Fighting Freddy Krueger, “Nightmare on Elm Street” and nightmare disorder

In the newly released remake of “Nightmare on Elm Street” the protagonists try to stay awake to avoid dreaming of the demonic Freddy Krueger. As evident by the high kill-counts in each of the horror film in the series, it turns out they were doing it all wrong.

In real life, people who have recurring nightmares about a menacing figure like Freddy should instead see a psychologist or behavioral sleep specialist. They likely have nightmare disorder, a type of parasomnia.

Nightmares can occur at any age. Children most frequently get nightmares. Only a small fraction of people who get nightmares have the disorder.

Nightmare disorder happens when the horrifying dreams are so frequent it causes you to fear going to sleep. Those who manage to fall asleep end up waking up in the middle of the night terrified. And the nightmares only get more intense as the sleep deprivation adds up.

The problems the teenagers in “Nightmare on Elm Street” face fit this description. Only in their dreams they can die.

Nightmare disorder tends to run in families. In other cases the nightmares are a side-effect of medications.

There are several treatment options available. Counseling is most often recommended. A therapist helps look and confront the thoughts and feelings that are the root cause of the nightmares. Relaxing training may be part of the therapy.

Image rehearsal therapy is another option. It’s a form of cognitive behavioral therapy. Patients record their dreams in a journal, and relive them during the daytime. Through practice, the aim is to confront and disarm the unpleasant elements of the nightmare.

Coincidently, this is how the protagonists of “Nightmare on Elm Street 3: Dream Warriors” defeated Freddy Krueger. They used lucid dreaming to give themselves magic powers to do battle with the ghoul.

Medications are not normally used to treat nightmares. Some researchers believe the drug prazosin can effectively reduce nightmares. The drug treatment would have to be ongoing; nightmares may return after drug withdrawal.

If you think you have nightmare disorder avoid watching scary movies, especially any of the “Nightmare on Elm Street” films. Instead find help at an AASM-accredited sleep center or behavioral sleep specialist near you.

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The real Freddy Krueger, “Nightmare on Elm Street” and sudden unexplained deaths

He visits us in our nightmares. The ghoul wearing a striped shirt and fedora slowly taps his razor-sharp finger knives as he approaches. Anyone who grew up in the 80’s knows his sneering burnt face. Freddy Krueger is a horror movie icon, representing everything we fear in our sleep.

Today a new generation meets the boogeyman for the first time. The remake of “Nightmare on Elm Street” is now open in theaters nationwide.

The movie is getting panned by most major critics. This blogger recommends instead checking out the 1984 original, or the self-aware follow-up "Wes Craven’s New Nightmare," where Freddy haunts the actors and crew behind the first film.

The franchise is about a child murderer who was burned alive by a mob of angry parents and returns to haunt their teenage children in their dreams.

Director Wes Craven reportedly came up with the premise after reading in the news about a group of young Cambodian refugees who, haunted by terrifying nightmares, refused to sleep. The group had escaped the countries genocidal Khmer Rouge regime, only to face those same fears in their dreams while safe in America. This is where it gets chilling -when they gave in and returned to sleep, they died.

Craven described his reaction to the article he read in the Los Angeles Times:

In the middle of the night they heard these horrendous screams and crashings and they ran in and he’s thrashing on the bed. They ran to him and by the time they got to him he was dead. They did an autopsy on him and there was nothing physically wrong with him. And I just thought: “My God.”

Researchers believe the deaths were caused by a mysterious disorder called sudden unexplained death nocturnal syndrome. Otherwise healthy men from Southeast Asian countries ages 20 to 45 years old suddenly die in their sleep.

Some in Thailand and the Philippines believe the incidents are supernatural. A spirit comes to kill them by sitting on their chests while they sleep. This belief is not unlike the “Nightmare on Elm Street” antagonist. To avoid the spectral threat, some Thai men would disguise themselves as women.

Though researchers have offered a variety of hypothesis over the last few decades, none have held up. Many have not been disproven either. Relatives of some of the victims describe hearing a sudden gasp for air, before they died.

In “Nightmare on Elm Street,” the victims tried to stay awake to avoid Freddy Krueger’s nightmare assaults. Coming up Sunday morning on the blog, find out what doctors say they should have done instead.

