1 of 13

Nightmares and the �Nervous System

Dr. Leslie Ellis

2 of 13

Overview

  • Nightmares as an image of the state of the autonomic nervous system (ANS)
  • Porges’ Polyvagal Theory has changed the way trauma is treated, but not nightmares
  • Polyvagal Theory’s key concepts
  • Evidence linking nightmares and the nervous system: physiology and dream content
  • Proposed treatment taking PVT into account: safety first

3 of 13

A polyvagal primer

  • Porges’ PVT updates the former view of the ANS as paired circuits of sympathetic arousal and parasympathetic relaxation
  • Instead: a hierarchical and adaptive response to threat: fight/flight, immobility
  • Under threat, the uniquely mammalian ability to mitigate threat response (social engagement system) shuts down
  • WE NEED TO FEEL SAFE TO CONNECT WITH OTHERS
  • Ventral branch governs health, growth, restoration, connection
  • Dorsal branch (below the diaphram) initiates shutdown

4 of 13

Key New Ideas from Polyvagal Theory

  • “Safety is the treatment”
  • Porges identified 4 key aspects relevant to therapists
  • Vagal brake regulates heart rate, is released under threat
  • Social engagement system: face-heart connection
  • Neuroception: an automatic, embodied perception
  • Frequency Band of Perceptual Advantage: sound frequency communicates threat or safety

​

5 of 13

Dreaming with our hearts as well as our minds

  • ‘Activation of brain-heart access during REM sleep: a trigger for dreaming’ (Nardelli et al. 2021)
  • Study shows ANS activation (HRV, blood pressure) coincides with the shift into REM sleep
  • Researchers found a causal link between body state and conscious dream experience...
  • AND this in turn influences our body – a bi-directional link
  • Our dreams are a picture of the shifting state of the ANS
  • Blog link: https://drleslieellis.com/dreaming-with-our-hearts-as-well-as-our-minds/

​

6 of 13

Nightmare Content and the ANS

  • The most common nightmare content coincides closely with ANS threat responses:
  • In order, the most frequent nightmare themes:

​

    • failure or helplessness (immobility)
    • physical aggression (fight)
    • accidents
    • being chased (flight)
    • illness or death (immobility)
    • interpersonal conflict (fight)

7 of 13

Who has nightmares?

  • Researchers have found that NMS need two conditions: a trait and a trigger
  • Traits: emotional dysregulation, high sensitivity, highly active stress response
  • My question: Are these inborn traits or signs the ANS has been sensitized to threat?
  • ‘Early adversity’ is linked to NMs (siblings’ birth, maternal separation, ACES)
  • NMs linked to post-traumatic stress (90%), anxiety, depression, higher suicide risk and in general, all forms of psychological injury

8 of 13

  • The top half of the diagram demotes states where there is little or no sense of safety
  • ANS can loop between activation and immobility, leaving someone locked in a state of PTSI
  • Post traumatic stress INJURY is the preferred term: PVT does not pathologize ANS response
  • Based on Jan Winhall’s Felt Sense Polyvagal Model

FSPM for Nightmares - Notes

9 of 13

Nightmares: a symptom and an (attempted) solution

  • Nightmares are an indication of a nervous system that doesn’t feel safe – the reflect a history of trauma and adversity
  • They occur in the state shift between non-REM and REM sleep
  • They can be seen as the body’s attempt to regulate
  • When overwhelmed, the ANS can be locked in a cycle of activation and immobility that is reflected in dreams
  • Nightmares can and should be treated

10 of 13

Nightmare Treatment: �Finding ‘home’

  • Dreams also depict the full range of the ANS: ie social engagement, intimacy, creativity, and play
  • Nightmare therapy is typically a ‘rescripting’ process
  • Nightmare Relief incorporates polyvagal theory:
    • Begins with resourcing and establishing a sense of safety
    • Bring in this sense of safety while dreaming the dream onward
    • Dream content shifts to home (not a place but safe and with others)
    • Future dreams (often no longer nightmares) reflect this shift

11 of 13

Nightmare Relief protocol

  • Instil hope, positive expectation
  • Calming, clearing (from Focusing)
  • Bringing back the dream (manage activation/overwhelm)
  • