Cannabis and PTSD — Taming Nightmares

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Nightmares are one of the most common manifestations of previous traumatic stress. A study by the National Center for PTSD showed that 52% of Vietnam combat veterans with PTSD regularly experience nightmares as a primary symptom of their post-traumatic stress. New research, which includes veterans of our most recent (and longest) wars, indicates a much higher rate, with anywhere from 71% to 96% of PTSD sufferers experiencing nightmares, compared to only around 5% for the general population.

As a combat veteran severely injured in Iraq, this author has seen the toll nightmares take on our service members first-hand. While I am fortunate to be in the minority that has no issues with nightmares, I have many friends who face incredible horrors — and fight valiant battles — almost every night, and often without anyone else’s knowledge of their struggle.

Some pharmaceuticals that treat nightmares exist but data to their efficacy are low grade and sparse. These drugs include trazodone, atypical antipsychotic medications, topiramate, low dose cortisol, fluvoxamine, triazolam and nitrazepam, phenelzine, gabapentin, cyproheptadine, and tricyclic antidepressants. Like most manmade medications, they all come with a host of side effects, some including nightmares themselves. In fact, while an inpatient at Walter Reed, I was given an atypical antipsychotic — Seroquel — for insomnia. I literally lived through a Saw movie, almost as real as life itself, knowing the whole time it was a dream, yet not being able to wake up.

There are some non-medicinal therapies that help over time, most notably Imagery Rehearsal Therapy, “IRT”. In fact, IRT has been show to be very effective and should be considered a first line treatment. It works by reflecting on an experienced nightmare and changing the ending to a positive one, and then reinforcing this new narrative in one’s head. However, IRT’s key shortcoming is that it addresses specific nightmares only after they happen, in the hopes of preventing them in the future; in some cases, particularly in the most severe instances of PTSD, it may be too difficult to even begin IRT. As such, for those who feel their nightmares pose a substantial and immediate threat to their overall well-being, some form of external help is probably needed.

As the title indicates, there is a completely natural therapy that is incredibly effective in treating nightmares — our dear old friend medical cannabis. In addition to the anti-anxiety and general mood stabilizing therapeutic effects, cannabis — particularly indica dominant strains used prior to bedtime — are almost guaranteed to stop nightmares cold. In most patient’s experience, they either seemingly don’t have dreams, or can’t remember them.

The exact mechanism of action isn’t fully understood, but it appears cannabis works by extending the duration of stage 3 “deep” sleep, in lieu of some stage 4 “REM” sleep. Shorter, less dense REM cycles prevent dreams from picking up the cognitive ‘momentum’ they need to fully form into a replay of a traumatic experience. While users do in fact experience periods of REM, they are often not coherent or long enough to consolidate into a memory of the dream.

So, if you are a nightmare sufferer, speak with your local medical professional versed in cannabis. Most indica strains offer a double whammy for sleeping problems — it will relax you into a slumber and ensure that no nightmare will ruin a restful night sleep.

One cautionary note: When abstaining from use for a bit, there is something of a dream rebound effect. Lucky folks can take advantage of that time to do deep reflection through lucid dreaming. However, it can potentially create a horrific experience for a nightmare sufferer, so caution and proper titration should be involved.

Do you use cannabis to treat nightmares from a traumatic event?