studio shooting in Monterey Park, Calif.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/CaliforniaShooting/7027b43e6ead4afa93ae360e3de6f86e/photo?Query=monterey%20park%20shooting&mediaType=photo&sortBy=&dateRange=Anytime&totalCount=79&currentItemNo=11">AP Photo/Jae C. Hong</a></span>
</figcaption>
</figure>
<p>Survivors of shootings may also experience <a href="https://www.ptsd.va.gov/understand/types/mass_violence_help.asp">survivor’s guilt</a>, the feeling that they failed others who died or did not do enough to help them, or just guilt at having survived. </p>
<p>PTSD can improve by itself, but many people need treatment. There are effective treatments available in the form of psychotherapy and medications. The more chronic it gets, the more negative the impact on the brain, and the harder to treat.</p>
<p>Children and adolescents, who are developing their worldview and deciding how safe it is to live in this society, may suffer even more. Exposure to horrific experiences such as school shootings or related news can fundamentally affect the way people perceive the world as a safe or unsafe place, and how much they can rely on the adults and society in general to protect them. </p>
<p>They can carry such a worldview for the rest of their lives, and even transfer it to their children. Research is also abundant on the <a href="https://theconversation.com/howard-stern-talks-childhood-trauma-and-a-trauma-psychiatrist-talks-about-its-lasting-effects-118027">long-term detrimental impact</a> of such childhood trauma on a person’s <a href="https://www.childwelfare.gov/pubpdfs/long_term_consequences.pdf">mental and physical health</a> and their ability to function through their adult life.</p>
<h2>The effect on those close by, or arriving later</h2>
<p>PTSD can develop not only through personal exposure to trauma, but also via exposure to others’ severe trauma. Humans have survived as a species particularly because of the ability to fear as a group. That means we <a href="https://theconversation.com/the-science-of-fright-why-we-love-to-be-scared-85885">learn fear and experience terror through exposure</a> to the trauma and fear of others. Even seeing a frightened face in black and white on a computer will make our <a href="https://doi.org/10.3389/fnbeh.2015.00154">amygdala</a>, the fear area of our brain, light up in brain imaging studies. </p>
<p>People in the vicinity of a mass shooting may see exposed, disfigured, burned or dead bodies. They may also see injured people in agony, hear extremely loud noises and experience chaos and terror in the post-shooting environment. They must also face the unknown, or a sense of lack of control over the situation. The fear of the unknown plays an important role in making people feel insecure, terrified and traumatized. </p>
<p>A group whose chronic exposure to such trauma is usually overlooked is the first responders. While victims and potential victims try to run away from an active shooter, <a href="https://theconversation.com/the-aching-blue-trauma-stress-and-invisible-wounds-of-those-in-law-enforcement-146539">the police</a>, <a href="https://theconversation.com/the-aching-red-firefighters-often-silently-suffer-from-trauma-and-job-related-stress-164994">firefighters</a> and paramedics rush into the danger zone. </p>
<p>Many of these first responders might have their own children in that school or nearby. They frequently face uncertainty; threats to themselves, their colleagues and others; and terrible bloody post-shooting scenes. This exposure happens to them too frequently. PTSD has been reported in up to <a href="https://doi.org/10.1016/j.psychres.2015.06.015">20% of first responders</a> to mass violence. </p>
<h2>Widespread panic and pain</h2>
<p>People who were not directly exposed to a disaster but who were <a href="https://doi.org/10.3402/ejpt.v3i0.19709">exposed to the news</a> also experience distress, anxiety or even PTSD. This happened <a href="https://doi.org/10.1001/jama.288.5.581">after 9/11</a>. Fear, the coming unknown – is there another strike? are other co-conspirators involved? – and reduced faith in perceived safety may all play a role in this. </p>
<p>Repeated media exposure to the circumstances surrounding a tragic event, including images of the aftermath of a shooting, can be highly stressful to survivors, those who lost loved ones and to first responders. In my clinic, I hear from affected people that repeatedly seeing the event on the news, as well as having others ask them about their experiences, can bring painful memories to the surface. Some first responders I’ve worked with try to hide their occupation from others to prevent being asked about such events.</p>
<p>Every time there is a mass shooting in a new place, people learn that kind of place is now on the not-very-safe list. People worry not only about themselves but also about the safety of their children and other loved ones.</p>
<h2>Is there any good to come of such tragedy?</h2>
<p>We can channel the collective agony and frustration to encourage meaningful changes, such as making gun laws safer, opening constructive discussions, informing the public about the risks and calling on lawmakers to take real action. In times of hardship, humans often can raise the sense of community, support one another and fight for their rights, including the right to be safe at schools, concerts, restaurants and movie theaters.</p>
<p>One beautiful outcome of the tragic shooting at the Tree of Life synagogue in October 2018 was the solidarity of the <a href="https://www.washingtonpost.com/lifestyle/2018/10/28/respond-evil-with-good-muslim-community-raises-money-victims-synagogue-shooting/">Muslim community with the Jewish</a>. This is especially productive in the <a href="https://theconversation.com/the-politics-of-fear-how-it-manipulates-us-to-tribalism-113815">current political environment</a>, with fear and division being so common.</p>
<p>Sadness, anxiety, anger and frustration can be channeled into actions such as becoming involved in activism and volunteering to help the victims. It is also important not to spend too much time watching television coverage; turn it off when it stresses you too much.</p>
<p>Finally, studies have shown that exposure to media coverage for several hours daily following a collective trauma <a href="https://doi.org/10.1073/pnas.1316265110">can lead to high stress</a>. So check the news a couple of times a day to be informed, but don’t continue seeking out coverage <a href="https://theconversation.com/how-to-protect-your-family-from-horrific-news-images-and-still-stay-informed-181818">and exposure to graphic images and news</a>. The news cycle tends to report the same stories without much additional information.</p>
<p>_Editor’s Note: This is an updated version of an article originally published on <a href="https://theconversation.com/mass-shootings-leave-emotional-and-mental-scars-on-survivors-first-responders-and-millions-of-others-157935">March 26, 2021</a>. It was updated with the news of an 11th death on Jan. 23, 2023.</p><img src="https://counter.theconversation.com/content/198366/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Arash Javanbakht does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Even people who are only indirectly exposed to these repeat tragedies, such as first responders and those affected by media coverage, can experience profound and long-lasting grief.Arash Javanbakht, Associate Professor of Psychiatry, Wayne State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1933552022-10-28T15:14:40Z2022-10-28T15:14:40ZDracula at 125: how Bram Stoker’s vampire is a monstrous creation of terrifying sleep disorders<p>Having celebrated the 125th anniversary of its 1897 publication earlier this year, <a href="https://www.theguardian.com/books/2012/jun/24/dracula-stoker-review-colm-toibin#:%7E:text=The%20%22rather%20cruel%2Dlooking%22,how%20events%20twist%20and%20turn%22.">Dracula</a> is deservedly considered a classic – not least for the way its eponymous vampire remains a cultural icon. Bram Stoker’s novel has prompted a wide variety of critical interpretations, from the existential dread of cursed immortality to the threat of disease, intrusion and colonialism.</p>
<p>But Stoker’s vampire represents something else that has gone relatively unexplored: he is a monstrous personification of sleep disorders known as <a href="https://www.sleepfoundation.org/parasomnias">parasomnias</a>. These involve hallucinations, dreams and involuntary movement, and include phenomena such as sleepwalking, nightmares and <a href="https://www.nhs.uk/conditions/sleep-paralysis/#:%7E:text=Sleep%20paralysis%20happens%20when%20you,insomnia">sleep paralysis</a> (when you cannot move your muscles as you are waking up or falling asleep). </p>
<p>I have slept strangely ever since I was a child. I used to sleepwalk and hide my teddies around the house, or eerily stand in the corner of my parents’ bedroom. As a teenager, I began to have recurring nightmares about a malevolent figure in my life, and started to hallucinate, have bizarre <a href="https://www.sleepfoundation.org/dreams/lucid-dreams">lucid dreams</a> and experience sleep paralysis.</p>
<p>I often wake up to sinister shadows looming down at me. A few years ago, I saw a woman every night for a week, and each time she appeared she got closer to my bed. For a long time, I thought no one else experienced these things. I didn’t even know the phenomena had a name. There were times that I wondered if I was being haunted. </p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/fokdvaYR220?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
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<p>My work investigates representations of insomnia in literature. Reading about the science of sleep, I was astounded to find descriptions of the peculiar things that often happened to me at night. I learned about the natural paralysis of the body during sleep, and the way the brain can create <a href="https://www.sleepfoundation.org/how-sleep-works/hypnopompic-hallucinations#:%7E:text=Hypnopompic%20hallucinations%20occur%20while%20a,of%20these%20hallucinations%20involve%20sound.">“hypnopompic” hallucinations</a> when half-awake.</p>
<p>Crucially, I learned how common parasomnias were, and that I wasn’t so strange after all. But for all I now understand the scientific explanations, I am often momentarily drawn into the delusion that I <em>really</em> am seeing a ghost in my bedroom.</p>
<p>As I examined sleep-related passages in Dracula while researching my non-fiction book, <a href="https://www.thetimes.co.uk/article/night-terrors-why-we-have-nightmares-and-how-to-stop-them-nfh0hdc5q">Night Terrors: Troubled Sleep And The Stories We Tell About It</a>, I returned to Stoker’s novel with a different perspective, and what I found has changed the way I feel about it. Dracula’s power is not in his fangs, but in the way he disturbs the sleep of his victims.</p>
<h2>Unnatural sleep</h2>
<p>At the beginning of the novel, for example, Dracula claims his first victim, Lucy Westenra. The initial sign that she is under the vampire’s influence is her sudden habit of sleepwalking across the cliffs of Whitby. </p>
<p>It is through the character of Mina Harker, however, that Stoker really delves into the stranger side of sleep. “Tonight,” she writes in her journal, “I shall strive hard to sleep naturally.” Unfortunately, for Mina, it will be a long time before that happens.</p>
<p>As Dracula begins to attack her, she suffers nearly every parasomnia: she talks in her sleep, sees strange hallucinations and, notably, experiences Dracula’s power in the form of sleep paralysis. Seeing the vampire move towards her in the form of mist, she describes in her journal that “some leaden lethargy seemed to chain my limbs”.</p>
<p>For those of us unlucky enough to experience this parasomnia, too, Stoker’s description feels remarkably accurate. You feel pinned down, unable to move, and, worse still, you hallucinate a sinister presence sitting on top of you. When I have sleep paralysis, I often feel hands grasping my arms and neck, disembodied fingers tangling themselves in my hair. I’ve even been convinced of hands dragging me down the mattress by my ankles, only to wake and find I haven’t moved.</p>
<figure class="align-center ">
<img alt="A 18th-century painting of a woman in a deep sleep, arms thrown wide, with a demon sitting on her chest." src="https://images.theconversation.com/files/492317/original/file-20221028-40947-h8jsdc.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/492317/original/file-20221028-40947-h8jsdc.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=473&fit=crop&dpr=1 600w, https://images.theconversation.com/files/492317/original/file-20221028-40947-h8jsdc.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=473&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/492317/original/file-20221028-40947-h8jsdc.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=473&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/492317/original/file-20221028-40947-h8jsdc.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=595&fit=crop&dpr=1 754w, https://images.theconversation.com/files/492317/original/file-20221028-40947-h8jsdc.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=595&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/492317/original/file-20221028-40947-h8jsdc.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=595&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">The Nightmare by John Henry Fuseli, 1781.</span>
<span class="attribution"><a class="source" href="https://upload.wikimedia.org/wikipedia/commons/5/56/John_Henry_Fuseli_-_The_Nightmare.JPG">Detroit Institute of Arts / Wikipedia</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<h2>Stoker and the Society for Psychical Research</h2>
<p>It’s clear, then, that there are obvious parallels between Stoker’s vampire and the symptoms of parasomnias. But why was he so fascinated by troubled sleep?</p>
<p>The answer may lie with a London-based paranormal society that was formed in 1882. <a href="https://www.spr.ac.uk/">The Society for Psychical Research</a> (SPR), which still meets today, investigated strange phenomena such as ghosts, telekinesis and mind-reading through experiments. Its members were keen to explain as much as they could through physical and scientific fact, in order to gather cases of truly inexplicable experiences.</p>
<p>In doing so, the SPR was at the forefront of certain areas of research – notably, sleep disorders. One of its founding members was Frederic Myers, a good friend of Bram Stoker who was known to visit Myers’ house for breakfast. While there’s no evidence of Stoker attending any SPR meetings, it’s not too wild to speculate that at these breakfasts, conversation would have turned to Myers’ involvement in the society.</p>
<p>What’s particularly illuminating is the similarity between certain aspects of Dracula and a major project, the <a href="https://archivesearch.lib.cam.ac.uk/repositories/2/archival_objects/630399">Census of Hallucinations</a>, undertaken by the society just before its publication. The SPR asked the general public if they had ever experienced a hallucination, and to describe what they had seen.</p>
<p>The results were compiled in the 1894 edition of their journal, <a href="https://archive.org/details/proceedingsofsoc10soci/page/n5/mode/2up">Proceedings of the Society for Psychical Research</a>, just three years before Dracula was published. One particular anecdote stands out as a possible influence on Stoker. A “Miss HT” describes seeing a figure in her bedroom on three occasions that “took the form of mist and then developed into a dark veiled figure, which came nearer to me”.</p>
<p>In Dracula, Mina describes a similar mist seeping into her room and forming the outline of a man before she experiences sleep paralysis. Again and again, the census anecdotes feature monsters, skeletons, beautiful women decaying into worm-eaten corpses – truly the stuff of horror novels.</p>
<p>With this research being undertaken around Stoker while he wrote Dracula, it’s no wonder that he chose to imbue his immortal vampire with the power to disturb sleep. It’s estimated that around <a href="https://doi.org/10.1016/j.sleep.2010.07.011">70% of us will suffer a parasomnia</a> at some point in our lives. </p>
<p>Dracula may be one of the most famous novels about the supernatural, but the vampire himself embodies phenomena you may well experience when you go to sleep tonight.</p><img src="https://counter.theconversation.com/content/193355/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Alice Vernon does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Dracula’s power is not in his fangs, but in the way he disturbs the sleep of his victims.Alice Vernon, Lecturer in Creative Writing and 19th-Century Literature, Aberystwyth UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1910162022-09-21T09:53:37Z2022-09-21T09:53:37ZNightmares are a good predictor of future dementia – new study<figure><img src="https://images.theconversation.com/files/485838/original/file-20220921-12-pif4y0.jpg?ixlib=rb-1.1.0&rect=9%2C0%2C6081%2C3990&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/only-entertainment-498711334">Ollyy/Shutterstock</a></span></figcaption></figure><p>We spend a third of our lives asleep. And a quarter of our time asleep is spent dreaming. So, for the average person alive in 2022, with a life expectancy of around <a href="https://www.who.int/data/gho/data/themes/mortality-and-global-health-estimates/ghe-life-expectancy-and-healthy-life-expectancy">73</a>, that clocks in at just over six years of dreaming. </p>
<p>Yet, given the central role that dreaming plays in our lives, we still know so little about why we dream, how the brain creates dreams, and importantly, what the significance of our dreams might be for our health – especially the health of our brains.</p>
<p>My latest study, published in The Lancet’s <a href="https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(22)00370-4/fulltext">eClinicalMedicine journal</a>, shows that our dreams can reveal a surprising amount of information about our brain health. More specifically, it shows that having frequent bad dreams and nightmares (bad dreams that make you wake up) during middle or older age, may be linked with an increased risk of developing <a href="https://www.nhs.uk/conditions/dementia/symptoms/">dementia</a>.</p>
<p>In the study, I analysed data from three large US studies of health and ageing. These included over 600 people aged between 35 and 64, and 2,600 people aged 79 and older. </p>
<p>All the participants were dementia-free at the start of the study and were followed for an average of nine years for the middle-aged group and five years for the older participants.</p>
<p>At the beginning of the study (2002-12), the participants completed a range of questionnaires, including one which asked about how often they experienced bad dreams and nightmares.</p>
<p>I analysed the data to find out whether participants with a higher frequency of nightmares at the beginning of the study were more likely to go on to experience cognitive decline (a fast decline in memory and thinking skills over time) and be diagnosed with dementia.</p>
<h2>Weekly nightmares</h2>
<p>I found that middle-aged participants who experienced nightmares every week, were four times more likely to experience cognitive decline (<a href="https://alz-journals.onlinelibrary.wiley.com/doi/10.1002/alz.12704">a precursor to dementia)</a> over the following decade, while the older participants were twice as likely to be diagnosed with dementia.</p>
<p>Interestingly, the connection between nightmares and future dementia was much stronger for men than for women. For example, older men who had nightmares every week were five times more likely to develop dementia compared with older men reporting no bad dreams. In women, however, the increase in risk was only 41%. I found a very similar pattern in the middle-aged group.</p>
<figure class="align-center ">
<img alt="Older adult with dementia" src="https://images.theconversation.com/files/485843/original/file-20220921-27-5x8mr9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/485843/original/file-20220921-27-5x8mr9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/485843/original/file-20220921-27-5x8mr9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/485843/original/file-20220921-27-5x8mr9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/485843/original/file-20220921-27-5x8mr9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/485843/original/file-20220921-27-5x8mr9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/485843/original/file-20220921-27-5x8mr9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The link between nightmares and later dementia was much stronger in men than in women.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/retired-couple-holding-hands-looking-each-1272275779">LightField Studios/Shutterstock</a></span>
</figcaption>
</figure>
<p>Overall, these results suggest frequent nightmares may be one of the earliest signs of dementia, which can precede the development of memory and thinking problems by several years or even decades – especially in men. </p>
<p>Alternatively, it is also possible that having regular bad dreams and nightmares might even be a cause of dementia.</p>
<p>Given the nature of this study, it is not possible to be certain which of these theories is correct (though I suspect it is the former). However, regardless of which theory turns out to be true – the major implication of the study remains the same, that is, that having regular bad dreams and nightmares during middle and older age may be linked to an increased risk of developing dementia later in life. </p>
<p>The good news is that recurring nightmares are <a href="https://jcsm.aasm.org/doi/10.5664/jcsm.7178">treatable</a>. And the first-line medical treatment for nightmares has already been shown to decrease the build-up of <a href="https://www.sciencedirect.com/science/article/pii/S0197458012004666?via%3Dihub">abnormal proteins</a> linked to <a href="https://en.wikipedia.org/wiki/Alzheimer%27s_disease">Alzheimer’s disease</a>. There have also been <a href="https://www.frontiersin.org/articles/10.3389/fpsyt.2022.803220/full">case reports</a> showing improvements in memory and thinking skills after treating nightmares.</p>
<p>These findings suggest that treating nightmares might help to slow cognitive decline and to prevent dementia from developing in some people. This will be an important avenue to explore in future research.</p>
<p>The next steps for my research will include investigating whether nightmares in young people might also be linked to increased dementia risk. This could help to determine whether nightmares cause dementia, or whether they are simply an early sign in some people. I also plan to investigate whether other dream characteristics, such as how often we remember our dreams and how vivid they are, might also help to determine how likely people are to develop dementia in the future.</p>
<p>This research might not only help to shed light on the relationship between dementia and dreaming, and provide new opportunities for earlier diagnoses – and possibly <a href="https://www.thelancet.com/article/S0140-6736(20)30367-6/fulltext">earlier interventions</a> – but it may also shed new light on the nature and function of the mysterious phenomenon that we call <a href="https://health.clevelandclinic.org/why-do-we-dream/">dreaming</a>.</p><img src="https://counter.theconversation.com/content/191016/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Abidemi Otaiku does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>New study finds that middle-aged people who had nightmares every week, are four times more likely to experience cognitive decline.Abidemi Otaiku, NIHR Academic Clinical Fellow in Neurology, University of BirminghamLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1884982022-08-12T15:21:57Z2022-08-12T15:21:57ZThe Sandman: how representations of dreams and nightmares have changed over time<p>As Netflix’s new series, The Sandman, notes, we spend a third of our lives in sleep and dream. In popular culture, The Sandman is a folkloric being who helps us drift off to the land of nod where he controls whether we have nightmares or dreams. He is also the centre of Neil Gaiman’s popular comic book series (1989-96), which the new series is based on. </p>
<p>The embodiment of dream as a mythological or literary character has variously been presented as benevolent or sinister, and these contradictory representations reflect our uneasy relationship with the nature and meaning of dreams and nightmares. </p>
<p>These conflicting personifications of dream (and nightmare) reflect our ambiguous cultural ideas of dreaming. Dreaming has been associated with supernatural messages, divinatory arts and psychotherapeutic insights. While seemingly at odds with modernity’s emphasis on rationalism, dreams and works of dreamlike fantasy such as The Sandman continue to provide a much-needed sense of enchantment in our modern age. </p>
<p>Personifications of dream go back far in history. As befits an entity who rules the shifting realm of dreams, he too is unfixed, referred to as Morpheus, Onieros, Dream King, and the Sandman, among others. </p>
<p>Ancient Greek and Roman civilisations understood dreams to be both the messengers and messages. In Homer’s <a href="https://www.goodreads.com/book/show/1371.The_Iliad">The Iliad</a>, Zeus sends an onieros, a personified dream, to the Greek camp at Troy to encourage Agamemnon to fight. In Hesiod’s <a href="https://www.ancient-literature.com/greece_hesiod_theogony.html">The Theogony</a> the oneiroi are the dream children of Nyx or Night. In Roman mythology, Morpheus served Somnus, the god of sleep. </p>
<p>Although a relatively minor figure, Morpheus appealed to classical poets. In Ovid’s <a href="https://www.ancient-literature.com/rome_ovid_metamorphoses.html">Metamorphosis</a> he is one of Somnus’s thousand children, a shapeshifting dream and “master mimic” who moved “on noiseless wings”. Morpheus reveals the psychological sophistication of classical mythology, a rich body of stories that not only accounted for the operation of the natural world but also the interior workings of the human mind. </p>
<p>By the 19th and 20th centuries, Morpheus, or The Sandman, had become a more benevolent character. No longer a servant of the gods, he was frequently evoked as someone who could reunite lost lovers in dreams. Such sentiments are found in Alexander Pushkin’s poem, <a href="https://www.poetryverse.com/alexander-pushkin-poems/morpheus">Morpheus</a>, and in Roy Orbison’s song In Dreams, where the Sandman becomes “a candy-coloured clown” who sprinkles stardust. The Chordettes 1954 hit <a href="https://www.youtube.com/watch?v=CX45pYvxDiA&ab_channel=RiulDoamnei">Mr Sandman</a> asked him to send them a dream lover before they got too old.</p>
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<p>Yet the Sandman has also taken on menacing aspects. In E.T.A. Hoffman’s disturbing story, <a href="https://www.ux1.eiu.edu/%7Erlbeebe/sandman.pdf">The Sandman</a> (1816), the titular bogeyman is said to throw sand in the eyes of children who won’t go to sleep, causing them to bleed. He then puts them in a bag and takes them to his owl-beaked children who peck out their eyes as food. This more malevolent embodiment of nightmare was updated in the character of Freddy Krueger, star of the Nightmare on Elm Street horror film franchise. </p>
<h2>Modern dreams</h2>
<p>Gaiman’s Sandman combines both caring and threatening aspects. A figure committed to protecting dreamers and The Dreaming, the place where we go in dreams, he also holds grudges and punishes dream creations who challenge his benignly authoritarian rule.</p>
<p>These personifications of dream and nightmare encourage the unsettling sense that such things come from outside us. Many ancient civilisations credited oneiromancy, the interpretation of dreams in order to foretell the future as a form of supernatural power. Such ideas are put to dramatic use in Shakespeare’s Julius Caesar. Oneiromancy persisted and was updated for an increasingly urban and literate population in the 19th- and 20th-century development of dream books. These popular publications, intended as a form of entertainment, provided an A-Z of dream images that helped dreamers interpret their dreams and foretell their future.</p>
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<p>The uninvited, uncontrollable and nonsensical nature of dreams disturbed our modern championing of rationality and reason, causing them to be dismissed as mere unconscious mental play. When the 19th- and early 20th-century pioneers of psychotherapy engaged with dreams, they attempted to rationalise the meaning and function of their seemingly random and illogical content. </p>
<p>Sigmund Freud’s <a href="https://psychclassics.yorku.ca/Freud/Dreams/dreams.pdf">The Interpretation of Dreams</a> (1899) argued dreams provided insight into psychological repression and trauma, much of it of a sexual nature. Applying rationalised interpretations, dreams were not mental junk but telling insights into the forbidden wishes of individual minds. No longer external influences delivered by divine messengers, dreams were firmly grounded within us. Interestingly, the sinister nature of Hoffman’s Sandman story attracted Freud’s attention in his 1919 essay, <a href="https://www.freud.org.uk/2020/02/01/the-sandman/">The Uncanny</a>.</p>
<p>Yet it is Freud’s former friend and rival, Carl Jung, to whom Gaiman’s idea of The Dreaming owes a greater debt. Morpheus’s shared realm of dreamers is the fictional expression of Jung’s notion of the <a href="https://www.verywellmind.com/what-is-the-collective-unconscious-2671571">collective unconscious</a>, a place of archetypal figures, symbols, and images that repeatedly appear in all our dreams. </p>
<p>Like all good works of fantasy, The Sandman questions the dominant story western society has repeatedly told itself for over three centuries: that we have become rational, disenchanted, free of the fantastical ideas of the past. As the glut of fantasy serials on Netflix suggests, such a world requires the compensatory enchantment of fantasy, fiction and dreams. </p>
<p>To borrow a line from Tori Amos’s <a href="https://open.spotify.com/track/5WNZswfEtZ6sAlH1lTzdx6">Tear in Your Hand</a>, we will be hanging out with the Dream King for the foreseeable future.</p><img src="https://counter.theconversation.com/content/188498/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Karl Bell does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Gaiman’s dream goes by many names, each inspired by different ideas of what dreams and nightmares have been to people throughout history.Karl Bell, Reader in Cultural History, University of PortsmouthLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1844952022-06-08T09:38:58Z2022-06-08T09:38:58ZParkinson’s disease: bad dreams could be an early warning sign – new study<figure><img src="https://images.theconversation.com/files/467443/original/file-20220607-15494-xj39l9.jpg?ixlib=rb-1.1.0&rect=10%2C0%2C6800%2C4400&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/scared-woman-hiding-under-blanket-afraid-1299304081">Tero Vesalainen/Shutterstock</a></span></figcaption></figure><p>Every night when we go to sleep, we spend a couple of hours in a virtual world created by our brains in which we are the main protagonist of an unfolding story we did not consciously create. In other words, we dream. </p>
<p>For most people, dreams are mainly pleasant, sometimes negative, often bizarre, but rarely terrifying. That is, if they are remembered at all. Yet for <a href="https://academic.oup.com/sleep/article/33/6/774/2454580">about 5%</a> of people, highly memorable and terrifying nightmares (bad dreams that make you wake up) happen on a weekly or even nightly basis.</p>
<p>Recent studies have shown that people with Parkinson’s disease have bad dreams and nightmares more often than people without the disease. Studies suggest that between <a href="https://www.sciencedirect.com/science/article/pii/S0022510X14005577">17%</a> and <a href="https://link.springer.com/article/10.1007/s10072-014-1870-x">78%</a> of people with Parkinson’s have nightmares weekly. </p>
<p>A study I conducted in 2021 found that people newly diagnosed with Parkinson’s who experience recurring dreams with “<a href="https://movementdisorders.onlinelibrary.wiley.com/doi/10.1002/mdc3.13318">aggressive or action-packed</a>” content, have more rapid disease progression in the years following their diagnosis, compared with those without aggressive dreams. As such, my study, alongside <a href="https://onlinelibrary.wiley.com/doi/10.1111/jsr.13163">similar studies</a>, strongly suggests that the dreams of people with Parkinson’s can predict future health outcomes.</p>
<p>This made me wonder, might the dreams of people who don’t have Parkinson’s predict future health outcomes, too? My latest study, published in <a href="https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(22)00204-8/fulltext">The Lancet’s eClinicalMedicine journal</a>, shows that they can. Specifically, it showed that developing frequent bad dreams or nightmares in older age could be an early warning sign of imminent Parkinson’s disease in otherwise healthy people.</p>
<p>I analysed data from a large US study that contained data over 12 years from 3,818 older men living independently. At the beginning of the study, the men completed a range of questionnaires, one of which included a question about bad dreams.</p>
<p>The participants who reported bad dreams at least once a week were then followed at the end of the study for an average of seven years to see whether they were more likely to be diagnosed with Parkinson’s.</p>
<p>During this period, 91 people were diagnosed with Parkinson’s. Those who reported having frequent bad dreams at the beginning of the study were twice as likely to develop Parkinson’s compared with those who had them less than weekly. </p>
<p>Intriguingly, a significant proportion of the diagnoses happened during the first five years of the study. During this period, the participants with frequent bad dreams were more than three times as likely to develop Parkinson’s disease.</p>
<h2>Years before</h2>
<p>These results suggest that older adults who will one day be diagnosed with Parkinson’s disease may start to experience bad dreams and nightmares a few years before developing the <a href="https://www.nhs.uk/conditions/parkinsons-disease/symptoms/">characteristic symptoms of Parkinson’s</a>, including tremors, stiffness and slowness of movement.</p>
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<img alt="Woman holding her wrist to steady it so she can drink a glass of water." src="https://images.theconversation.com/files/467478/original/file-20220607-20-ujizr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/467478/original/file-20220607-20-ujizr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/467478/original/file-20220607-20-ujizr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/467478/original/file-20220607-20-ujizr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/467478/original/file-20220607-20-ujizr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/467478/original/file-20220607-20-ujizr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/467478/original/file-20220607-20-ujizr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Symptoms of Parkinson’s include tremors, stiffness and slowness of movement.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/senior-woman-holding-glass-waterhand-shaking-1685125852">CGN089/Shutterstock</a></span>
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<p>The study also shows that our dreams can reveal important information about our brain structure and function and may prove to be an important target for neuroscience research.</p>
<p>However, it is important to highlight that only 16 of the 368 men with frequent bad dreams in this study developed Parkinson’s. Since Parkinson’s is a relatively rare condition, most people who have frequent bad dreams are unlikely to ever get the disease. </p>
<p>Still, for those who have other known Parkinson’s <a href="https://jamanetwork.com/journals/jamaneurology/article-abstract/2789505">risk factors</a>, such as excessive daytime sleepiness or constipation, the finding could be important. Being aware that frequent bad dreams and nightmares (particularly when they start suddenly in later life) may be an early indicator of Parkinson’s, could lead to earlier diagnoses and earlier treatment. One day, doctors may even be able to intervene to stop Parkinson’s disease from developing at all.</p>
<p>My team now plans to use electroencephalography (a technique to measure brainwaves) to look at the biological reasons for dream changes in people with Parkinson’s. This may help us identify treatments that could simultaneously treat bad dreams, and also slow down or prevent the onset of Parkinson’s in people at risk of developing the condition.</p><img src="https://counter.theconversation.com/content/184495/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Abidemi Otaiku does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>People reported having frequent bad dreams at the beginning of the study were twice as likely to develop Parkinson’s compared with those who had them less than once a week.Abidemi Otaiku, NIHR Academic Clinical Fellow in Neurology, University of BirminghamLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1660062021-08-18T13:33:19Z2021-08-18T13:33:19ZBeing chased, losing your teeth or falling down? What science says about recurring dreams<figure><img src="https://images.theconversation.com/files/415867/original/file-20210812-20-14a9lhf.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1351%2C665&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">In some cases, recurring dreams that emerge during childhood can even persist into adulthood. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/">(Shutterstock)</a></span></figcaption></figure><p>Having the same dream again and again is a well-known phenomenon — nearly <a href="https://psycnet.apa.org/record/1996-98816-016">two-thirds of the population</a> report having recurring dreams. Being chased, finding yourself naked in a public place or in the middle of a natural disaster, losing your teeth or forgetting to go to class for an entire semester are typical recurring scenarios in these dreams.</p>
<p>But where does the phenomenon come from? The science of dreams shows that recurring dreams may reflect unresolved conflicts in the dreamer’s life.</p>
<p>Recurring dreams <a href="https://doi.org/10.1023/A:1021152411010">often occur during times of stress</a>, or over long periods of time, sometimes several years or even a lifetime. Not only do these dreams have the same themes, they can also repeat the same narrative night after night. </p>
<p>Although the exact content of recurring dreams is unique to every individual, there are <a href="https://doi.org/10.1525/aa.1958.60.6.02a00110">common themes among individuals</a> and even among cultures and in different periods. For example, being chased, falling, being unprepared for an exam, arriving late or trying to do something repeatedly are among <a href="http://dreamscience.ca/en/documents/publications/_2003_Nielsen_Reprint_D_13_211-235_TDQ.pdf">the most prevalent scenarios</a>.</p>
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<img alt="A woman appears to levitate near a cliff" src="https://images.theconversation.com/files/410225/original/file-20210707-27-18yhy6z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/410225/original/file-20210707-27-18yhy6z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/410225/original/file-20210707-27-18yhy6z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/410225/original/file-20210707-27-18yhy6z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/410225/original/file-20210707-27-18yhy6z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/410225/original/file-20210707-27-18yhy6z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/410225/original/file-20210707-27-18yhy6z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Not all recurring dreams have a negative connotation. Some, such as being able to fly, can even have a euphoric effect.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>The majority of recurring dreams have negative content involving emotions such as fear, sadness, anger and guilt. More than half of recurring dreams involve a situation where the dreamer is in danger. But some recurring themes can also be positive, even euphoric, such as dreams where we discover new rooms in our house, erotic dreams or where we fly.</p>
<p>In some cases, recurring dreams that begin in childhood can persist into adulthood. These dreams may disappear for a few years, reappear in the presence of a new source of stress and then disappear again when the situation is over.</p>
<h2>Unresolved conflicts</h2>
<p>Why does our brain play the same dreams over and over again? Studies suggest that dreams, in general, help us <a href="https://doi.org/10.1037/a0016570">regulate our emotions</a> and adapt to stressful events. Incorporating emotional material into dreams may allow the dreamer to process a painful or difficult event.</p>
<p>In the case of recurrent dreams, repetitive content could represent an unsuccessful attempt to integrate these difficult experiences. <a href="https://www.proquest.com/docview/2490256841?pq-origsite=gscholar&fromopenview=true">Many theories</a> agree that recurring dreams are related to unresolved difficulties or conflicts in the dreamer’s life.</p>
<p>The presence of recurrent dreams has also been associated with <a href="https://doi.org/10.1037/0022-3514.50.3.612">lower levels of psychological well-being</a> and the presence of <a href="https://www.semanticscholar.org/paper/Dream-Content%2C-Dream-Recurrence-and-Well-Being%3A-A-a-Zadra-O%27Brien/af492efdd0bcdee15c4b5d743df9deb530e2daa0">symptoms of anxiety and depression</a>. These dreams tend to <a href="https://doi.org/10.1023/A:1021152411010">recur during stressful situations</a> and cease when the person <a href="https://psycnet.apa.org/record/1996-98816-016">has resolved their personal conflict</a>, which indicates improved well-being.</p>
<p>Recurrent dreams often metaphorically reflect the emotional concerns of the dreamers. For example, <a href="https://archive.org/details/dreamsnightmares0000hart_k4s6">dreaming about a tsunami</a> is common following trauma or abuse. This is a typical example of a metaphor that can represent emotions of helplessness, panic or fear experienced in waking life.</p>
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<img alt="Panicked man runs with his computer under his arm" src="https://images.theconversation.com/files/410226/original/file-20210707-21-drq5zk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/410226/original/file-20210707-21-drq5zk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/410226/original/file-20210707-21-drq5zk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/410226/original/file-20210707-21-drq5zk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/410226/original/file-20210707-21-drq5zk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/410226/original/file-20210707-21-drq5zk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/410226/original/file-20210707-21-drq5zk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Some people, during a stressful situation or when faced with a new challenge, may repeatedly dream that they are coming in late or unprepared for a math test, even years after they set foot in a school.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>Similarly, being inappropriately dressed in one’s dream, being naked or not being able to find a toilet can all represent scenarios of embarrassment or modesty.</p>
<p><a href="https://psycnet.apa.org/record/2011-11210-004">These themes can be thought of as scripts</a> or ready-to-dream scenarios that provide us with a space where we can digest our conflicting emotions. The same script can be reused in different situations where we experience similar emotions. This is why some people, when faced with a stressful situation or a new challenge, may dream they’re showing up unprepared for a math exam, even years after they have set foot in a school. Although the circumstances are different, a similar feeling of stress or desire to excel can trigger the same dream scenario again.</p>
<h2>A continuum of repetition</h2>
<p>William Domhoff, an American researcher and psychologist, proposes the concept of a <a href="https://dreams.ucsc.edu/Library/domhoff_2000b.html">continuum of repetition in dreams</a>. At the extreme end, traumatic nightmares directly reproduce a lived trauma — one of the main symptoms of post-traumatic stress disorder.</p>
<p>Then there are recurring dreams where the same dream content is replayed in part or in its entirety. Unlike traumatic dreams, recurring dreams rarely replay an event or conflict directly but reflect it metaphorically through a central emotion.</p>
<p>Further along the continuum are the recurring themes in dreams. These dreams tend to replay a similar situation, such as being late, being chased or being lost, but the exact content of the dream differs from one time to the next, such as being late for a train rather than for an exam.</p>
<p>Finally, at the other end of the continuum, we find certain dream elements recurring in the dreams of one individual, such as characters, actions or objects. All these dreams would reflect, at different levels, an attempt to resolve certain emotional concerns.</p>
<p>Moving from an intense level to a lower level on the continuum of repetition is often a sign that a person’s psychological state is improving. For example, in the content of traumatic nightmares <a href="https://www.jstor.org/stable/43853181">progressive and positive changes</a> are often observed in people who have experienced trauma as they gradually overcome their difficulties.</p>
<h2>Physiological phenomena</h2>
<p>Why do the themes tend to be the same from person to person? One possible explanation is that some of these scripts have been preserved in humans due to the evolutionary advantage they bring. By <a href="https://doi.org/10.1017/S0140525X00004015">simulating a threatening situation</a>, the dream of being chased, for example, provides a space for a person to practise perceiving and escaping predators in their sleep.</p>
<figure class="align-center ">
<img alt="A young woman in bed holds her cheeks" src="https://images.theconversation.com/files/410227/original/file-20210707-15-16ptuyb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/410227/original/file-20210707-15-16ptuyb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/410227/original/file-20210707-15-16ptuyb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/410227/original/file-20210707-15-16ptuyb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/410227/original/file-20210707-15-16ptuyb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/410227/original/file-20210707-15-16ptuyb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/410227/original/file-20210707-15-16ptuyb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Some recurring dreams, such as losing one’s teeth, may be related to clenching one’s teeth during sleep or dental discomfort upon waking.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Some common themes may also be explained, in part, by physiological phenomena that take place during sleep. A 2018 study by a research team in Israel found that dreaming of <a href="https://doi.org/10.3389/fpsyg.2018.01812">losing one’s teeth</a> was not particularly linked to symptoms of anxiety but rather associated to teeth clenching during sleep or dental discomfort upon waking.</p>
<p>When we sleep, our brain is not completely cut off from the outside world. It continues to perceive external stimuli, such as sounds or smells, or internal body sensations. That means that other themes, such as not being able to find a toilet or being naked in a public space, could actually be spurred by the need to urinate during the night or by wearing loose pyjamas in bed.</p>
<p>Some physical phenomena specific to REM sleep, the stage of sleep when we dream the most, could also be at play. In REM sleep, our muscles are paralyzed, which could provoke dreams of having heavy legs or being paralyzed in bed.</p>
<p>Similarly, some authors have proposed that dreams of <a href="https://doi.org/10.1176/ajp.134.12.1335">falling or flying are caused by our vestibular system</a>, which contributes to balance and can reactivate spontaneously during REM sleep. Of course, these sensations are not sufficient to explain the recurrence of these dreams in some people and their sudden occurrence in times of stress, but they probably play a significant role in the construction of our most typical dreams.</p>
<h2>Breaking the cycle</h2>
<p>People who experience a recurring nightmare have in some ways become stuck in a particular way of responding to the dream scenario and anticipating it. Therapies have been developed to try to resolve this recurrence and break the vicious cycle of nightmares.</p>
<p>One technique is to visualize the nightmare while awake and then rewrite it, that is, to modify the narrative by <a href="https://doi.org/10.1037/drm0000031">changing one aspect, for example, the end of the dream</a> to something more positive. <a href="https://www.academia.edu/6707271/Lucid_Dreaming_as_a_Treatment_for_Recurrent_Nightmares">Lucid dreaming</a> may also be a solution.</p>
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À lire aussi :
<a href="https://theconversation.com/the-ability-to-control-dreams-may-help-us-unravel-the-mystery-of-consciousness-52394">The ability to control dreams may help us unravel the mystery of consciousness</a>
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</em>
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<p>In lucid dreams we become aware that we are dreaming and can sometimes influence the content of the dream. Becoming lucid in a recurring dream might allow us to think or react differently to the dream and thereby alter the repetitive nature of it.</p>
<p>However, not all recurring dreams are bad in themselves. They can even be helpful insofar as they are informing us about our personal conflicts. Paying attention to the repetitive elements of dreams could be a way to better understand and resolve our greatest desires and torments.</p><img src="https://counter.theconversation.com/content/166006/count.gif" alt="La Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Claudia Picard-Deland has received funding from the Natural Sciences and Engineering Research Council of Canada. </span></em></p><p class="fine-print"><em><span>Tore Nielsen has received funding from the Natural Sciences and Engineering Research Council of Canada. </span></em></p>Dreams help us regulate our emotions and adapt to stressful events. Repetitive content may represent an unsuccessful attempt to integrate difficult experiences.Claudia Picard-Deland, Candidate au doctorat en neurosciences, Université de MontréalTore Nielsen, Professor of Psychiatry, Université de MontréalLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1649942021-08-13T12:26:10Z2021-08-13T12:26:10ZThe aching red: Firefighters often silently suffer from trauma and job-related stress<figure><img src="https://images.theconversation.com/files/415589/original/file-20210811-13-z6z0us.jpg?ixlib=rb-1.1.0&rect=241%2C607%2C4173%2C2773&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Firefighters regularly face scenes of loss and suffering.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/silhouette-firefighter-standing-by-bonfire-at-night-royalty-free-image/1164532738?adppopup=true"> Mike Dohmen/EyeEm via Getty Images</a></span></figcaption></figure><p>Matthew was exposed to unimaginable scenes of pain and suffering in his job over more than a decade as a firefighter. The last straw came when he witnessed the death of a teenager – who was the same age as his son – from an overdose.</p>
<p>“The worst part is when you see an infant or a child die,” he told me during a visit. “Exposure to their family’s pain – and that you could not save that life – is very heartbreaking.” Matthew, for whom I’m using a pseudonym to protect his privacy, was being treated at my clinic for post-traumatic stress disorder and depression.</p>
<p>Images of tragedy, <a href="https://www.nytimes.com/2018/11/12/us/california-fires-camp-fire.html">loss of entire communities</a> and the terrible destruction wrought by deadly wildfires in the West have sadly become <a href="https://www.theatlantic.com/health/archive/2020/07/mental-health-aftermath-california-wildfires/608656/">all too common</a>. But the public hears relatively little about the suffering of the firefighters who risk their lives and are away from their families for days and weeks at a time. And though firefighters are primarily recognized for responding to fires, they’re also often among the first to arrive at all other manner of disasters and accidents too, as Matthew’s example shows.</p>
<p>While the choice to become a firefighter often stems from a passion for, and a mindset of, helping others and saving lives, being constantly exposed to death, injury and suffering comes with a cost. Cumulative stressors include the physical toll on the body, long working hours, work-related sleep disturbance and an inability to attend to daily family life. </p>
<p>I am <a href="https://scholar.google.com/citations?user=UDytFmIAAAAJ&hl=en">a psychiatrist and trauma expert</a> who often works with <a href="https://theconversation.com/the-aching-blue-trauma-stress-and-invisible-wounds-of-those-in-law-enforcement-146539">first responders</a> <a href="https://theconversation.com/veterans-refugees-and-victims-of-war-crimes-are-all-vulnerable-to-ptsd-130144">as well as refugees</a> and victims of war crimes. While many people think of firefighters as the happy heroes, the real-life, day-to-day experiences of these heroes can have real consequences for their mental health that remain largely invisible to the public eye.</p>
<h2>The life of a firefighter</h2>
<p>Firefighters have their own family-like “culture” and lifestyle, and they have experiences that often only their peers can relate to. Teams often spend whole 24-hour shifts together for years – even decades – and share holiday meals together when they can’t be with their own families.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/415694/original/file-20210811-17-gju6ve.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Firefighters dressed in uniforms, talking at fire station" src="https://images.theconversation.com/files/415694/original/file-20210811-17-gju6ve.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/415694/original/file-20210811-17-gju6ve.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/415694/original/file-20210811-17-gju6ve.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/415694/original/file-20210811-17-gju6ve.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/415694/original/file-20210811-17-gju6ve.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/415694/original/file-20210811-17-gju6ve.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/415694/original/file-20210811-17-gju6ve.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Firefighters spend long shifts together and tend to form close-knit bonds.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/firefighters-in-uniform-talking-while-standing-at-royalty-free-image/1180594729?adppopup=true">Maskot/Getty Images</a></span>
</figcaption>
</figure>
<p>Recently, when I spent time with a firefighter team in Dearborn, Michigan, one of the firefighters who was of German descent made a full German dinner, complete with schnitzel, sauerkraut, potatoes and dessert. When I sat at my assigned seat waiting for others to join, the firefighter sitting next to me said, “If you wait, you might never be able to eat your dinner.” Sure enough, five minutes later we had to go out on a call. During the ride, I reflected on how stressful it is to drive at high speeds to a potential disaster where you will have to problem-solve to save a life – or fail at doing so. </p>
<p>The life of a firefighter requires a frequent and immediate switch from laid-back life at the station to racing to unimaginable scenes that could involve anything from a light car accident to horrible car crashes, where first responders have to pull people or bodies from crushed or burning cars.</p>
<p>Exposure to tragic scenes – and the associated risks to firefighters’ lives or their colleagues’ – is a routine part of this job. Often, firefighters are re-exposed to these traumatic experiences via stories in the media or through videos and other posts by bystanders on social media. During the ride along, one firefighter said of this re-exposure, “You see it on all the local TV channels, along with the frequent updates.” </p>
<h2>Mental health impacts of stress and trauma</h2>
<p>PTSD is a condition caused by <a href="https://theconversation.com/veterans-refugees-and-victims-of-war-crimes-are-all-vulnerable-to-ptsd-130144">exposure to traumatic experiences</a> such as natural disasters, war, shootings, motor vehicle accidents and assault. It can result from one’s personal exposure to a trauma, or to someone else’s exposure.</p>
<p>More often, people have heard about PTSD in the context of war, with combat-exposed veterans. While combat veterans often return to the normality of the civilian life after deployment, the job of firefighters, police officers and emergency medical services workers involves regular, routine exposure to all types of traumas, for years and decades of their careers. </p>
<p>The <a href="https://doi.org/10.31887/DCNS.2006.8.4/jbremner">PTSD brain</a> is constantly on alert, screening for danger. Symptoms of PTSD include frequent nightmares, flashbacks, avoiding reminders of trauma and being easily startled and angered. Research shows that <a href="https://doi.org/10.1037//1076-8998.4.2.131">20% of firefighters and other first responders</a> pass the diagnostic threshold for PTSD at some point in their career, <a href="https://www.iaffrecoverycenter.com/blog/trauma-firefighting-and-ptsd/">in comparison with 6.8%</a> <a href="https://www.ptsd.va.gov/professional/treat/essentials/epidemiology.asp">in the general population</a>. A higher number of first responders experience symptoms that do not meet full diagnostic criteria for PTSD. </p>
<p><a href="https://www.samhsa.gov/sites/default/files/dtac/supplementalresearchbulletin-firstresponders-may2018.pdf">Other consequences</a> of cumulative trauma exposure include depression, anxiety, substance use and suicide, all of which are more common among firefighters and other first responders than in the general population. <a href="https://www.samhsa.gov/sites/default/files/dtac/supplementalresearchbulletin-firstresponders-may2018.pdf">Alcohol use</a> often becomes a coping mechanism. A recent study found that more firefighters and police officers <a href="https://rudermanfoundation.org/white_papers/police-officers-and-firefighters-are-more-likely-to-die-by-suicide-than-in-line-of-duty/">die by suicide</a> than in the line of duty. </p>
<h2>The challenges and solutions</h2>
<p>The problem-solving and “being in charge” work attitude that is a strength of firefighters can sometimes become a barrier in seeking help, as they might see vulnerability as a sign of failure. Often I have heard from first responders the feeling of shame and worries that others might see them as weak for discussing these issues. First responders sometimes tell us that they can have a hard time trusting mental health providers, some of whom might not have much firsthand experience with understanding a first responder’s life and challenges. Firefighters often also find it impossible to share their tough work experiences with their families. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/412888/original/file-20210723-17-18awme.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Firefighters and police offers move truck at crash scene" src="https://images.theconversation.com/files/412888/original/file-20210723-17-18awme.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/412888/original/file-20210723-17-18awme.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/412888/original/file-20210723-17-18awme.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/412888/original/file-20210723-17-18awme.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/412888/original/file-20210723-17-18awme.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=753&fit=crop&dpr=1 754w, https://images.theconversation.com/files/412888/original/file-20210723-17-18awme.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=753&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/412888/original/file-20210723-17-18awme.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=753&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Problem-solving and teamwork are a big part of a first responder’s job. Here, firefighters and police officers help move a car at a crash scene in Dearborn, Michigan.</span>
<span class="attribution"><span class="source">Arash Javanbakht</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>Left unaddressed, trauma and chronic stress can lead to not only mental health consequences but also <a href="https://theconversation.com/howard-stern-talks-childhood-trauma-and-a-trauma-psychiatrist-talks-about-its-lasting-effects-118027">physical illness</a>, including diabetes, hypertension and heart disease, obesity and chronic pain.</p>
<h2>Steps forward</h2>
<p>Fortunately, serious efforts are being made to spread awareness and fight stigma related to mental health. <a href="https://www.iaffrecoverycenter.com/blog/peer-support-combat-addiction-ptsd/">Peer-support programs</a> are made available to first responders to provide empathetic support and to encourage those in need to seek mental health care. Such programs can help fight stigma by explaining the mechanisms of trauma and stress in the body and brain. This approach can also reframe these experiences as vulnerabilities rather than weaknesses. The “don’t quit” mentality of firefighters can be shifted toward encouraging fighting the mental health consequences of trauma, instead of avoiding and denying it. </p>
<p>There are a growing number of effective treatments and interventions for addressing PTSD, depression and substance use, including <a href="https://www.ptsd.va.gov/understand_tx/talk_therapy.asp">talk therapy</a>, <a href="https://www.cnn.com/2019/02/04/health/life-you-evolved-for-partner/index.html">lifestyle changes</a> and safe <a href="https://www.ptsd.va.gov/understand_tx/meds_for_ptsd.asp">medications</a>. Knowing that the consequences of trauma can be resolved by proper interventions also helps reduce the stigma that can sometimes be associated with mental health problems. This can lead to the mindset that PTSD is a treatable condition rather than a label to live with for the rest of one’s life.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/YO9WjwWD7_0?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Researchers are using novel approaches to trauma therapy, including augmented reality, to help first responders, civilians and others heal and improve their well-being.</span></figcaption>
</figure>
<p>Other comprehensive programs are underway nationwide, dedicating resources to providing education, support, prevention and intervention for first responders and their families. <a href="https://today.wayne.edu/medicine/news/2021/03/04/wsu-psychiatry-developing-statewide-mental-health-program-to-address-stress-among-first-responders-and-their-families-41646">One such initiative</a>, which involves <a href="https://psychiatry.med.wayne.edu">my department</a> and <a href="https://www.starclab.org">my research clinic</a>, recently started at Wayne State University with the support of the state of Michigan. This program aims to provide education, prevention, peer support and a statewide network of mental health providers familiar with specific challenges of first responders. We are also developing novel methods for trauma treatment using cutting-edge augmented reality and telemedicine technologies.</p>
<p>Having worked with hundreds of civilians and first responders with trauma over more than a decade, I have time and again seen people recover from PTSD and depression and successfully return to a thriving career and family life. I have high hopes that we can help create awareness and, ultimately, improve the lives and well-being of many first responders.</p>
<p>[<em>Like what you’ve read? Want more?</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=likethis">Sign up for The Conversation’s daily newsletter</a>.]</p><img src="https://counter.theconversation.com/content/164994/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Arash Javanbakht does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Firefighters are hailed as heroes and pillars of strength, bravery and courage. But the daily stressors and traumas of their jobs take a heavy emotional toll that largely goes unnoticed by the public.Arash Javanbakht, Associate Professor of Psychiatry, Wayne State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1590862021-05-14T12:46:19Z2021-05-14T12:46:19ZWhy genocide survivors can offer a way to heal from the trauma of the pandemic year<figure><img src="https://images.theconversation.com/files/400129/original/file-20210511-20-buga1p.JPG?ixlib=rb-1.1.0&rect=5%2C5%2C3493%2C2297&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A gathering of women survivors at a Solace Ministries meeting, near Kigali, Rwanda, in 2010.</span> <span class="attribution"><span class="source">Donald E. Miller</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>The pandemic has been a period of acute trauma at many levels. More than <a href="https://www.worldometers.info/coronavirus/">3 million</a> people have died globally from COVID-19, including over 600,000 in the United States. <a href="https://doi.org/10.3390/ijerph18020601">Doctors and nurses</a> have experienced a moral crisis, feeling that perhaps they could have done more in spite of the tremendous demands on their time and resources. <a href="https://doi.org/10.1371/journal.pone.0240146">Families separated from loved ones</a>, even those in their dying moments, are dealing with their own trauma. </p>
<p>It is a <a href="https://medicine.umich.edu/dept/psychiatry/michigan-psychiatry-resources-covid-19/specific-mental-health-conditions/posttraumatic-stress-disorder-during-covid-19">collective trauma</a> – one suffered by the young and old, and shared in common around the globe.</p>
<p>I have spent much of my <a href="https://dornsife.usc.edu/cf/faculty-and-staff/faculty.cfm?pid=1003537">academic career studying genocide</a>, most recently the 1994 genocide in Rwanda, in which at least 800,000 minority ethnic Tutsis were killed by armed militias within just 100 days. At one level, genocide and the pandemic have little in common other than the loss of life that occurs on a terrifying scale. But they both require a process of healing and recovery after the trauma ends.</p>
<p>The pandemic has traumatized people to a lesser degree but may also affect many well into the future. In interviews that I have done with survivors of the <a href="https://www.ucpress.edu/book/9780520343788/becoming-human-again">genocide in Rwanda</a>, as well as elderly <a href="https://www.ucpress.edu/book/9780520219564/survivors">Armenian survivors</a> of the 1915 genocide in Turkey, it has been clear that their trauma lingered for decades. </p>
<p>Looking at such extreme cases of genocide-related trauma can shed light on the experience of loss, isolation and fear that <a href="https://www.psychiatrictimes.com/view/post-covid-stress-disorder-emerging-consequence-global-pandemic">many people have experienced during the pandemic</a>. The healing process of genocide survivors may offer lessons for post-pandemic recovery.</p>
<h2>Survivor trauma</h2>
<p>The growing <a href="https://doi.org/10.1002/wps.20838">body of research</a> on trauma and the pandemic suggests that these experiences parallel, even if to a reduced degree, some of the characteristics I have observed among genocide survivors. They have shown many of the classic <a href="https://psychotherapyacademy.org/pe-trauma-training-ptsd/understanding-dsm-5-criteria-for-ptsd-a-disorder-of-extinction/">symptoms of post-traumatic stress syndrome</a>, or PTSD. These include flashbacks of violence; nightmares; alterations in moods and emotions, such as being unable to remember events; difficulty concentrating, irrational guilt; and diminished interest in social interaction. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/398728/original/file-20210504-24-hoxv8u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Members of a survivors group of the Rwandan genocide gather for a meeting on trauma recovery at a place near Kigali." src="https://images.theconversation.com/files/398728/original/file-20210504-24-hoxv8u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/398728/original/file-20210504-24-hoxv8u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/398728/original/file-20210504-24-hoxv8u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/398728/original/file-20210504-24-hoxv8u.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/398728/original/file-20210504-24-hoxv8u.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/398728/original/file-20210504-24-hoxv8u.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/398728/original/file-20210504-24-hoxv8u.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Members of one of the 60 communities of Solace Ministries at their gathering place near Kigali.</span>
<span class="attribution"><span class="source">Donald E. Miller</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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</figure>
<p>Many of the genocide survivors I’ve interviewed were unable to express positive emotions, including love and affection. They sometimes had dramatic swings in emotion from rage to withdrawal, as well as reckless behaviors including drug and alcohol use. During the genocide, survivors told me, they felt hopeless, disoriented, confused and unable to believe in the goodness of life.</p>
<p>In <a href="https://www.ucpress.edu/book/9780520343788/becoming-human-again">my book on the genocide in Rwanda</a>, I argue that survivor trauma is in part a result of the collapse of the moral structures that make sense out of life. In Rwanda, half of all the <a href="https://www.cambridge.org/us/academic/subjects/history/african-history/christianity-and-genocide-rwanda?format=PB">killings occurred in churches</a> where Tutsis had fled for safety. They were killed by members of the Hutu Power militia, or sometimes by neighbors who had been influenced by government propaganda. </p>
<p>Survivors said they cried out during the genocide, “Where is God?” Neighbors had turned against neighbor, and they felt a sense of hopelessness in feeling that God had not intervened. There was a crisis of trust.</p>
<p>When the genocide ended in mid-July 1994, the <a href="https://www.cornellpress.cornell.edu/?q=scott%20strauss">major institutions</a> of society were gone. There were very few jobs, many survivors were homeless and <a href="https://ugapress.org/book/9780820338910/stuck/">family networks</a> had been destroyed. Many Tutsi survivors I have spoken with expressed an extreme need to heal the rupture that had occurred in their moral sensibilities, the fracture in their sense of community and their personal sense of identity. </p>
<h2>The healing process</h2>
<p>On my first trip to Rwanda, I met a survivor named <a href="https://crcc.usc.edu/jean-gakwandi-rwanda-ministry-brings-genocide-survivors-hope/">Jean Gakwandi</a>, who invited me to Solace Ministries. Gakwandi established this organization shortly after the genocide. It is headquartered in Kigali and has 60 communities of survivors around the country. </p>
<p>Gakwandi said that at first, survivors who had witnessed their children and spouses being killed could only cry, so he wept with them. He saw that his role was to listen to their stories, comfort them and offer words of hope. As Solace Ministries evolved, the focal point of its weekly meetings – which often last three to four hours – became the opportunity for survivors to stand and testify about their experiences, followed by singing, dancing and warm embraces.<br>
At these gatherings, healing occurred in the context of community. It became a place where one was accepted and could develop a narrative about what happened during the genocide. Members became a surrogate family of widows and orphans who could share and shoulder each other’s burdens. </p>
<p>Solace Ministries developed programs to assist survivors with food, housing, education and medical care. But fundamentally, survivors needed to restore their sense of dignity as human beings, and that involved processing the traumatic events that they experienced. Forgiving perpetrators, if it occurred, happened at the end point of the healing process. </p>
<p>It was at Solace that I videotaped interviews with 100 survivors: orphans and widows of men killed in the genocide. A psychologist colleague, <a href="https://dornsife.usc.edu/cf/labs/meyerowitz/meyerowitz-faculty-display.cfm">Beth Meyerowitz</a>, also conducted surveys with widows at Solace Ministries, as well as with members of an orphan association of households headed by children. These surveys indicated extremely high levels of trauma. </p>
<p>But at Solace Ministries in particular, many survivors said that they had learned how to manage their trauma. In their words, they had “become human again” as they were able to tell their stories to, and be accepted by, a group of fellow survivors. They found new meaning in the context of a faith community.</p>
<h2>The pandemic and trauma</h2>
<p>The acute trauma of the Rwandan genocide is quite different from the deaths that occur in a pandemic. <a href="https://yalebooks.yale.edu/book/9780300197396/rwanda">What happened in 1994</a> was a deliberate, hate-filled attempt, orchestrated by a small elite, to eliminate the Tutsi population. But there are parallels, I argue, in terms of the trauma experienced by pandemic survivors, and perhaps even in their healing process. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/400133/original/file-20210511-16-eis95t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman and a man mourn for a family member who died from the COVID-19 in Kathmandu, Nepal" src="https://images.theconversation.com/files/400133/original/file-20210511-16-eis95t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/400133/original/file-20210511-16-eis95t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/400133/original/file-20210511-16-eis95t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/400133/original/file-20210511-16-eis95t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/400133/original/file-20210511-16-eis95t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/400133/original/file-20210511-16-eis95t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/400133/original/file-20210511-16-eis95t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">The pandemic will leave behind a considerable amount of trauma.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/april-30-2021-a-woman-cries-as-she-mourns-for-her-family-news-photo/1232643523?adppopup=true">Sulav Shrestha/Xinhua via Getty</a></span>
