Reducing nightmares as a cause area
I am someone who suffers from truly terrible nightmares. I’ve spent many hours running from murderous villains, being killed by monsters, and being forced to watch my loved ones suffer. If you haven’t had a vivid nightmare, you must understand that they feel 100% real. And if you’re open to the idea that every moment of experience matters, even when we’re asleep, then you’ve gotta care about nightmares.
To me, nightmares fit the classic EA criteria of being important, neglected, and tractable.
Nightmares are Important
Nightmares tend to have a negative affect on those who experience them. When they are related to PTSD, they lead to “decreased psychological and physiological functioning.” Other studies link them to “waking psychopathology.” And they negatively affect overall sleep quality.
According to the American Academy of Sleep Medicine, 50-85% of people have the occasional nightmare. (They don’t give a source for that though 🤨)
One thing researchers seem to agree on is that traumatic life experiences cause nightmares. I think it’s safe to assume that there are millions of people around the world suffering through traumatic experiences on a semi-regular basis. How tragic that these people don’t just suffer while awake, but also must be terrorized in their sleep.
As for me, I’ve seen and done things in nightmares that are so horrific that they leave me shaken throughout the day. I can’t even tell most people about them because I feel like they’d look at me differently. I can’t go into my tech job and be like, “I don’t think I’m going to be as productive today because I just had to guillotine my little sister in a dream and it felt very real and it’s kind of messing with my head.”
And I’ve lived a pretty sheltered life! I can’t imagine what I’d be like if I fought in a war. Someone who goes off to battle and then gets nightmares of being back on the battlefield really, actually suffers during those dreams. Night after night after night.
I keep hammering the point about the suffering being real because I think it’s easy to dismiss nightmares as little aberrations that can be easily shrugged off. It feels like the cultural consensus around nightmares, at least in the USA, is,”It didn’t really happen, so what’s the big deal?” Or people will say, “They serve an evolutionary purpose.”
I want to be like, you don’t get it. What happened in that nightmare really did happen to me! And there are a whole bunch of quirks of evolution that cause for needless suffering. I put nightmares into the category of things we should fight to get rid of, evolution be damned.
Finally, if you buy into the idea that suffering is on a log scale, then it might be really, really bad to be a soldier who has to relive their torture several times a week.
Nightmares are Neglected
I searched the EA forum for posts on nightmares and didn’t find a single one. Anecdotally, when I bring this up with people they seem highly skeptical that nightmares are a problem. Perhaps I’m the crazy one, or maybe they’ve just never had a bad enough nightmare.
The Nightmare Problem is Tractable
From what I can tell, Imagery Rehearsal Therapy shows great promise (68% of subjects in one study decreased their nightmares), so perhaps finding ways to publicize that treatment more would have a big effect.
What if someone made a free website or app that walks people through the steps of imagery rehearsal treatment? Seems relatively low effort with a potentially high payoff.
What I’d like to see
Clearer research into how many people suffer from nightmares, and how bad that suffering is
Clearer research into ways to prevent nightmares.
We should eradicate the worst forms of nightmares
I know this might seem a little wacky. I’m not trying to pretend that having a nightmare is as bad as dying of a tropical disease or suffering from malnutrition. But if we’re talking about mental health problems that might be overlooked and that are affecting the quality of life of billions of people, I think nightmares are a problem worth addressing.
Thank you for joining the forum to share this. I am sorry to hear about your nightmares. I also suffer from terrible nightmares at times. It’s very dispiriting. I hope that someone gets around to working on this eventually, even if it never makes the cut as a top cause area.
Sorry to you as well. A brutal nightmare is dispiriting indeed. I totally agree, I hope there is an effective, low-risk, pharmaceutical + therapy combo that can knock out the worst of these things.
What is very interesting to consider is that we forget most of our dreams, including nightmares.
Consequently, it may be the case that a tremendous amount of negative subjective experience is transpiring without being remembered… One can imagine that many people go to hell for some period of their slumbers, migrate to subsequent dreams, and they have no memory of many of the horrid experiences they had.
Also brings to mind the differences between the experienced life and the remembered life discussed by Kahneman in Thinking Fast and Slow.
