When Dreams are NOT So Sweet

Have you ever been startled out of a deep sleep by a crying child? The first few times this happens, we parents levitate out of bed with our heart pumping and adrenaline surging, ready to do battle to protect our offspring. Parents are ever diligent during the day to make their children’s world as safe as possible. We hold their hands while crossing the street, we child proof our homes, we make sure their daytime care facilities – be it daycare, babysitter or school – are a safe environment. And at night, we tuck them in their warm and cozy beds with a full tummy and a gentle kiss on the forehead. Then we allow ourselves to relax, enjoy adult company and finally sleep before we have to do it all over again the next day.

Then the nightmares begin. For most children, nightmares are occasional incidents that can often be attributed to a specific event, or to an overtiring and difficult day. Sometimes we never know what triggered them. We are just glad they don’t happen very often.

Are nightmares normal? It certainly looks that way. Most children will have some experience with them. Nightmares may be the brain doing some extra work, below the level of full consciousness, to work through a stressful situation from their day. We all need time to process difficult issues and sometimes nightmares are a side effect of that healthy process. When the nightmares happen more often, this could be a sign that the child is not coping well with something stressful. The nightmares continue, increasing in frequency, as the child tries and fails to resolve the stressful issue.

How can we help our crying child in the middle of the night? Alan Siegel, Ph.D. from Cappella University suggests the four R’s for nightmare relief.

Reassurance that they are not alone, that they are safe and that it is OK to talk about their dream is the most important first step. Give your child a hug and let them know that you understand about nightmares and that everyone has them. Then discuss the dream.

Rescripting how the dream ends after you’ve gotten the details of the actual dream is like assertiveness training for the imagination, (according to Gordon Halliday, see reference below). Encourage your child to use their imagination in changing the scary parts and rewriting the ending where they are in control of the situation. Put that dinosaur in time out, tell that tiger, “bad kitty!” and make him turn into a kitten, or shout, “Boo!” to the ghost and scare him away. But be cautious about using so much imagination here that the nightmare’s message or warning of a possible coping problem goes unanswered. And certainly, don’t be so creative that you end up creating your own nightmare scenario!

Rehearsal goes a step beyond the new endings we imagined in rescripting. We go over the dream again with our new solution, and then we apply that tool to a similar situation.

Resolution involves getting to the root of the matter. Or what caused the nightmare in the first place. If the child had difficulty with a similar situation the previous day, ask them how they would now change that outcome? And remember that children will only talk about the scary stuff when they feel safe enough to relive it in the retelling. Writing, art work, or creating a play or story are good alternate ways your children can express their fears.

So what do we do when nightmares occur too frequently? When the nightmares are consistently violent or disturbing, when they just won’t go away no matter what you try, it may be time to turn to an expert. Your pediatrician can rule out any side effects from prescription drugs or any physical condition that may be triggering the nightmares. After the physical aspect has been ruled out, a behavioral health specialist should be consulted.

Now, as a practicing psychologist, I can tell you that I have also used some of these same procedures, very slightly amended, to help older children and adults as well. So, keep that in mind if you have your own issues with troubling dreams. Hopefully, this little ditty on nightmares will help you and help our little ones sleep like the proverbial baby.

Pleasant dreams.

Thanks for reading and please leave a comment on your own experience with childhood nightmares.

References for this blog:

Dreamcatching: Every Parent's Guide to Exploring and Understanding Children's Dreams and Nightmares by Alan Siegel and Kelly Bulkeley. Published by Random House's Three Rivers Press. Copyright © 1998.

"Treating Nightmares in Children" by Gordon Halliday in Charles Schaeffer, (editor) Clinical Handbook of Sleep Disorders in Children (New York, Jason Aronson, 1995)

Problems with your “Z’s”: New research on treatment of persistent insomnia – help is more than just medication.

The May 20th issue of JAMA (Journal of the American Medical Association) includes an article on treatments for persistent insomnia. Insomnia is the most common of all the sleep disorders and is described as having problems with the ability to gain sufficient sleep or to feel rested and characterized by difficulty getting to sleep or staying asleep. Insomnia may be situational, recurrent, or chronic. Most people know if they have problems with sleep, and most of us have had personal experience with occasional bouts of insomnia.

Lack of adequate sleep over time, or persistent insomnia, can have a very big impact on daily functioning; it will lower your quality of life and can contribute to various health and emotional problems. When untreated, insomnia can also contribute to major depression and other physical problems. When you get behind the wheel with not enough quality sleep, you not only put your life at risk, but those around you as well. A large number of auto accidents are attributed to driving while drowsy. Although it may be tempting to use alcohol as a sleep aid, it will work in the opposite way and create insomnia and other health-related issues as well. And…of course this will not help your driving either!

Here are some sleep-promoting tips that can work well to help you get into a healthy sleep routine:

1. Maintain a regular bedtime and awakening time schedule including weekends. Get up about the same time every day, regardless of what time you fell asleep.
2. Establish a regular, relaxing bedtime routine. Relaxing rituals prior to bedtime many include a warm bath or shower, aroma therapy, reading, or listening to soothing music.
3. Sleep in a room that is dark, quiet, comfortable, and cool; sleep on comfortable mattress and pillows.
4. Use your bedroom only for sleep and sex. Have work materials, computers, and TVs in another room.
5. Finish eating at least 2-3 hours prior to your regular bedtime.
6. Avoid caffeine within 6 hours; alcohol & smoking within 2 hours of bedtime.
7. Exercise regularly; finish a few hours before bedtime.
8. Avoid naps.
9. Go to bed only when sleepy. Lay in bed only for sleeping, not for work or watching TV.
10. Designate another time to write down problems & possible solutions in the late afternoon or early evening, not close to bedtime.
11. After 10-15 minutes of not being able to get to sleep, go to another room to read or watch TV until sleepy.