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<p>Symptoms of <a href="https://www.apa.org/pubs/journals/special/tra-covid-19">pandemic trauma</a> include increased levels of anxiety, fear, depression and suicidal thoughts, even in people who were not on the front lines of medical intervention or did not experience the death of a family member or friend. </p>
<p>Parents have communicated <a href="https://childmind.org/article/anxiety-and-coping-with-coronavirus/">fear to children</a>, while isolation from others has turned people inward. The “unknowns” of the virus, including its <a href="https://www.nih.gov/about-nih/who-we-are/nih-director/statements/nih-launches-new-initiative-study-long-covid">long-term impacts</a>, have instilled fear. </p>
<p>In the U.S., there are indications that <a href="https://doi.org/10.1016/j.psychres.2020.113312">medical professionals</a> are experiencing heightened levels of trauma-related symptoms, as is the general public. Future research may find the same phenomenon in <a href="https://www.scmp.com/week-asia/health-environment/article/3131843/what-its-not-have-covid-19-india-how-second-wave">India</a>, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7527181/">Brazil</a> and <a href="https://www.medpagetoday.com/infectiousdisease/covid19/91255">other places</a> where there have been large outbreaks of the virus.</p>
<p>[<em>3 media outlets, 1 religion newsletter.</em> <a href="https://theconversation.com/us/newsletters/this-week-in-religion-76/?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=religion-3-in-1">Get stories from The Conversation, AP and RNS.</a>]</p>
<p>In my work on the Rwanda genocide, I draw on the research of <a href="https://www.basicbooks.com/?s=judith+herman">Judith Herman</a>, who wrote a seminal book called “<a href="https://www.basicbooks.com/titles/judith-lewis-herman/trauma-and-recovery/9780465061716/">Trauma and Recovery: The Aftermath of Violence – From Domestic Abuse to Political Terror</a>.” She believes there are three elements involved in the healing process: Survivors need to reach a place of safety, reconstruct the trauma narrative and restore the connection between individual and community. </p>
<p>These three steps have relevance to healing from the trauma of a pandemic:</p>
<p>First, one needs to feel safe. This feeling of safety is occurring for many in the U.S. as an increasing number of pandemic survivors become <a href="https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/whats-safe-after-your-covid19-vaccine">vaccinated</a>.</p>
<p>Secondly, individuals needs to <a href="https://theconversation.com/7-science-based-strategies-to-cope-with-coronavirus-anxiety-133207">reconstruct their own trauma story</a> and integrate it into their larger life narrative. This accounts for the need of people to talk about the pandemic and their experience of it. </p>
<p>Thirdly, the connection between individual and community must be restored, so that the individual can once again experience trusting relationships with others. This connection was especially important in the <a href="https://www.cambridge.org/us/academic/subjects/law/human-rights/gacaca-courts-post-genocide-justice-and-reconciliation-rwanda-justice-without-lawyers?format=PB">divide between Tutsi and Hutu neighbors</a> after the genocide and explains the role of Solace Ministries in creating a social structure in which survivors could once again experience their own humanity. Similarly, pandemic survivors are <a href="https://www.aarp.org/health/conditions-treatments/info-2021/hugging-after-covid-vaccine.html">learning to hug again</a> as they come out of their self-imposed quarantines. </p>
<p>These three elements, in my view, will be relevant as survivors of COVID-19 attempt to deal with their residual fears and anxieties, as well as deeper trauma. The very deprivation of community, the isolation from extended family and friends, and memories of lost loved ones provide prisms for thinking deeply about what’s really important. As the pandemic winds down and people venture outside, the opportunity exists to value life in new ways.</p><img src="https://counter.theconversation.com/content/159086/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Donald E Miller receives funding from the Templeton Religion Trust and the John Templeton Foundation. </span></em></p>A scholar of the Rwandan genocide argues that while a genocide and a pandemic are very different, the experiences of Rwanda’s survivors may provide lessons on how to heal from pandemic trauma.Donald E Miller, Professor of Religion at the University of Southern California and Director of Strategic Initiatives at the Center for Religion and Civic Culture, USC Dornsife College of Letters, Arts and SciencesLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1373872020-05-01T07:06:19Z2020-05-01T07:06:19ZWhat dreams may come: why you’re having more vivid dreams during the pandemic<figure><img src="https://images.theconversation.com/files/331681/original/file-20200430-42923-52ezge.jpg?ixlib=rb-1.1.0&rect=0%2C23%2C3888%2C2438&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Bruce Rolff/Shutterstock</span></span></figcaption></figure><p>An interesting side effect of the coronavirus pandemic is the number of people who say they are having <a href="https://www.tvnz.co.nz/one-news/new-zealand/its-having-impact-why-you-shouldnt-stress-over-vivid-covid-19-quaran-dreams">vivid dreams</a>.</p>
<p>Many are turning to <a href="https://neptunearchive.org/COVID-19-COLLECTIVE-DREAM-JOURNAL">blogs</a> and social media to describe their experiences.</p>
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<p>While such dreams can be confusing or distressing, dreaming is normal and considered helpful in processing our waking situation, which for many people is far from normal at the moment.</p>
<h2>While we are sleeping</h2>
<p>Adults are recommended to sleep for <a href="https://www.sleepfoundation.org/articles/how-much-sleep-do-we-really-need">seven to nine hours</a> to maintain optimal health and well-being.</p>
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Read more:
<a href="https://theconversation.com/no-wonder-isolations-so-tiring-all-those-extra-tiny-decisions-are-taxing-our-brains-136965">No wonder isolation's so tiring. All those extra, tiny decisions are taxing our brains</a>
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<p>When we sleep we go through different stages which cycle throughout the night. This includes light and deep sleep and a period known as rapid eye movement (REM) sleep, which features more prominently in the second half of the night. As the name implies, during REM sleep the eyes move rapidly.</p>
<p>Dreams can occur within all sleep stages but REM sleep is considered responsible for highly emotive and visual <a href="https://theconversation.com/explainer-what-is-dreaming-9618">dreams</a>. </p>
<p>We typically have several REM dream periods a night, yet we do not necessarily remember the experiences and content. <a href="https://www.nature.com/articles/nrn915" title="The cognitive neuroscience of sleep: neuronal systems, consciousness and learning">Researchers</a> have identified that REM sleep has unique properties that help us regulate our mood, performance and cognitive functioning. </p>
<p>Some say dreams act like a <a href="https://www.sciencedirect.com/science/article/pii/S1053810017302283" title="Social contents in dreams: An empirical test of the Social Simulation Theory">defence mechanism</a> for our mental health, by giving us a <a href="https://www.sciencedirect.com/science/article/pii/S1053810003000199" title="The threat simulation theory of the evolutionary function of dreaming: Evidence from dreams of traumatized children">simulated</a> opportunity to work through our fears and to rehearse for stressful real-life events.</p>
<p>This global pandemic and associated restrictions may have impacts on how and when we sleep. This has positive effects for some and negative effects for others. Both situations can lead to heightened recollection of dreams.</p>
<h2>Disrupted sleep and dreams</h2>
<p>During this pandemic, studies from <a href="http://www.chinadailyhk.com/article/126633" title="Insomnia and rise in anxiety emerge as big problems">China</a> and the <a href="https://www.ipsos.com/ipsos-mori/en-uk/life-under-lockdown-coronavirus-uk">UK</a> show many people are reporting a heightened state of anxiety and are having shorter or more disturbed sleep.</p>
<p>Ruminating about the pandemic, either directly or via the media, just before going to bed can work against our need to relax and get a good night’s sleep. It may also provide fodder for dreams.</p>
<p>When we are sleep deprived, the pressure for REM sleep increases and so at the next sleep opportunity a so-called <a href="https://www.sciencedirect.com/science/article/pii/S1053810017302271" title="Daytime microsleeps during 7 days of sleep restriction followed by 13 days of sleep recovery in healthy young adults">rebound</a> in REM sleep occurs. During this time dreams are reportedly more <a href="https://www.scientificamerican.com/article/strange-but-true-less-sleep-means-more-dreams/">vivid</a> and emotional than usual.</p>
<h2>More time in bed</h2>
<p>Other studies indicate that people may be <a href="https://evidation.com/news/covid-19-pulse-first-data-evidation/">sleeping more</a> and <a href="https://blog.fitbit.com/covid-19-sleep-patterns/">moving less</a> during the pandemic. </p>
<p>If you’re working and learning from home on flexible schedules without the usual commute it means you avoid the morning rush and don’t need to get up so early. Heightened dream <a href="https://pubmed.ncbi.nlm.nih.gov/18556915/" title="Dream Recall, Dream Length, and Sleep Duration: State or Trait Factor">recall</a> has been associated with having a longer sleep as well as waking more naturally from a state of REM sleep.</p>
<p>If you’re at home with other people you have a captive audience and time to exchange dream stories in the morning. The act of sharing dreams reinforces our memory of them. It might also prepare us to <a href="https://www.healthline.com/health/mental-health/remembering-dreams-psychology#1">remember</a> more on subsequent nights.</p>
<p>This has likely created a spike in dream recall and interest during this time.</p>
<h2>The pandemic concerns</h2>
<p>Dreaming can help us to cope mentally with our waking situation as well as simply reflect <a href="https://www.frontiersin.org/articles/10.3389/fpsyg.2019.00459/full" title="The Functional Role of Dreaming in Emotional Processes">realities and concerns</a>.</p>
<p>In this time of heightened alert and changing social norms, our brains have much more to process during sleep and dreaming. More stressful dream content is to be expected if we feel anxious or stressed in relation to the pandemic, or our working or family situations.</p>
<p>Hence more <a href="https://thespinoff.co.nz/society/04-04-2020/you-arent-the-only-one-having-buzzy-covid-dreams/">reports</a> of dreams containing fear, embarrassment, social taboos, occupational stress, grief and loss, unreachable family, as well as more literal dreams around contamination or disease are <a href="https://www.idreamofcovid.com/dreams">being recorded</a>.</p>
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<p>An increase in unusual or vivid dreams and nightmares is not surprising. Such experiences have been reported before at times associated with sudden change, anxiety or <a href="https://www.sleepfoundation.org/articles/how-trauma-can-affect-your-dreams">trauma</a>, such as the aftermath of the <a href="https://www.reuters.com/article/us-terror-attacks-dreams/impact-of-9-11-terror-attacks-evident-in-dreams-idUSKIM95168020080219">terrorist attacks</a> in the US in 2001, or <a href="https://pubmed.ncbi.nlm.nih.gov/11752360/" title="Sleep Disturbances in the Wake of Traumatic Events">natural disasters or war</a>. </p>
<p>Those with an <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3690155" title="Bad Dream Frequency in Older Adults with Generalized Anxiety Disorder: Prevalence, Correlates, and Effect of Cognitive Behavioral Treatment for Anxiety">anxiety disorder</a> or experiencing the trauma first-hand are highly likely also to experience changes to dreams.</p>
<p>But such changes are also reported by those <a href="https://pubmed.ncbi.nlm.nih.gov/11752360/" title="Sleep Disturbances in the Wake of Traumatic Events">witnessing</a> events like the <a href="https://www.reuters.com/article/us-terror-attacks-dreams/impact-of-9-11-terror-attacks-evident-in-dreams-idUSKIM95168020080219">9/11</a> attacks second-hand or via the media.</p>
<h2>Problems solved in dreams</h2>
<p>One <a href="https://www.frontiersin.org/articles/10.3389/fpsyg.2019.00459/full" title="The Functional Role of Dreaming in Emotional Processes">theory on dreams</a> is they serve to process the emotional demands of the day, to commit experiences to memory, solve problems, adapt and <a href="http://healthysleep.med.harvard.edu/healthy/matters/benefits-of-sleep/learning-memory">learn</a>.</p>
<p>This is achieved through the reactivation of particular brain areas during REM sleep and the consolidation of neural connections. </p>
<p>During REM the areas of the brain responsible for emotions, memory, behaviour and vision are reactivated (as opposed to those required for logical thinking, reasoning and movement, which remain in a state of rest).</p>
<p>The activity and connections made during dreaming are considered to be guided by the dreamer’s <a href="https://www.sciencedirect.com/science/article/pii/S1053810017302283" title="Social contents in dreams: An empirical test of the Social Simulation Theory">waking activities</a>, exposures and <a href="https://open-mind.net/papers/the-avatars-in-the-machine-dreaming-as-a-simulation-of-social-reality">stressors</a>.</p>
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Read more:
<a href="https://theconversation.com/while-we-wait-for-a-coronavirus-vaccine-eating-well-exercising-and-managing-stress-can-boost-your-immune-system-137255">While we wait for a coronavirus vaccine, eating well, exercising and managing stress can boost your immune system</a>
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<p>The neural activity has been proposed to <a href="https://www.nature.com/articles/nrn915">synthesise</a> learning and memory. The actual dream experience is more a by-product of this activity, which we assemble into a more logical narrative when the remainder of the brain attempts to catch up and reason with the activity on waking.</p>
<h2>Please … go to sleep</h2>
<p>If disrupted sleep and dreams are problematic or distressing for you, consider how your sleep schedule and behaviour has changed with the pandemic. Maybe seek advice for supporting your sleep and well-being during this time.</p>
<p>My colleagues and I at the <a href="https://www.sleepwake.ac.nz/">Sleep/Wake Research Centre</a> have produced several <a href="https://www.sleepwake.ac.nz/what-we-do/covid-19-resources/">information sheets</a> on sleep during the pandemic.</p>
<p>We are also conducting a <a href="https://massey.au1.qualtrics.com/jfe/form/SV_e3EQd7khA328R0h">survey</a> concerning the sleep of people living in New Zealand. This explores factors affecting sleep during the pandemic, and participants can comment on their dreaming.</p><img src="https://counter.theconversation.com/content/137387/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rosie Gibson does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>At times of anxiety and trauma an increase in unusual or vivid dreams and nightmares is not surprising.Rosie Gibson, Research Officer, Sleep/Wake Research Centre, College of Health, Massey UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1056132018-11-08T14:28:47Z2018-11-08T14:28:47ZWhat World War I taught us about PTSD<figure><img src="https://images.theconversation.com/files/243885/original/file-20181105-12015-1sbk4co.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/red-poppy-flowers-june-rhinelandpalatinate-germany-383740150?src=T7I-_ThuMSifL5-h2TNg7g-1-14">Nailia Schwarz/Shutterstock.com</a></span></figcaption></figure><p>People often experience trauma during war. Over time, this can develop into a condition we now recognise as post-traumatic stress disorder (PTSD). Sufferers can experience severe anxiety, flashbacks, nightmares, insomnia and anger, amongst other symptoms. </p>
<p>It has a long history. Cases of PTSD have been identified from descriptions <a href="https://www.history.com/topics/inventions/history-of-ptsd-and-shell-shock">in ancient Greek history</a> of people experiencing persistent nightmares. Other symptoms, such as feeling anxious and constantly on edge, were described as “<a href="http://operationcompassionatecare.org/historical-names-for-ptsd/">soldier’s heart</a>” during the American Civil War. But this history took a sharp turn a hundred years ago, during World War I, when the prevalence of what was then known as “shell-shock” meant that a formal treatment for psychological trauma was needed.</p>
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<img alt="" src="https://images.theconversation.com/files/242598/original/file-20181028-7062-t1rk1v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/242598/original/file-20181028-7062-t1rk1v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=424&fit=crop&dpr=1 600w, https://images.theconversation.com/files/242598/original/file-20181028-7062-t1rk1v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=424&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/242598/original/file-20181028-7062-t1rk1v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=424&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/242598/original/file-20181028-7062-t1rk1v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=533&fit=crop&dpr=1 754w, https://images.theconversation.com/files/242598/original/file-20181028-7062-t1rk1v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=533&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/242598/original/file-20181028-7062-t1rk1v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=533&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">The Battle of the Somme.</span>
<span class="attribution"><span class="source">Wikimedia Commons</span></span>
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<p>Psychological trauma experienced during the war had an unprecedented toll on veterans, many of whom suffered symptoms for the <a href="https://en.wikipedia.org/wiki/Shell_shock#Commission_of_enquiry">rest of their lives</a>. These ranged from distressing memories that veterans found difficult to forget, to extreme episodes of <a href="http://ww1centenary.oucs.ox.ac.uk/body-and-mind/shell-shock-on-film/">catatonia and terror</a> when reminded of their trauma. The sheer scale of veterans experiencing such symptoms after World War I led to the definition of “<a href="https://en.wikipedia.org/wiki/Combat_stress_reaction">combat stress reaction</a>”, informing our modern concept of PTSD. </p>