Image courtesy New Line Cinema

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New PTSD Sleep Clinic Opens in New Mexico

A new PTSD Sleep Clinic is opening today in Albuquerque, N.M. The clinic will target the sleep problems that plague people who have post-traumatic stress disorder.

The clinic is directed by AASM member Dr. Barry Krakow. He is the founder of the Maimonides International Nightmare Treatment Center.

Krakow notes that antidepressant medications may not be the best option for people who have PTSD. And many people with PTSD also have obstructive sleep apnea. This can make their PTSD symptoms even worse.



The AASM reports that recurring nightmares tend to be most disturbing aspect of PTSD. In these dreams the event may be relived in a way that seems shockingly real.

Krakow says that treating sleep problems can greatly reduce PTSD symptoms. Daytime fatigue and sleepiness decrease, and energy levels increase. This provides a boost for the coping skills and motivation needed to tackle the problems related to PTSD.

His clinic uses a variety of techniques to treat PTSD. These include cognitive behavioral therapy, imagery rehearsal therapy and sleep-related emotion-focused therapy.

Last year the Sleep Education Blog reported that imagery rehearsal therapy is helping some people change their nightmares. Yoga also is being used to help soldiers who have PTSD. And a recent study showed that old fear memories can be “updated” to prevent the return of fear.

Read more about PTSD and nightmares.

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Sleep Apnea & Nightmare Recall

A new study examined nightmare recall in people with obstructive sleep apnea. The results were published yesterday in the Journal of Clinical Sleep Medicine.

The study involved 393 consecutive patients at an AASM-accredited sleep center. They were evaluated by an overnight sleep study. Their mean age was 50.5 years with a range of 13 to 82 years. Sixty-seven percent of participants were male.

Severe OSA was common. They had a mean apnea-hypopnea index of 34.9 breathing pauses per hour of sleep. An AHI of more than 30 is considered “severe” OSA.

They were asked about dream and nightmare recall frequency. Recall was considered to be “infrequent” when it was reported once a month or less. Recall was “frequent” when it was reported at least weekly.

Results show that about 52 percent of people reported frequent dream recall. Thirty-four percent reported frequent nightmare recall.

The percent of people with frequent nightmare recall decreased as sleep apnea severity increased. Frequent nightmare recall was reported by 71.4 percent of people who did not have OSA and 43.2 percent of people with mild OSA.

The rate of frequent nightmare recall dropped to 29.9 percent in people with moderate OSA. Only 20.6 percent of people with severe OSA frequently recalled nightmares.

Average sleep apnea severity was much higher in people who reported infrequent nightmare recall. They had a mean AHI of 40.3. People who reported frequent nightmare recall had a mean AHI of 24.6.

“The results were somewhat surprising, since nightmares are frequently reported by patients with sleep apnea,” lead author Dr. Jim Pagel told the AASM.

Pagel suspects that the decline in nightmare recall may be attributed to the sleep fragmentation that is caused by OSA. This leads to a reduction in the nightly amount of rapid eye movement (REM) sleep. REM sleep is the sleep stage when nightmares generally occur.

Treating OSA with CPAP therapy leads to increases in the amount of REM sleep per night. This may cause the frequency of nightmare recall to rise when OSA is treated.

Are you at risk for sleep apnea? STOP and find out. You also can answer these questions on SleepEducation.com to learn more about your risk. Get help for sleep apnea at an AASM-accredited sleep center near you.

Read more about nightmares and about obstructive sleep apnea.

Image by Franco Marconi

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Updating Memories to Prevent the Return of Fear

A new study shows that old fear memories can be “updated” to prevent the return of fear. The discovery is promising for the treatment of post-traumatic stress disorder.

"Our results suggest a non-pharmacological, naturalistic approach to more effectively manage emotional memories," study co-author Elizabeth Phelps, PhD, said in a press release.

The researchers used mild wrist shocks to condition participants to fear colored squares. A day later, the memory was reactivated.

Participants were re-exposed to the feared squares. This was followed by extinction training. They were repeatedly exposed to the colored squares without shocks.