It is a bit curious that the exploration of the dreamscape hasn’t been more thoroughly ventured by EAs, given their proclivity for being willing to consider out of the box subject matters and, cumulatively, so much time is spent in dreams.
Makes you think—it’s at least 1.66x as important as we usually think to be mentally healthy and able to flexibly and skillfully respond to distress if we need those skills when we’re asleep too. Maybe more important than that if we deal with more extreme and less reality-constrained challenges in sleep!
Nitpicking, but don’t you mean 1.5x as important? If we neglect 8 hours of sleep, there are 16 hours of daily experience. If we include 8 hours of sleep, there are 24 hours of daily experience. And 24 is 1.5x as large as 16.
I love your thinking here. I was only considering dreams people remember. Now I’m wondering what affects a dream can have even if it’s forgotten, kind of like how things that happen to babies can affect them even though they can’t remember them, as MichaelStJules notes in an above comment.
Yes, the effects of forgotten dreams is an interesting matter to be considered. But even if there are no negative long-term consequences associated with forgotten nightmares, the negative subjective experience still has significant disvalue. Bad experiences are bad for their own sake, and not just as a function of how they contribute to later dysfunction.
Quick thoughts:
I like how novel this idea is.
I have never had a nightmare that bad, I it must be terrible to have them frequently. I feel like my nightmares are like a stubbed toe (I get one every few years, it sucks, and then I get over it) while yours are… well: really bad.
I think that my main concerns at this point are about intensity and frequency of nightmares. Not all nightmares are equally intense, right? Maybe 85% of people have occasional nightmares of low impact/intensity, and 0.001% of people have occasional nightmares of high impact/intensity (such as what you describe from your own experience).
Is nightmare intensity inversely related to frequency in the population? My assumption is that most people have occasional nightmares, but within 60 seconds of waking up these people can get on with their day. I’d want to see more information about intensity and frequency of nightmares before endorsing.
What about the existing medical system? In a developed country are there treatments/interventions that a person can get? If I go to a doctor and describe terrible nightmares, will I be referred to a sleep specialist who will give me what I need to solve the problem?
It seems similar to saying that “physical health” is important. That statement is true, but there is a vast variety in the types of physical health ailments that people suffer from. Preventing different specific issues would need different interventions, which would have different cost-benefit ratios.
First off, thanks!
I agree that not all nightmares are equally intense. But I bet it’s more than your suggested 0.001% of people that occasionally have really awful ones.
I just did a quick Reddit search and found several long threads with hundreds of comments where people describe awful nightmares they’ve had. Examples:
“Had one where my skin was falling off and I kept trying to keep it on by sewing it.”
“I dreamed that I was a young Harry Potter and found out that Voldemort was trying to kill me every night by cooking me (as if the bed were a stovetop)”
”I dreamt that I fell off a cliff and slamed onto the ground. That was scary, but usually falling/dying wakes me up. This time I kept dreaming as a ghost after I had died.”
What about the existing medical system? In a developed country are there treatments/interventions that a person can get? If I go to a doctor and describe terrible nightmares, will I be referred to a sleep specialist who will give me what I need to solve the problem?
As discussed in other comments and in the ACT post, there does seem to be some promising pharmaceutical treatments, but they have not-so-great side effects.
I forgot to mention that I know a lot of people who regularly consume THC/cannabis who say that they no longer even dream, and so they don’t have nightmares either. Maybe that’s something to explore further for people who are really struggling with nightmares.
It seems similar to saying that “physical health” is important. That statement is true, but there is a vast variety in the types of physical health ailments that people suffer from. Preventing different specific issues would need different interventions, which would have different cost-benefit ratios.
I don’t think I agree, assuming I understand your argument. If we’re taking the worst nightmares, I see seeking treatment to be more akin to going to a doctor and saying, “I have really bad low back pain.” The medical systems isn’t great at addressing nightmares or low back pain, but both are very common and make up their own category of thing.
(also sorry for the bolded quoting, every time I try to quote it puts all text in a quote and I can’t figure out a better solution right now)
The cannabis claim you made sounded interesting to me since I have heard comparable stories.
However there are usually quite a bit of unbacked myths circulated so I did some (shallow) research.
These two sites did mention the phenomena of weed use reducing or even eliminating dreams, however they both reported users experiencing extra vivid dreams whenever they stop their (heavy) cannabis use.
This paper could be used as tentative evidence that higher dosage CBD might also repress REM sleep. CBD being the non psychoactive component of cannabis it is usually legal and easy to access.
A literature review did find that THC use has been proven to help with nightmares suffered by those with PTSD. It also mentioned that during withdrawal more vivid dreams were found in one study, and that overall sleep is more disturbed.
One study found that this disturbed sleep reduced REM sleep, which should also reduce dreams.
However, another found an increase in REM sleep.
I hope to have been of at least some service.
Feedback welcome
The likelihood of having a strong rebound effect when stopping THC use seems really bad, thanks for pointing it out. There’s definitely a lot to explore in this area.
I think it would be interesting to see statistics on this. Some examples could be: What frequency of people suffer from nightmares? How do they rate it on an intensity scale? What’s the proportion for whom nightmares affect their everyday living? Are there DALYs associated with nightmares (probably such data won’t be available, but it could be interesting to explore)?
The data might come from either current studies or from future ones that you/others might want to conduct.
ACT recently did a write-up on nightmares if you’re interested!
Wow, I thought I kept up on everything ACT related so I can’t believe I missed this! Thanks for sharing. There’s super interesting stuff in there. I’m glad he also mentions image rehearsal therapy so that I don’t feel way off base mentioning it in my post. I need to read more about the pharmaceutical treatment (prazosin) he mentions as being the standard of care.
Honestly, I’m glad I never read the article because it probably would have dissuaded me from posting here. I would have thought, “Well what’s the point of writing about something Scott already covered.” But that’s not the right attitude! We need a multitude of voices pushing things forward, even if some voices are far less talented at writing than others :)
My story: I had terrible ‘ PTSD type’ nightmares after a home invasion in 2016. (I woke with a man standing over me, stealing my wedding ring and phone off my bedside table, I was pregnant and my toddler was in the next room. Alex chased off the guy). The nightmares lasted for 5 years, and would be worse when I was generally more worried in life. It sucked, but I was still able to be a functional professional.
Last year, after breaking my bedside lamp one night during a nightmare, I read The Body Keeps The Score and decided to try EMDR (Eye Movement Desensitization and Reprocessing). I did 8 sessions and it totally worked—from 8⁄10 bad to 1-2/10 bad. My situation of an isolated trauma works best for this tool, apparently. The sessions were exhausting, but I’m so glad I invested in solving the problem.
I hope me sharing this helps someone.
Thanks for sharing. I’m so glad you were able to find relief. I’ll have to take a closer look at EMDR.
I started reading The Body Keeps the Score a couple years ago but set it aside because the writing style grated on me. Maybe I should give it another go.
Thanks for this post! You might be interested to read Eric Schwitzgebel’s “Dream Argument” against utilitarianism:
I was puzzled at the time by his second premise. I don’t know how tractable the issue is, but if our dream experiences can be significantly improved at low cost, then I would have thought that well worth doing.
I agree that it’s weird to discount experiences in dreams. I haven’t read that paper, but if we have genuine conscious preferences or pleasure or suffering in our dreams, then I imagine arguments that dreams don’t matter will prove too much:
If they don’t matter because we usually don’t remember them or they don’t really affect what happens after, then we don’t remember anything after we’re dead and life doesn’t really affect us after death, and so by a similar argument, what happens in our lives before death doesn’t matter, and nothing matters!
If they don’t matter in themselves because we’re not sufficiently reflective during them (but still assuming conscious experience), then nonhuman animals and certain humans are also not reflective enough to matter in themselves. Also, some extremely intense experiences, possibly torture or panic, may prevent reflection, but I wouldn’t be indifferent between them and unconsciousness, even setting indirect effects aside.
I also think the same way about infants’ experiences. I don’t remember anything from before around 3 or 4 years old, but that doesn’t mean my first 3 years of life didn’t matter to me at the time.
Maybe there are other important arguments I’ve missed, though. Maybe reflective preferences matter more in humans, but I would give intense suffering without reflection more weight.