<p>The public perception of PTSD is still rooted in this past, and some of the problems discovered during World War I regarding psychological trauma have not yet been answered. Though much has changed, many principles and challenges of PTSD treatment were first identified during World War I. If we are to learn lessons from the war and better acknowledge the sacrifices of those who served, we must also acknowledge the impact of psychological trauma, both then and now.</p>
<h2>Shell-shock</h2>
<p>Soldiers described the effects of trauma as “shell-shock” because they believed them to be caused by exposure to artillery bombardments. As early as 1915, army hospitals became inundated with soldiers requiring treatment for “wounded minds”, tremors, blurred vision and fits, taking the military establishment <a href="https://spartacus-educational.com/FWWmental.htm">entirely by surprise</a>. An army psychiatrist, Charles Myers, subsequently published observations <a href="https://www.sciencedirect.com/science/article/pii/S014067360052916X?via%3Dihub">in the Lancet</a>, coining the term shell-shock. Approximately <a href="http://www.bbc.co.uk/history/worldwars/wwone/shellshock_01.shtml">80,000 British soldiers</a> were treated for shell-shock over the course of the war. Despite its prevalence, experiencing shell-shock was often attributed to moral failings and weaknesses, with some soldiers even being accused of <a href="http://www.bbc.co.uk/history/british/britain_wwone/shot_at_dawn_01.shtml">cowardice</a>. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/242599/original/file-20181028-7065-k5c4rt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/242599/original/file-20181028-7065-k5c4rt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=559&fit=crop&dpr=1 600w, https://images.theconversation.com/files/242599/original/file-20181028-7065-k5c4rt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=559&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/242599/original/file-20181028-7065-k5c4rt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=559&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/242599/original/file-20181028-7065-k5c4rt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=702&fit=crop&dpr=1 754w, https://images.theconversation.com/files/242599/original/file-20181028-7065-k5c4rt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=702&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/242599/original/file-20181028-7065-k5c4rt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=702&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">An Australian soldier displaying signs of shell-shock (bottom left)</span>
<span class="attribution"><span class="source">Wikimedia Commons</span></span>
</figcaption>
</figure>
<p>But the concept of shell-shock had its limitations. Despite coining the term, <a href="https://www.apa.org/monitor/2012/06/shell-shocked.aspx">Charles Myers</a> noted that shell-shock implied that one had to be directly exposed to combat, even though many suffering from the condition had been exposed to non-combat related trauma (such as the threat of injury and death). Cognitive and behavioural symptoms of trauma, such as nightmares, hyper-vigilance and avoiding triggering situations, were also overlooked compared to physical symptoms. </p>
<p>Today, it is these cognitive and behavioural symptoms that <a href="https://www.nhs.uk/conditions/post-traumatic-stress-disorder-ptsd/symptoms/">define PTSD</a>. The physical symptoms that defined shell-shock are often consequences of these nonphysical symptoms.</p>
<h2>Treating shell-shock</h2>
<p>Treatments were harsh. As depicted in Pat Barker’s novel <a href="https://en.wikipedia.org/wiki/Regeneration_%28novel%29">Regeneration</a>, shell-shock patients could receive courses of electroshock therapy and physical conditioning, with the aim of alleviating physical symptoms quickly. </p>
<p>Not only were such treatments brutal, they were typically ineffective, with <a href="http://www.bbc.co.uk/insideout/extra/series-1/shell_shocked.shtml">80% of those treated</a> unable to serve again. They were very commonly used to treat physical symptoms such as fits and tremors, as shown in the video below. While the man in the video is shown walking again, it is unknown if psychological symptoms were <a href="https://www.britishpathe.com/gallery/shell-shock-victims/1">alleviated</a>. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/S7Jll9_EiyA?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">(Video, Shellshock patient in treatment- War Archives from British Pathé: GRAPHIC)</span></figcaption>
</figure>
<p>Due to the ineffectiveness of prescribed treatments, many soldiers who had witnessed trauma or experienced shell-shock attempted to <a href="https://www.kcl.ac.uk/kcmhr/publications/assetfiles/alcoholsmoking/Jones2011-Alcoholuseandmisusewithinthemilitary.pdf">self-medicate their symptoms</a>. Alcohol and drug use were common methods to treat immediate symptoms, much like Captain Stanhope’s use of alcohol to cope with the onset of anxiety in the novel <a href="https://en.wikipedia.org/wiki/Journey%27s_End">Journey’s End</a>. While prevalent, self-medication undoubtedly <a href="https://counselorssoapbox.com/2012/12/26/drinking-a-little-alcohol-can-make-ptsd-worse/">exacerbated untreated cognitive symptoms</a>, such as flashbacks and nightmares, as is commonly found with PTSD today.</p>
<p>But some shell-shock treatments were highly effective: those that focused on the cognitive and behavioural symptoms now associated with PTSD. One army physician, <a href="https://www.kcl.ac.uk/kcmhr/publications/assetfiles/historical/Jones2011-warneuroses.pdf">Arthur Hurst</a>, went to great lengths to encourage shell-shock patients to reconstruct their traumatic experiences, using films and simulations to help confront their traumatic memories. These “talking cures”, which emphasised the cognitive and behavioural symptoms of trauma, had a much <a href="http://www.bbc.co.uk/insideout/extra/series-1/shell_shocked.shtml">better success rate</a>. Although used rarely during the war, many modern PTSD treatments can trace their development to these talking therapies, moving away from only treating physical symptoms and <a href="https://www.talkspace.com/blog/2017/06/the-history-of-ptsd/">targeting psychological issues</a>, such as distress caused by traumatic memories. </p>
<h2>Trauma and PTSD today</h2>
<p>Though the concept of shell-shock shares many features with PTSD, ideas of what constitutes trauma and treatments have since changed dramatically. The focus towards treating underlying cognitive and behavioural symptoms has shown a great reduction in the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4138705/">physical consequences of trauma</a> observed during World War I. Service personnel are routinely screened for symptoms of trauma before and after deployment; identifying issues early reduces the risk of developing PTSD, whereas shell-shock treatment focused on treating symptoms once they became severe.</p>
<p>Nevertheless, many of the same challenges observed a century ago are equally relevant today. The stigma attached to mental illness still obstructs people from receiving treatment, causing many to <a href="https://www.theguardian.com/society/2014/oct/18/collateral-damage-ex-soldiers-living-with-ptsd">self-medicate with alcohol</a> to ease their symptoms instead. Such challenges are not unique to veterans either; <a href="https://healthydebate.ca/2016/12/topic/syrian-refugees-ptsd">refugees</a> and <a href="https://www.brit.co/what-ptsd-looks-like-for-sexual-assault-survivors/">sexual assault survivors</a> are also deeply affected by trauma, but often face barriers to receiving proper treatment, exacerbating their PTSD.</p>
<p>Overall, we have a better understanding of what trauma is because of World War I. Although modern treatments for PTSD are more effective than those for shell-shock, issues such as social stigma and alcohol misuse remain. These are lessons from World War I we are still learning. We must not forget the challenges facing service personnel exposed to trauma, both today and a century ago.</p><img src="https://counter.theconversation.com/content/105613/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Benjamin Russell Butterworth does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>To some extent, shell-shock still shapes our understanding of PTSD today.Benjamin Russell Butterworth, PhD Researcher, Glasgow Caledonian UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/816612017-09-11T00:26:35Z2017-09-11T00:26:35ZDoes marijuana affect your sleep?<figure><img src="https://images.theconversation.com/files/184991/original/file-20170906-9823-mrt3sc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Results may vary.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-teenage-boy-smoking-drugs-lying-110426945">Stokkete/shutterstock.com</a></span></figcaption></figure><p>If you speak to someone who has suffered from insomnia at all as an adult, chances are good that person has either tried using marijuana, or cannabis, for sleep or <a href="https://doi.org/10.1016/j.addbeh.2017.08.001">has thought about it</a>. </p>
<p>This is reflected in the many variations of cannabinoid or cannabis-based medicines available to improve sleep – like Nabilone, Dronabinol and Marinol. It’s also a <a href="https://doi.org/10.1016/j.addbeh.2017.08.001">common reason</a> why many cannabis users seek medical marijuana cards. </p>
<p>I am a sleep psychologist who has treated hundreds of patients with insomnia, and it seems to me the success of cannabis as a sleep aid is highly individual. What makes cannabis effective for one person’s sleep and not another’s? </p>
<p>While there are still many questions to be answered, existing research suggests that the effects of cannabis on sleep may depend on many factors, including individual differences, cannabis concentrations and frequency of use.</p>
<h1>Cannabis and sleep</h1>
<p>Access to cannabis is increasing. As of last November, 28 U.S. states and the District of Columbia had <a href="http://www.ncsl.org/research/health/state-medical-marijuana-laws.aspx">legalized cannabis</a> for medicinal purposes.</p>
<p>Research on the <a href="http://doi.org/10.1007/s11920-017-0775-9">effects of cannabis on sleep</a> in humans has largely been compiled of <a href="http://doi.org/10.1007/s11920-014-0487-3">somewhat inconsistent studies</a> conducted in the 1970s. Researchers seeking to learn how cannabis affects the sleeping brain have studied volunteers in the sleep laboratory and measured sleep stages and sleep continuity. Some studies showed that users’ ability to fall and stay asleep improved. A small number of subjects also had a slight <a href="http://doi.org/10.1002/cpt1975174458">increase</a> in slow wave sleep, the deepest stage of sleep. </p>
<p>However, once <a href="http://doi.org/10.1093/sleep/31.6.901">nightly cannabis use</a> stops, sleep clearly worsens across <a href="http://doi.org/10.1016/j.sleep.2010.02.013">the withdrawal period</a>. </p>
<p>Over the past decade, research has focused more on the use of cannabis for medical purposes. Individuals with insomnia tend to use medical cannabis for sleep at a <a href="http://doi.org/10.1016/j.addbeh.2017.08.001">high rate</a>. Up to 65 percent of former cannabis users identified poor sleep as a reason for <a href="http://doi.org/10.1016/j.jsat.2008.01.002">relapsing</a>. Use for sleep is particularly common in individuals with <a href="http://doi.org/10.1016/j.copsyc.2016.12.001">PTSD</a> and <a href="http://doi.org/10.1002/cbdv.200790150">pain</a>. </p>
<p>This research suggests that, while motivation to use cannabis for sleep is high, and might initially be beneficial to sleep, these improvements might wane with chronic use over time.</p>
<h1>Does frequency matter?</h1>
<p>We were interested in how sleep quality differs between daily cannabis users, occasional users who smoked at least once in the last month and people who don’t smoke at all. </p>
<p>We asked 98 mostly young and healthy male volunteers to answer surveys, keep daily sleep diaries and wear accelerometers for one week. Accelerometers, or actigraphs, measure activity patterns across multiple days. Throughout the study, subjects used cannabis as they typically would.</p>
<p><a href="http://doi.org/10.1080/10550887.2015.1132986">Our results</a> show that the frequency of use seems to be an important factor as it relates to the effects on sleep. Thirty-nine percent of daily users complained of clinically significant insomnia. Meanwhile, only 10 percent of occasional users had insomnia complaints. There were no differences in sleep complaints between nonusers and nondaily users. </p>
<p>Interestingly, when controlling for the presence of anxiety and depression, the differences disappeared. This suggests that cannabis’s effect on sleep may differ depending on whether you have depression or anxiety. In order words, if you have depression, cannabis may help you sleep – but if you don’t, cannabis may hurt.</p>
<h1>Future directions</h1>
<p>Cannabis is still a schedule I substance, meaning that the government does not consider cannabis to be medically therapeutic due to lack of research to support its benefits. This creates a barrier to research, as only one university in the country, <a href="https://pharmacy.olemiss.edu/ncnpr/research-programs/cannabis-research/">University of Mississippi</a>, is permitted by the National Institute of Drug Abuse to grow marijuana for research.</p>
<p>New areas for exploration in the field of cannabis research might examine how various cannabis subspecies influence sleep and how this may differ between individuals. </p>
<p>One research group has been exploring <a href="http://doi.org/10.1016/j.addbeh.2015.06.032">cannabis types or cannabinoid concentrations</a> that are preferable depending on one’s sleep disturbance. For example, one strain might relieve insomnia, while another can affect nightmares. </p>
<p><a href="http://doi.org/10.1016/j.addbeh.2015.06.032">Other studies</a> suggest that medical cannabis users with insomnia tend to prefer higher concentrations of cannabidiol, a nonintoxicating ingredient in cannabis.</p>
<p>This raises an important question. Should the medical community communicate these findings to patients with insomnia who inquire about medical cannabis? Some health professionals may not feel comfortable due to the fluctuating legal status, a lack of confidence in the state of the science or their personal opinions.</p>
<p>At this point, cannabis’s effect on sleep seems highly variable, depending on the person, the timing of use, the cannabis type and concentration, mode of ingestion and other factors. Perhaps the future will yield more fruitful discoveries.</p><img src="https://counter.theconversation.com/content/81661/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Deirdre Conroy does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Many hope that marijuana will help their insomnia. A sleep psychologist examines the evidence.Deirdre Conroy, Clinical Associate Professor of Psychiatry, University of MichiganLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/813292017-09-05T20:08:17Z2017-09-05T20:08:17ZCurious Kids: Why do our brains freak us out with scary dreams?<figure><img src="https://images.theconversation.com/files/180155/original/file-20170728-5404-2f34yj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Dreams are like a forest walkway: there's no clear sense of direction and you can easily get lost.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/ollierb/14758863162/in/photostream/">ollierb/flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span></figcaption></figure><p><em>This is an article from <a href="https://theconversation.com/au/topics/curious-kids-36782">Curious Kids</a>, a series for children. The Conversation is asking kids to send in questions they’d like an expert to answer. All questions are welcome – serious, weird or wacky!</em> </p>
<hr>
<blockquote>
<p><strong>Why do our brains freak us out with scary dreams? – Niamh, 8, Newcastle.</strong></p>
</blockquote>
<p>Great question, Niamh.</p>
<p>Getting a fright from a dream is very normal. But our brains don’t have a secret plan to freak us out with nightmares.</p>
<p>In the olden days, many people believed dreams were a window to another world. People lived two inseparable lives: one in a waking world and the other in a dream world. </p>
<p>They believed the dream world contained a mixture of the past and the future, gods and goddesses, and helped people find purpose with their lives. These dreams often revealed new people and ideas, which explains why some people found them scary. Others saw them as a sign or a prophesy from the gods. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/180485/original/file-20170801-766-gyvwbi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/180485/original/file-20170801-766-gyvwbi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/180485/original/file-20170801-766-gyvwbi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/180485/original/file-20170801-766-gyvwbi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/180485/original/file-20170801-766-gyvwbi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/180485/original/file-20170801-766-gyvwbi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=565&fit=crop&dpr=1 754w, https://images.theconversation.com/files/180485/original/file-20170801-766-gyvwbi.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=565&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/180485/original/file-20170801-766-gyvwbi.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=565&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The dreamcatcher is a Native American invention used to protect people while they sleep.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/bsheets/294218008/">bsheets/flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span>
</figcaption>
</figure>
<p>When scientists first studied dreams, around 200 years ago, they thought dreams were a special type of story that brains told themselves. Scientists thought it was a special language where ideas and emotions were explained using symbols and signs. Different parts of the brain would talk with other parts in this dream state. </p>