The fear response was banished only if extinction training followed soon after the fear reactivation. This “reconsolidation window” appears to last for about six hours after the fear is reactivated.

During this time an old memory can be “rewritten.” It can be updated with non-fearful information.

"Timing may have a more important role in the control of fear than previously appreciated," said Phelps. "Our memory reflects our last retrieval of it rather than an exact account of the original event."

The study also found that the technique had a long-lasting effect. Fear responses were no longer expressed when tested one year later.

The AASM reports that recurring nightmares tend to be most disturbing aspect of PTSD. In these dreams the event may be relived in a way that seems shockingly real.

Earlier this year the Sleep Education Blog reported that playing the computer game Tetris can reduce unwanted “flashbacks.” Last month the blog noted that imagery rehearsal therapy is helping some people change their nightmares.

Learn more about sleep and memory.

Image by Stu Mayhew

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Changing Nightmares: Imagery Rehearsal Therapy

“Your Health” columnist Kim Painter reports in USA Today that imagery rehearsal therapy is helping some people change their nightmares.

This method is just one form of cognitive behavioral therapy. A variety of CBT techniques have been used to reduce nightmare frequency.

One method is to record your nightmares in a diary. Relaxation exercises also may be helpful. Exposure techniques involve “reliving” a nightmare in your imagination during the daytime.

Cognitive-restructuring techniques involve changing a nightmare. One technique is lucid dreaming treatment; you change the nightmare as it occurs during sleep.

Imagery rehearsal therapy involves changing the nightmare while awake; you “rehearse” the new version in your mind during the day.

The first step is to write down a recent nightmare. Then you change the nightmare. Usually you change it to a more positive version.

You write down this new version. Then you rehearse it in your mind daily; you imagine the imagery of the changed nightmare.

In 2008 a review in the Journal of Clinical Sleep Medicine noted that CBT has become the treatment of choice for nightmares. It reported that imagery rehearsal therapy and exposure are effective at reducing nightmares; the methods also reduce other sleep complaints and mental distress.

The authors noted that the drug prazosin also may be effective at reducing nightmares. But it appears that treatment requires ongoing use of the drug; nightmares may return after drug withdrawal.

One of the review’s co-authors was sleep specialist Dr. Barry Krakow. He is founder of the Maimonides International Nightmare Treatment Center in Albuquerque, N.M.

In 1992 Krakow and colleagues at the University of New Mexico published a study of imagery rehearsal therapy in the journal Sleep. They found that the therapy reduced nightmare frequency by 72 percent.

Nightmare rehearsal was first reported as an effective treatment option in a 1978 case study. The method was adapted into an imagery rehearsal technique at the University of New Mexico; the first case studies were reported in 1991.

In June the Sleep Education Blog reported that imagery rehearsal therapy also can be helpful for children with nightmares. Learn more about dreams and nightmares on SleepEducation.com. Get help for nightmare disorder at an AASM-accredited sleep center near you.

Image by Cornelia Kopp

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Children, Media Violence & Nightmares

Just in time for Halloween, the thriller Paranormal Activity and horror flick Saw VI topped the box office charts last weekend. The House of the Devil opened on Friday.

They’re the kind of movies that the American Academy of Pediatrics wants parents to help their children avoid. The AAP has just released a revised policy statement on media violence.

It reports that the average young person will have viewed an estimated 200,000 acts of violence on TV by the age of 18 years. That doesn’t include exposure to violence in movies, music and video games.

Does this exposure to violence have an effect? The statement reports that it has been linked to a variety of physical and mental health problems in children and teens. This includes fear, depression, nightmares and sleep disturbances.

The AAP recommends that parents make thoughtful media choices that limit violent content. Parents should view and discuss programs together with their children.

Parents also are encouraged to limit their children’s screen time to one or two hours per day. This includes time watching TV and videos, playing video games and surfing the Internet.

The AAP also advises parents to keep the TV, computer and video games out of children’s bedrooms. It reports that children with a TV in their bedroom watch an additional hour of TV per day.

Children also are likely to sleep better in a media-free room. In March the Sleep Education Blog reported that sleep problems often occur when children have a TV in their bedroom.

When nightmares do occur, parents can provide comfort and reassurance. Learn more about nightmares and children.

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