(Of course, OP is also concerned with the effects of dreams on wakeful life.)
I agree with everything you said Michael. And this makes me think of the hernia operation that I can no longer remember. My mother told me that the doctor said he would give me some anesthetic. But I was still tied up by adhesive tapes and I was struggling violently during the operation, so much that the bruises on my limbs are still there after a week.
I really enjoyed the Schwitzgebel post, thanks. When he says “We don’t really care that much about our hedonic states in sleep” it reminded me of the TV show Severance.
In the show (minor spoilers) a group of people get a procedure so that their working self has no memory of their self when they are not at work, and vice versa. The selves that work are treated almost like slaves by the selves don’t work, even though it’s technically the same person.
It’s weird to imagine that there is one version of me that routinely goes through torturous experiences. Meanwhile, the awake version of me is mostly just like, “Meh, whatever, dream Drew has been bitten by poisonous snakes before, one more time won’t hurt him.”
For what it’s worth, I think Schwitzgebel’s premise makes more sense in the case of good dreams than bad dreams. In particular, it is intuitive to many people that positive fulfillment requires not just positive feelings, but also the appropriate grounding for these feelings—i.e. if your child died and someone gives you a shot that causes you to be thrilled about it, intuitively this is not good for you. On the other hand negative experiences don’t seem to have this same requirement, if your child is alive, and someone gives you a shot that makes you miserable about this, that is still bad for you even if it is not properly grounded in this same way.
In the case of dreams you could imagine a more direct connection, for instance if you improve your “dream life” that might mean giving yourself a sense of accomplishment you re-evaluate the overall quality of your life through, a sense of how well your life is going that is actually hollow and will either be forgotten, or cause regret on waking. Personally I’m not compelled by this very much either and think it actually would be a good thing to enhance one’s dreams to be even more positive, but if this is ultimately what is behind Schwitzgebel’s intuition, then it doesn’t undermine the case for reducing nightmares. I think it is actually pretty hard to come up with a compelling theory of value that would rule out the value of reducing nightmares.
For my own part I can’t relate very much because I rarely have nightmares and usually wake up from those I do have quickly, but I’m very sorry to hear the author does, and I can imagine this issue has gotten ignored for mostly very poor reasons. I’m excited to see more work done on it.
I’d be interested to here your views beyond suffering/pleasure on how the cognitive benefits could fit in here given that these could translate into useful abilities in waking life:
normal dreams are important for processing of experiences, memories, etc.
some evidence that lucid dreaming can improve motor performance in real life (not sure how robust)
likewise I’d expect there to be creative utility to influence a world without physical limitations (not dissimilar to video games)
Couldn’t resist clicking on this!
Going to put forward a provocation here: If nightmares are an expression of trauma, then wouldn’t it make most sense to target the root cause of poor mental health/trauma/PTSD?
Another provocation: can nightmares (presumably those not routed directly in a deeply traumatic event) be positive in anyway? One theory is that nightmares simulate threats and act out scenarios which could provide a survival benefit.
This leads me to a really interesting question - can nightmares (and dreams) be influenced to play an important role in healing trauma? Could teaching people to lucid dream give a person a sense of control again?
Thanks for sharing this very original idea! I’m somewhat sceptical of the intervention you mention but it definitely seems like a large and neglected issue.
What makes you skeptical of the intervention?
Thanks a lot for this post. Some quick thoughts:
I appreciate this post! It’s creative and interesting
I wonder if other people looking into image rehearsals or other nightmare-reducing interventions can create some Fermi estimates of cost-effectiveness so we can evaluate it against other global health or mental well-being intervneitons.
Personally, my rate of nightmares went way up when I started taking melatonin for sleep (and then settled down to an okay equilibrium after I switched to the .3 mg version)
Presumably there might be a bit of symmetry with really good dreams. If reducing nightmares is good, it might also be especially valuable to teach ways to have really good dreams.
I’ve always heard that it was hard to get what you called imagery reversal therapy because not many are trained in it, so I like this idea! Maybe you could persuade people who want to make yet another meditation or CBT app to try this instead, or for this to be added to an existing CBT app.