<p>If your house was damaged, for example, it was supposed to represent the dreamer, and the brain was trying to tell you that you or your ego had been damaged. Dr Sigmund Freud, seen by many as the founder of psychoanalysis, wrote a very famous book about dreams called “<a href="https://pdfs.semanticscholar.org/a342/beb8bc59dc106f7a7f3f4336a00c0a61ba2f.pdf">The Interpretation of Dreams</a>” in 1900.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/180483/original/file-20170801-12621-762qqs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/180483/original/file-20170801-12621-762qqs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/180483/original/file-20170801-12621-762qqs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/180483/original/file-20170801-12621-762qqs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/180483/original/file-20170801-12621-762qqs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/180483/original/file-20170801-12621-762qqs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/180483/original/file-20170801-12621-762qqs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/180483/original/file-20170801-12621-762qqs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Sigmund Freud wrote a very famous book about dreams called The Interpretation of Dreams.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/Category:Sigmund_Freud#/media/File:Sigmund_Freud_1926.jpg">Wikimedia</a></span>
</figcaption>
</figure>
<p>About 100 years ago, people started to explain things more thoroughly using science and technology. This brought a different way of understanding why things happen. But it doesn’t mean the way other people thought about dreams was necessarily wrong.</p>
<p>There are two main types of sleep, according to scientists, and dreams occur during a stage called REM sleep (Rapid Eye Movement).</p>
<p>REM sleep is when we are most likely to dream. It is called REM because people quickly flick their eyes back and forward while they sleep. </p>
<p>If you watch cats or dogs sleeping, you will sometimes see their eyes moving and their paws twitching. This indicates they are in REM sleep and probably dreaming. But we don’t really know what cats and dogs dream about because they can’t tell us.</p>
<iframe src="https://giphy.com/embed/HhRGUdBJ5RVT2" width="100%" height="270" frameborder="0" class="giphy-embed" allowfullscreen=""></iframe>
<p><a href="https://giphy.com/gifs/dreaming-cat-HhRGUdBJ5RVT2"></a></p>
<p>The other main type of sleep is non-REM sleep, called deep sleep or Slow Wave Sleep (SWS). In this type, people sleep very deeply. But they don’t typically report dreaming. If you try to wake them, they’re often slow and confused. </p>
<p>For the last 50 years, some scientists believed that dreaming was the way brains decide what to keep and what to throw away each day. In a sense, it’s like cleaning your room: your brain decides what you’ll need to know and tosses the unimportant stuff into the bin.</p>
<p>Scientists think young people find it harder to separate the waking and dreaming worlds and often <a href="https://en.wikipedia.org/wiki/Dream">confuse the two</a>.</p>
<p>Filmmakers have taken this confusion to the screen again and again over the years. There are many movies about how dreams can scare and confuse us. </p>
<p>As you can see, lots of people wonder why dreams are scary. The truth is that we don’t know for sure. </p>
<p>What we do know is that all people dream, and all people think dreams can be weird, scary and puzzling at times. We share the ability to dream with all <a href="https://en.wikipedia.org/wiki/Sleep_in_non-human_animals">warm-blooded animals</a>, so it likely has an important function in keeping us healthy. </p>
<p>I suspect everyone tries to make sense of their dreams — even scientists. But we still can’t see inside someone else’s brain to see what they are dreaming about. And that’s probably a good thing.</p>
<p><em>Hello, curious kids! Have you got a question you’d like an expert to answer? Ask an adult to send your question to us. They can:</em></p>
<p><em>* Email your question to curiouskids@theconversation.edu.au
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* Tell us on <a href="https://twitter.com/ConversationEDU">Twitter</a> by tagging <a href="https://twitter.com/ConversationEDU">@ConversationEDU</a> with the hashtag #curiouskids, or
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<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/168011/original/file-20170505-21620-huq4lj.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/168011/original/file-20170505-21620-huq4lj.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=376&fit=crop&dpr=1 600w, https://images.theconversation.com/files/168011/original/file-20170505-21620-huq4lj.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=376&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/168011/original/file-20170505-21620-huq4lj.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=376&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/168011/original/file-20170505-21620-huq4lj.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=472&fit=crop&dpr=1 754w, https://images.theconversation.com/files/168011/original/file-20170505-21620-huq4lj.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=472&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/168011/original/file-20170505-21620-huq4lj.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=472&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption"></span>
<span class="attribution"><a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
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<p><em>Please tell us your name, age, and which city you live in. You can send an audio recording of your question too, if you want. Send as many questions as you like! We won’t be able to answer every question but we will do our best.</em></p><img src="https://counter.theconversation.com/content/81329/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Drew Dawson does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Niamh, age 7, wants to know why we have scary dreams. But after 200 years of study, dreams are still very much a mystery.Drew Dawson, Director, Appleton Institute, CQUniversity AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/647252016-09-09T04:35:39Z2016-09-09T04:35:39ZHow the pain of 9/11 still stays with a generation<p>The Sept. 11, 2001 terrorist attacks were the worst acts of terrorism on American soil to date. Designed to instill panic and fear, the attacks were unprecedented in terms of their scope, magnitude and impact on the American psyche.</p>
<p>The <a href="http://doi.org/10.1037/0022-3514.95.3.709">vast majority (over 60 percent) of Americans watched</a> these attacks occur live on television or saw them replayed over and over again in the days, weeks and years following the attacks.</p>
<p>As we reflect on the anniversary of this tragic event, a question to consider is: How has this event impacted those individuals who are too young to remember a world before 9/11? </p>
<p>As an applied social psychologist, <a href="http://www.danarosegarfin.com/about.html">I study</a> responses to natural and human-caused adversities that impact large segments of the population – also called <a href="http://www.danarosegarfin.com/uploads/3/0/8/5/30858187/vol4_ch29_silver_garfin.pdf">“collective trauma.”</a> My research group at the University of California, Irvine (UCI) has found that such exposures have compounding effects over the course of one’s lifespan. This is particularly relevant for children who have grown up in a post-9/11 society. </p>
<h2>PTSD and Ground Zero</h2>
<p>Many of the outcomes on which my team and I focus involve mental health, such as post-traumatic stress symptoms (PTS) and post-traumatic stress disorder (PTSD). </p>
<p><a href="http://www.ptsd.va.gov/professional/PTSD-overview/dsm5_criteria_ptsd.asp">Post-traumatic stress symptoms</a> include feeling the event is happening again (e.g., flashbacks, nightmares), avoiding situations that remind individuals of the event (e.g., public places, movies about an event), negative feelings and beliefs (e.g., the world is dangerous) or feeling “keyed up” (e.g., difficulty sleeping or concentrating). </p>
<p>In order to meet diagnostic criteria for PTSD, an individual must have been directly exposed to a <a href="http://www.dsm5.org/Pages/Default.aspx">“traumatic event”</a> (e.g., assault, violence, accidental injury). Direct exposure means that an individual (or their loved one) was at or very near the site of the event. It might be somewhat obvious that people directly exposed to a collective trauma like 9/11 might suffer from associated physical and mental health problems. What is less obvious is how people geographically distant from the epicenter or “Ground Zero” might have been impacted.</p>
<p>This is particularly relevant when considering the impact of 9/11 on children and youth across America: Many reside far from the location of the actual attacks and were too young to have experienced or seen the attacks as they occurred. The point is people can <a href="http://dx.doi.org/10.1037/0022-006X.76.4.657">experience collective trauma</a> solely through the media and report symptoms that <a href="http://doi.org/10.1002/jts.20289">resemble those typically associated</a> with direct trauma exposure.</p>
<h2>Impact on physical and mental health</h2>
<p>The events of 9/11 ushered in a new era of media coverage of collective trauma, where terrorism and other forms of large-scale violence are transmitted into the daily lives of children and Americans families. </p>
<p>I have been exploring these issues with my collaborators <a href="http://faculty.sites.uci.edu/rsilver/">Roxane Cohen Silver</a> and <a href="http://www.faculty.uci.edu/profile.cfm?faculty_id=5441">E. Alison Holman</a>. My colleagues surveyed a nationally representative sample of over 3,400 Americans shortly after 9/11 and then followed them for three years after the attacks. </p>
<p>In the weeks and months following the 9/11 attacks, media-based exposure was associated with <a href="http://jama.jamanetwork.com/article.aspx?articleid=195281">psychological distress</a>. This included <a href="http://www.ptsd.va.gov/professional/treatment/early/acute-stress-disorder.asp">acute stress</a> (which is similar to PTS but must be experienced in the first month of exposure), post-traumatic stress and ongoing fears and worries about future acts of terrorism (in the months following the attacks). </p>
<p>These harmful effects persisted in the years following 9/11. For example, the team found <a href="http://doi.org/10.1001/archgenpsychiatry.2007.6">measurable impact</a> on the mental and physical health (such as increased risk of heart diseases) of the sample three years after the attacks. Importantly, those who responded with distress in the immediate aftermath were more likely to report subsequent problems as well. </p>
<p>These findings bear close resemblance to research led by psychologist <a href="http://psychiatry.duke.edu/faculty/details/0098909">William Schlenger</a>, whose team found that Americans who reported watching more hours of 9/11 television in the immediate aftermath of 9/11 were more likely to report symptoms resembling PTSD. For example, those who reported watching four to seven hours were almost four times as likely to report such symptoms <a href="http://jama.jamanetwork.com/article.aspx?articleid=195165">compared to those who watched less</a>. </p>
<p>These findings were echoed in work conducted by <a href="https://www.bu.edu/card/profile/michael-w-otto-ph-d/">Michael W. Otto</a>, who also found that more hours of 9/11-related television watching was <a href="http://dx.doi.org/10.1016/j.janxdis.2006.10.008">associated with higher post-traumatic stress symptoms</a> in children under 10 in the first year following the attacks. </p>
<h2>9/11’s impact on children</h2>
<p>However, it is also the case that studies have found the number of children who reported longer-term distress symptoms to be relatively low. Among other factors, children whose parents had low coping abilities or themselves had learning disabilities tended to report higher distress. </p>
<p>For example, my collaborator <a href="http://psych.uncc.edu/people/gil-rivas-virginia">Virginia Gil-Rivas</a>, who <a href="http://dx.doi.org/10.1002/jts.20277">studied American adolescents</a> exposed to 9/11 only through the media, found that symptoms of post-traumatic distress decreased in most adolescents at the one-year mark. An important finding of her study was how parental coping abilities and parental availability to discuss the attacks made a difference. </p>
<p>Furthermore, children who had prior mental health problems or learning disabilities <a href="http://dx.doi.org/10.1002/jts.20277">tended to be at higher risk for distress symptoms</a>. That could be because children prone to anxiety in general experienced increased <a href="http://dx.doi.org/10.1080/15374410802148145">feelings of vulnerability</a>. </p>
<p>Despite the <a href="http://dx.doi.org/10.1037/a0024619">number of studies</a> that have followed children over the course of several years, no studies have comprehensively examined the long-term impact of 9/11 on children’s development and adjustment. That is because it is difficult to compare American children who lived through 9/11 with those who did not, since almost every American child was exposed to images of 9/11 at some point in time. </p>
<p>This limits the ability of researchers to examine how children’s lives might have changed over time.</p>
<p>However, some researchers believe that even media-based exposure to collective trauma could likely have a longer-term impact on the <a href="http://dx.doi.org/10.1037/a0024619">attitudes and beliefs</a> of those who grew up in a post-9/11 world. It is possible, for example, that exposure to 9/11 and other acts of terrorism <a href="http://dx.doi.org/10.1111/j.1540-5907.2005.00144.x">has led to fears of perceived threats</a>, political intolerance, prejudice and xenophobia in some American children.</p>
<h2>How 9/11 trauma impacts people today</h2>
<p>Years later, a bigger question is: How does the collective trauma of 9/11 affect people today?</p>
<p>Over the past several years, my team and I have sought to address many of the issues that remained unanswered in the scientific literature after 9/11. We sought to replicate and extend the findings initially produced after 9/11 through an examination of responses to the 2013 Boston Marathon bombing, the worst act of terrorism in America since 9/11. </p>
<p>To this end, <a href="http://www.pnas.org/content/111/1/93">we surveyed 4,675 Americans</a>. Our sample was demographically representative, meaning that our sample proportionally matched the U.S. Census data on key indicators such as ethnicity, income, gender and marital status. </p>
<p>This allowed us to make stronger inferences about how “Americans” responded. Within the first two to four weeks of the Boston Marathon bombings, we surveyed our sample about their direct and media-based exposure to the 2013 Boston Marathon bombing and their subsequent psychological responses. </p>
<p>Our study found that as media exposure (a sum of daily hours of Boston Marathon bombing-related television, radio, print, online news and social media coverage) increased, so did <a href="http://www.pnas.org/content/111/1/93">respondents’ acute stress symptoms</a>. This was even after statistically accounting for other variables typically associated with distress responses (such as mental health). </p>
<p>People who reported more than three hours of media exposure had higher probability of reporting high acute stress symptoms than were people who were directly exposed to the bombing. </p>
<p>Then, last year, we <a href="http://dx.doi.org/10.1177/0956797614561043">sought to explore</a> whether the accumulation of exposure to events like 9/11 and other collective trauma might influence responses to subsequent events like the Boston Marathon bombing.</p>
<p>Once again, we used data from demographically representative samples of people who lived in the New York and Boston metropolitan areas. We assessed people who lived in the New York and Boston areas to facilitate a stronger comparison of direct and media-based exposure to 9/11 and the Boston Marathon bombing: people who lived in New York or Boston were more likely to meet criteria for “trauma exposure.” </p>
<p>This study had two primary, congruent findings. First, people who experienced greater numbers of direct exposure to prior collective trauma (e.g., 9/11, the <a href="http://www.cnn.com/interactive/2012/12/us/sandy-hook-timeline/">Sandy Hook Elementary School shooting</a>, <a href="https://weather.com/storms/hurricane/news/superstorm-sandy-anniversary-20141029">Superstorm Sandy</a>) reported higher acute stress symptoms after the Boston Marathon bombings. </p>
<p>Second, greater amounts of media-based live exposure (i.e., people watched or listened to the event as it occurred on live television, radio, or online streaming) to prior collective trauma were also associated with higher acute stress symptoms after the Boston Marathon bombing.</p>
<p>So greater direct and media-based exposure to prior collective trauma was linked with greater acute stress responses (e.g., anxiety, nightmares, trouble concentrating) after a subsequent event. </p>
<h2>Stay informed, but limit exposure</h2>
<p>Overall, our research indicates that the impact on children growing up post-9/11 likely extends well beyond the physical and mental health effects of exposure – be it direct or media-based. Each tragic incident that individuals witness, even if only through the media, likely has a cumulative effect.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/137093/original/image-20160908-25249-lzoe0f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/137093/original/image-20160908-25249-lzoe0f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=429&fit=crop&dpr=1 600w, https://images.theconversation.com/files/137093/original/image-20160908-25249-lzoe0f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=429&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/137093/original/image-20160908-25249-lzoe0f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=429&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/137093/original/image-20160908-25249-lzoe0f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=539&fit=crop&dpr=1 754w, https://images.theconversation.com/files/137093/original/image-20160908-25249-lzoe0f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=539&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/137093/original/image-20160908-25249-lzoe0f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=539&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">People are resilient, but they need to be aware of the potential for distress.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/dvids/4990687967/in/photolist-8B1zEg-o9P5QB-2VZDA9-2VVeti-4pB8f-kAHLQX-akD8ep-ame3o6-am4QmR-fnyKvK-hzH1Uo-7p9WEb-am4yyK-oJTDo1-pGWYHT-2VZDxw-hyiVZA-dfu157-am4E6T-am4RxM-hwUCie-am4vHr-am4LZp-5kRRU5-am7p9Q-2VVevH-5kEtCa-am7s3m-am7k4A-am4kh4-am4Ls6-2VZDjs-u2ZEmQ-5JjbsH-7ZMhfx-7841HP-eMkA8Q-6XCcg9-787URG-oQjvQ2-6C1gop-hAMzpN-2VVeDt-am4Txp-am7ax3-bTVtwr-am7Cab-Curwec-am79UG-kGfxc3">DVIDSHUB</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Nevertheless, the positive finding is that <a href="http://dx.doi.org/10.1037/0003-066X.59.1.20">most people are resilient</a> in the face of tragedy. In the early years following 9/11, several studies examined <a href="http://doi.org/10.1111/j.1469-7610.2006.01664.x">how 9/11 impacted children nationally</a>. Like adults, children exposed both directly and through the media tended to be resilient in the early years following the attacks and symptoms generally decreased over time. </p>