This latest research in JAMA shows that CBT (Cognitive Behavioral Therapy), a structured form of psychological treatment that focuses on modifying thoughts and behavioral patterns, was effective for treating persistent insomnia. The addition of a sleep medication to CBT treatment like zolpidem (generic name for a prescription sleep medication) produced some benefits, although such benefits were modest to treatment outcomes. Such findings suggest CBT may provide an added benefit in treatment of insomnia.

Since you are awake anyway, sign on and leave a comment about how your sleep is going. All comments from those who are sleep-deprived and others are always welcome. Sweet Dreams!

When Pigs Fly: Dealing with the Swine Flu Jitters

Remember the old adage, "that'll happen when pigs fly"? Well, the swine flu is floating around.... Does that count?

If so, we have nothing to worry about with the swine flu; it's merely a symptom. The real things you need to worry about are all of the "that''ll never happen" things that are about to come true. Like Carrot Top winning a Nobel Prize or the Rams winning the Superbowl, or a black man being elected president. Oh wait, that's already happened and I voted for him. See? It's already started. What will happen next? Will Angelina stop adopting kids?

I think it's time to put the swine flu epidemic in perspective. According to a recent WebMD article: In a typical U.S. flu season, an average of 36,000 people die of flu or flu complications, and about 200,000 people are hospitalized.

Swine flu hasn't come anywhere close to that. Swine flu has sickened at least 141 people in the U.S. and 365 people worldwide, according to the CDC and World Health Organization's tally of lab-confirmed swine flu cases as of Friday, May 1.

Here in Arkansas at UAMS there has been such a run on Tamiflu prescriptions, an anti-viral medication, that all physicians have been requested to think very carefully before giving in to patient hysteria when prescribing this medication. Predictions are that much of the Tamiflu prescribed will never be taken, but it is removing significant numbers from pharmacy shelves which may be detrimental in the future should we need it. So far, there are no reported cases in Arkansas.

So how do you stay informed without letting the hysteria take over your life?

Adopt Rational Measures

· Hand washing. Mom always said, “Wash your hands” because she knew it prevents more illness than any other single proactive thing you can do to keep yourself healthy. But we don’t want to tip the scales into obsessive compulsive behavior. Wash your hands as needed relative to your situation and exposure. If you have minimal contact with others at work, you are not at as great a risk as someone in the health, school, nursing home or daycare industry.

· Cover your mouth. Another gem from Mom. It is common courtesy to cover your mouth when coughing or sneezing, then go back to the first example given here and wash your hands.

· Avoid sick people when you can. You can’t avoid your sick husband or two year old, but if someone is hacking up a lung in isle three, use isle seven to get to the milk.

· Go home if you’re sick. Don’t expose everyone else in the office just because you have to update your spreadsheet. It is much more cost effective for you to miss a day than the entire office.

Restrict Media Exposure

· A little bit can go a long way. The best way to scare yourself about anything is to become an expert on the subject. Too much information can generate its own anxiety. Only read what you need and leave the technical stuff to the experts who get paid to worry.

· Be a good role model for your children and grandchildren. Your role is to take care of them and make their world a safe and secure place. So if they see you watching CNN all day long willing to drop everything when they announce an update, children will take that fear you are demonstrating and multiply it out of orbit. Do not transfer your fear into your child’s anxiety. Unless you like staying up with a four year old too afraid to go to sleep because the swine flu might get them.

The bottom line is stay informed, but stay sane in how you go about it. Keep your update watching in moderation and take normal precautions with the health of yourself and your family. Yes, moderation works for swine flu fear too.

And since we are in Arkansas and our favorite football team is the Razorbacks, I’d like to add that the only swine you should fear is on the football field, “GO HOGS!”

Finding Quality Mental Health Treatment: Voodoo Science

The Wall Street Journal posted an article reporting that primary care physicians have difficulty getting mental health services for patients. One blogger rightly mentioned that mental health treatment is still considered a ‘voodoo science’ even in the medical community. Great Point! Let’s face some other hard facts.

Overburdened PCP’s have been asked to handle mental health issues for too long

Mental health treatment has the stigma of a second class citizen in the medical community

Many educated persons can’t tell you the difference between a psychologist, psychiatrist, and a social worker

Mental health treatment is shunned by insurance companies

Few patients can pay for mental health services

It is no wonder that services are under-funded and quality mental health providers are hard to find. Based on these facts, anyone going into the mental health field should have their head examined.

We need to face the fact that relationship problems, community violence, job loss, financial stress and depression are increasing along with mortgage foreclosures. There is a lot more to do in dealing with these problems than reaching for Prozac! Most mental health patients get very little in the way of targeted treatment, and often receive a treat ‘em and street ‘em approach characterized by promiscuous prescribing practices and embarrassing treatment outcomes if not outright fraud.

The Mental Health Parity Act promises better days ahead, but it is no bail-out. In fact, it will be a while yet before anyone can receive help. The parity act has been delayed until 2010.

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