And I love that you started with the most rough and ready possibility, literally just describing the steps and making them available. Is this something you could do? Could you oversee a bright high schooler as they did it over the summer?
Thanks, yeah, I think starting with the simples possible thing is usually a good idea.
Unfortunately, I could not build the app myself nor could I supervise a bright high schooler building it. But I am brimming with enthusiasm and would love to help out in other ways if I could!
I just got a forum DM from an EA-aligned mental health charity saying they might be able to recruit volunteers to build some digital tools to help in this space. I look forward to having a call with them and seeing how I can contribute.
I’ve worked in tech basically my whole career but it’s always been on the growth/sales/marketing side of things.
Oh and thanks for calling out my mistake on imagery reversal / imagery rehearsal, that is now fixed that in the post.
This is a fascinating topic, and I’d be interested in the feasibility of other interventions to improve the quality of our dream-lives (lucid dreaming can also be extremely pleasant!).
I’m uncertain about how intense, relative to waking, is our conscious experience of dreams. I think a less vivid experience can justify a discount.
I think I would trade several dreaming hours of 9⁄10 for a waking hour of 9⁄10 pleasantness. This may be biased by my poor memory of my dreams. Maybe I’d make the same tradeoff if asked while in REM. I’ve also had a friend tell me she’d trade half a day to prevent an hour of her nightmares, which is troubling.
Would anyone else chime in on how they’d make this tradeoff from a completely self-interested hedonic perspective?
I think it’s telling that some of the phrases people use to describe a really terrible experience they had is that it was ‘an absolute nightmare’, ‘worse then your worse nightmare’. Do other cultures and languages use this phrase? If so it seems like evidence to be that a lot of people’s reference for ‘very traumatic or unpleasant experience’ is nightmares. OP, I’d think you could put that to people who dismiss nightmares.
That’s a good point, thanks
Thanks this is interesting, I wrote a bit about my own experiences here:
https://applieddivinitystudies.com/subconscious/
Perhaps a pedantic point, but re:
I think most likely your subjective experience of time was not dilated as much as your subjective experience of the experience of time. (E.g., if you have a dream where a year “went by”, it is not the case that subjective experience of time actually went through an entire year, in the sense of massive acceleration of clock speeds).
Whether or not you care about this distinction is of course another matter.
I mention this because “people cannot be wrong about their own subjective experiences” used to be one of the strongest beliefs I had, but now I think this is pretty wrong, and I consider it a moderately important example of philosophical progress in myself.
Can you explain more about what you mean when you say people are wrong about their subjective experience? To me, what you feel in your internal world simulation is what matters, whether or not time is objectively speeding up or down.
And when referring to people, do you only mean humans? Seems like animals can have totally different subjective experiences of time that we should take into consideration when thinking about harms being done to them.
I am basing that on an article linked to in the above Applied Divinity Studies blog post called The Subjective Experience of Time: Welfare Implications, where the author states:
“convergent evidence from their neurology, behavior, and the temporal resolution of their senses indicates songbirds and honeybees experience 2-10 times as many subjective moments per objective unit of time as humans.”
So I’m approaching this question from a moral weights perspective, where subjective time/clock speed is plausibly one of the most important questions about utilitarian weighings. If we have a digital human who experiences reality at 1000x the speed I experience time, him being tortured for one objective minute is ~1000x worse than if I were tortured for one minute.
I don’t think most (human) accounts of massively increased subjective experience of time are analogous to digital people with much faster clock speeds.
I agree! I was thinking of subjective experience of the experiencing self. Not the objective time.
Yes. I definitely think it’s possible to get 2-10x differences in perceptual time (or more) across species, and honestly I wouldn’t be too surprised if intra-human variation is 2-4x either. To me, this has moral implications.
But “a lifetime in 5 to 20 minutes” is a difference of a few million times, which I think is implausible.