<p>Even so, being aware of the potential for distress through media exposure is important. Even small percentages can have large implications for our nation’s physical and mental health. For example, in the case of 9/11, 10 percent of a nationally-representative sample reporting <a href="http://jama.jamanetwork.com/article.aspx?articleid=195281">post-traumatic stress</a> represents <a href="http://www.census.gov/popclock/">32,443,375 Americans</a> with similar symptoms. </p>
<p>So, people should stay informed, but limit repeated exposure to disturbing images, <a href="http://guilfordjournals.com/doi/abs/10.1521/psyc.65.4.289.20240">which can elicit</a> post-traumatic stress and lead to negative psychological and physical health outcomes.</p><img src="https://counter.theconversation.com/content/64725/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dana Rose Garfin receives funding from the National Science Foundation to conduct this research. </span></em></p>Even indirect exposure to the terrorist attacks of September 11 has left profound and deep impact on those too young to remember a world before that.Dana Rose Garfin, Research Scientist, Department of Psychology and Social Behavior, University of California, IrvineLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/646942016-09-01T09:09:15Z2016-09-01T09:09:15ZMany parents won’t read their children scary stories – but perhaps we shouldn’t blame them<figure><img src="https://images.theconversation.com/files/136098/original/image-20160831-30768-19budnh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Gwoeii/Shutterstock.com</span></span></figcaption></figure><p>As a children’s literature scholar, I’m filled with horror by the results of a <a href="https://www.thebookpeople.co.uk/blog/index.php/2016/08/09/the-baddest-book-characters/">recent survey</a> indicating that over a third of parents avoid reading frightening stories to their children. And as a parent of two small children, the study makes my heart sink and – in the manner of <a href="http://peterandjaneblog.blogspot.co.uk">blogging mother</a> Gill Sims – reach for the gin.</p>
<p>What exactly counts as frightening in a children’s book is a fairly moot point. Parents in the study named the Wicked Witch of the West and Red Riding Hood’s grandmother-gobbling wolf as fitting the bill.</p>
<p>Of course, it must vary from child to child. When I told my six-year-old what I was writing last night (i.e. this), he promptly decided against the poisonous animals section of Creaturepedia for fear of it giving him nightmares – we read about the spiky critters instead. Ernest the Moose, on the other hand, who is so large that his squirrel friend has to construct a fold-out page so that he can fit in his own book, is a source of huge amusement to my three-year-old – but possibly claustrophobia-inducing in another (more empathetic) child. Personally, I find the Cat In The Hat pretty sinister. And the Babar books are also deeply disturbing – in their representation of racial politics.</p>
<p>Fear is a moveable feast, temporally, geographically and culturally. <a href="https://theconversation.com/uk/topics/alice-in-wonderland-14042">Alice of Wonderland fame</a> may be widely regarded as the epitome of innocence and delight but she almost never laughs, is fairly constantly belittled and berated, and spends a good deal of time more or less explicitly contemplating life after death. Reader after reader reports being scared out of their wits by <a href="https://www.britannica.com/biography/John-Tenniel">John Tenniel’s iconic illustrations</a>. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/136139/original/image-20160831-30790-1hv5sd9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/136139/original/image-20160831-30790-1hv5sd9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/136139/original/image-20160831-30790-1hv5sd9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=492&fit=crop&dpr=1 600w, https://images.theconversation.com/files/136139/original/image-20160831-30790-1hv5sd9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=492&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/136139/original/image-20160831-30790-1hv5sd9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=492&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/136139/original/image-20160831-30790-1hv5sd9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=618&fit=crop&dpr=1 754w, https://images.theconversation.com/files/136139/original/image-20160831-30790-1hv5sd9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=618&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/136139/original/image-20160831-30790-1hv5sd9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=618&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">From John Tenniel’s Alice in Wonderland.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:John_Tenniel_-_Illustration_from_The_Nursery_Alice_(1890)_-_c06543_08.jpg">Wikimedia Commons</a></span>
</figcaption>
</figure>
<p>All the (good) deaths and funerals that permeate 19th-century literature must be more troubling in today’s secular society than they would have been at the time. The classic example that does the rounds of the children’s literature world is Mary Martha Sherwood’s <a href="http://www.gutenberg.org/files/29725/29725-h/29725-h.htm">History of the Fairchild Family</a> (1818-1847), famously featuring a father escorting his children to a hanging in order to teach them about the consequences of fraternal discord. Today, even quite young Francophone children can read stories about <a href="http://www.ricochet-jeunes.org/livres/livre/3106-reves-amers">child slavery</a> and <a href="http://www.ricochet-jeunes.org/livres/livre/4171-alerte-au-cyclone">deathly hurricanes</a> and (in picture book form) <a href="http://www.leseditionsdelabagnole.com/fete-morts/dany-laferriere/livre/9782923342276">the day of the dead</a>.</p>
<p>There is certainly no shortage of dark and difficult material in children’s books, even for the very young. Having spent a good deal of my scholarly career on books for children featuring journeys to hell and back (not to mention slavery and sexualised treasure maps), and having recently examined a doctoral thesis on physical, sexual and psychological abuse in French children’s literature, I know that there are no taboos; that nothing is off–limits in books for the young.</p>
<p>And the scholar in me knows that it’s important for children to encounter difficult and challenging material, to confront their fears and anxieties in the space of the book. Quite apart from anything else, being afraid or horrified or disgusted can, in the closed, reassuring world of narrative, be a thrilling and deeply pleasurable experience. </p>
<p>Even when it’s not enjoyable, it’s still vitally important. The inevitable comparison is with forms of physical activity, and, in a health and safety obsessed, no blame no gain culture, the dangers of wrapping children up in cotton wool. Kids need to get stung and fall out of trees if they’re going to build the resources to deal with all the various bumps and knocks and traumas that their lives will throw at them.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/136145/original/image-20160831-30768-ccqrm9.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/136145/original/image-20160831-30768-ccqrm9.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/136145/original/image-20160831-30768-ccqrm9.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=384&fit=crop&dpr=1 600w, https://images.theconversation.com/files/136145/original/image-20160831-30768-ccqrm9.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=384&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/136145/original/image-20160831-30768-ccqrm9.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=384&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/136145/original/image-20160831-30768-ccqrm9.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=483&fit=crop&dpr=1 754w, https://images.theconversation.com/files/136145/original/image-20160831-30768-ccqrm9.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=483&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/136145/original/image-20160831-30768-ccqrm9.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=483&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Gobbled grandmothers too much after an exhausting day?</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:WalterCrane-Little_Red_Riding_Hood-4.png">Walter Crane, Little Red Riding Hood.</a></span>
</figcaption>
</figure>
<p>And I know all this. But as a parent, and especially as a tired working one (what other kind is there?) I can’t help feeling that this study is yet another stick with which to beat already battered and bruised parents. At the end of a long day, having just seen the evening news with all the woes of the world on view, almost the last thing I want to do is deal with death and darkness and destruction when I read my children their bedtime stories. What I want is to be close to them and to share something stupid or funny or beautiful before they sleep. </p>
<p>Perhaps I’m putting my own needs before theirs. Perhaps it will be different when – if! – they read alone. But for the time being, it seems to me that what matters most is the intimacy that reading can generate. A sense of shared pleasure and contact and connection.</p>
<p>There are obviously plenty of other times in the day when books can be pored over. But I’d bet that few really frightening books for children are owned by parents today. Certainly, even in the fairly progressive, cosmopolitan and (I like to think) cultured world my children are growing up in, it’s fairly unimaginable to offer a “difficult” or frightening book to a child as a birthday or Christmas present. There are definitely books I’ve picked up and put back down again, shuddering at what Johnnie’s parents would think about marking their much-loved infant’s birthday with a picture book about the plight of child refugees.</p>
<p>Because of this, tons of ultra anodyne books are littering the homes of flustered and frenetic families today. Children’s books are big business and publishers both cater to and stoke parental anxieties and protectionism. Big companies take punts on “difficult” books less and less, and it’s left to small, imperilled independents to fill these crucial gaps.</p>
<p>And this is one of the many, many, reasons why we should support small publishing initiatives like <a href="http://towerblockbooks.com">Tower Block Books</a>, and why public libraries and independent reading in schools must, categorically, be protected. Books are certainly gifts to the next generation, but they’re not just for Christmas (or birthdays). Parents, publishers and politicians all have their part to play. Children need to encounter all manner of books from all manner of sources dealing with all of the multifarious experiences of life. Children need the books that parents like me can’t themselves always face.</p><img src="https://counter.theconversation.com/content/64694/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kiera Vaclavik does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A recent survey suggests that a third of UK parents avoid reading their children scary stories. Is this a worrying trend?Kiera Vaclavik, Professor of Children's Literature & Childhood Culture, Queen Mary University of LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/602572016-07-18T20:06:43Z2016-07-18T20:06:43ZNightmares and night terrors in kids: when do they stop being normal?<figure><img src="https://images.theconversation.com/files/127027/original/image-20160617-30170-1lf6c9z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Night terrors and nightmares are very different things and need to be managed differently. </span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/clement127/15444970547/">clement127/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p><em>This article is part of our series looking at health conditions in children. Later in the week, we’ll have others about childhood migraines and bed-wetting in older kids. Read yesterday’s article about asthma <a href="https://theconversation.com/do-kids-grow-out-of-childhood-asthma-61277">here</a>.</em></p>
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<p>Two of the most common causes of night waking in children are night terrors and nightmares. Parents often get them confused but they are different, as is how they should be managed. </p>
<p>Before we can understand night terrors and nightmares, we need to understand normal sleep. All children and adults cycle through stages of deep sleep, also known as non-rapid eye movement (non-REM), and light sleep, also known as REM. </p>
<p>We fall immediately into deep sleep where we typically stay for the first few hours of the night. Thereafter, we cycle through deep and light sleep. These sleep cycles last 30-60 minutes in children and around 90 minutes in adults. When we come into light sleep, we can wake up briefly, look around the room, adjust the bedclothes, and if everything is OK, go back to sleep again.</p>
<p>Night terrors and nightmares happen in different parts of the sleep cycle and in different parts of the night. Night terrors usually happen before midnight and occur when the child is “stuck” between a deep and light sleep stage. Their body is therefore “awake” but their mind isn’t. In contrast, nightmares tend to occur after midnight and happen during the light sleep stage, when we do most of our dreaming.</p>
<p>During a night terror, the child has a sudden onset of screaming, can have their eyes open or shut, can breathe rapidly and have a fast heartbeat. They look terrified and can get up and run around. However, because they are not truly awake, children have no memory of the event in the morning. If their parent tries to comfort them with a hug, the child will typically push the parent away.</p>
<p>During nightmares, however, children will usually wake up completely from their bad dream and be scared. They welcome a hug and can remember what happened in the morning.</p>
<h2>Managing nightmares and night terrors</h2>
<p>These differences give us an insight into how best to manage night terrors and nightmares. </p>
<p>For night terrors, parents would do best to check their child is OK (hasn’t got their leg stuck in the cot, for example) and then leave them be if it is safe to do so. Many parents continue to try to comfort their child but this usually results in the child waking up completely and being very confused and hard to re-settle. </p>
<p>Children who are having a nightmare need to be comforted by their parent and returned to bed once they have calmed down.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/127029/original/image-20160617-30196-orw4li.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/127029/original/image-20160617-30196-orw4li.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/127029/original/image-20160617-30196-orw4li.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/127029/original/image-20160617-30196-orw4li.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/127029/original/image-20160617-30196-orw4li.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/127029/original/image-20160617-30196-orw4li.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/127029/original/image-20160617-30196-orw4li.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/127029/original/image-20160617-30196-orw4li.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Children will usually wake up from nightmares, remember the content, and be scared.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/whoisthatfreakwiththecamera/8184672835/">Michael Day/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<p>For almost all children, night terrors and nightmares are a part of normal development and not a cause for concern. Both can run in families. </p>
<p>For some children, who have frequent nightmares and show other signs of distress, such as changes in their appetite or recurrent body pains (think headaches and stomach pains), or who appear withdrawn or upset, nightmares can be a sign something else is going on. </p>
<p>These children should be seen by a health professional, who can work with the child and the family to identify and address underlying issues, such as problems at school with learning or bullying or family problems including violence.</p>
<h2>How to treat them</h2>
<p>Night terrors that persist and occur around the same time each night can be treated with a technique called “scheduled awakening”. This involves waking the child up around 30 minutes before their night terror. This is thought to reset the sleep cycle, thereby helping them avoid getting “stuck” between deep and light sleep stages. </p>
<p>Parents need to persist with this technique for at least three weeks to know if it helps or not.</p>
<p>Triggers common to both nightmares and night terrors include illnesses and lack of sleep. While illnesses are hard to avoid, parents can ensure their child has adequate sleep, starting with a good bedtime routine. </p>
<p>There are many helpful resources on how to help children sleep including the <a href="http://www.raisingchildren.net.au">Raising Children Network</a> and the <a href="http://www.sleephealthfoundation.org.au">Sleep Health Foundation</a>. Ensuring a good nights’ sleep for children can benefit not only the child, but the rest of the family as well.</p>
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<p><em>Further reading:</em></p>
<p><a href="https://theconversation.com/do-kids-grow-out-of-childhood-asthma-61277"><em>Do kids grow out of childhood asthma?</em></a></p>
<p><a href="https://theconversation.com/a-snapshot-of-childrens-health-in-australia-62500"><em>A snapshot of children’s health in Australia</em></a></p><img src="https://counter.theconversation.com/content/60257/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Harriet Hiscock is affiliated with the Sleep Health Foundation (member, GP Education subcommittee) and is an Expert Content Advisor to the Raising Children Network.
Harriet Hiscock has received NHMRC project grants to evaluate sleep strategies for infant sleep problems and sleep problems in primary school aged children and in children with ADHD.</span></em></p>Before we can understand night terrors and nightmares, we need to understand normal sleep.Harriet Hiscock, Principal Fellow, Department of Paediatrics, The University of Melbourne, Murdoch Children's Research InstituteLicensed as Creative Commons – attribution, no derivatives.