Bruce Dow, M.D.

Dreaming and PTSD

There are two current treatments for PTSD that involve dreams.  One treatment is dream revision, the focus of this website.  The other treatment is the anti-hypertensive medication, prazosin, which has been shown to block nightmares (as well as lowering blood pressure).

Some people have low blood pressure to begin with.  They should not take prazosin, since it could lower their blood pressure to levels that might cause them to get dizzy or actually faint and fall down, possibly hurting themselves.

Other people with PTSD are too afraid to examine their dreams in an attempt to change them.  They are advised to try prazosin, as it doesn’t require addressing their dreams at all.  For many people, the combination of dream revision and prazosin works very well.  In such cases, a low dose of prazosin is used, to allow a few nightmares to break through.  These breakthrough nightmares may be less frightening, allowing them to be addressed with dream revision techniques.

Complete recovery from PTSD is possible, using only these two techniques, either separately or in combination.  This seems remarkable, that an entire syndrome of quite devastating and debilitating symptoms can be treated by simply getting rid of nightmares.  A possible explanation comes from recent research studies showing that emotional memories appear to be consolidated (i.e., established in the brain) during sleep episodes involving rapid eye movements, referred to as REM (rapid eye movement) sleep.

REM sleep has been known for more than fifty years (since 1953) to be associated with dreaming.  Recent research evidence suggests that current emotional memories are compared with earlier emotional memories during REM periods, allowing new emotionally challenging situations to be assimilated into the brain’s emotional memory stores.  There is evidence to suggest that these emotional memory stores are situated in a midline region of the brain, known as the posterior cingulate cortex (PCC).

A traumatic experience seems to overwhelm the brain’s emotional memory system, causing the system to break down.  The undigested traumatic memory is then played over and over again as a nightmare.  Changing the nightmare allows it to be digested by the brain’s emotional memory system, restoring the system to its normal operation during REM sleep.  Once emotional memories can be processed again, the person’s waking life gradually returns to normal.  Other PTSD symptoms go away.  The recovery process can be quite dramatic.

A point of caution from my recent experiences with prescribing prazosin.  Although prazosin can be quite effective in blocking nightmares, the nightmares can return with a vengeance if prazosin is suddenly stopped.  Dream revision is preferable to prazosin in that it permanently eliminates a given nightmare.  New nightmares can similarly be permanently eliminated, if and when they occur.  Prazosin is not a substitute for dream revision, but it works faster, may be less stressful to tolerate, and can be a useful adjunct to dream revision.