A useful exercise is to consider meditation, and many drugs, both of which appear to increase the subjective experience of time. My understanding from
readingskimming studies on them is that they don’t increase objective correlates of that experience (ie, it’s not like people are thinking faster and processing more content, or have faster reaction speeds). So my overall takeaway is that their underlying subjective experience has not gotten (noticeably) faster (in the sense of much faster clock speed). But their subjective experience of that experience has gotten faster, in that they now believe they experience more.I liked that post a lot, thanks for sharing. I wholeheartedly agree with your first footnote — “The moral importance of time-dilation turns out to be an absolutely fascinating question”
It’s something I want to learn more about.
Thanks for posting this. I’m curious how many people suffer from nightmares and get more a lot more clarity on how much suffering nightmares cause overall.
You might be interested in this LessWrong shortform post by Harri Besceli, “The best and worst experiences you had last week probably happened when you were dreaming.” Including a comment from gwern.
I liked that a lot, thanks for the share. This reminds me that I wanted to note that I also have incredibly positive dreams as well. I have higher dream highs, I am pretty sure, than most of my friends. This is especially true if I am able to lucid dream.
There are so many interesting things to note in that post and in Gwern’s comment.
There’s one part of Gwern’s post I’d like to pull over here because I think it adds to the conversation around how bad nightmares are (or aren’t.)
I agree with Harri’s observation that some dreams can feel like they are lasting an incredibly long time. And if it’s a bad dream that’s obviously really bad.
Gwern brushes that concern aside by saying:
“You can’t remember or produce hours of experience corresponding to [the dream], and when you try to intervene by waking people up in lucid dreams or doing tasks, they seem to still be processing time at a normal 1:1 rate.”
It doesn’t seem relevant to me that the awake person is processing time normally. I care about the subjective experience of whatever person is suffering. And if someone has an awful experience that feels like it lasts hours or even days, I think that’s worse than a subjectively shorter bad experience. This kind of stuff happens with psychedelics, too.
Melatonin supplements can increase the vividness of dreams, which seems counterproductive here. But maybe there is a drug with the opposite effect?
The Astral Codex Ten post linked above covers this—for some people, nightmares and blood pressure seem to be connected, and prazosin (a blood pressure medication) can reduce nightmares. The problem being that sometimes it lowers blood pressure too much and makes people dizzy.
Has anyone noticed that nightmares are also associated with “bad trips” from psychedelics, given that psychedelics are “waking dreams”? (the fear of a bad trip is what interferes with many of the profoundly beneficial effects of psychedelics transpiring to a broader population ⇒ significantly blunts their “healing potential”)
So I took a class on sleep and I read some papers about it. Here are some thoughts:
I do think it’s a cause area with a very clear solution: train more imagery rehearsal therapists, and disperse them/make them available through telehealth. I read the papers and it does seem highly effective. I think a lot of people would have enrolled even at high cost if they knew it existed/they had access to it. And then after there were more therapists we could probably talk about raising awareness/providing these servies for free and at places where they are more needed (women’s shelters, refugee camps, etc)
I think you would have made a more powerful argument if you framed it from the point of view of PTSD. Nightmares are a staple of PTSD and IRT is probably the most effective intervention for PTSD! I don’t know the numbers but PTSD is common, and I think if you looked up PTSD you would get better stats about nightmares. I do realize that you didn’t frame it like this because you seem to have a very atypical type of nightmares (lots of variety, and the nightmares aren’t related to a life event that is replayed in your head) and I am sorry for what you have to go throug
Points for a novel EA Forum topic! I also have pretty horrific nightmares pretty frequently, and have also lived a relatively good life/have nothing in my conscious lived experience that seems like it would be producing these. (Luckily I’m almost never enacting harm on people I love though—that’s a level above, I’m really sorry that you repeatedly go through that.) Many of my nightmares essentially seem like they could be scenes from horror movies, but I don’t watch horror movies (ever, at all) so this is pretty bizarre. I have actually considered trying to sell some of the images and events from my nightmares to horror filmmakers, though I haven’t figured out exactly how I’d go about this. If I ever manage to do it, I will consider donating my profits to your potential future nightmare-prevention charity :)
Ha, that’s great, points for a novel earning to give strategy. Some of the stuff that happens to Dream Drew would not be out of place in a Rob Zombie film or the Saw franchise, so I see where you’re coming from.
When watching shows or movies now I usually look away from anything even a little gory out of fear that the images will find a way into my dreams.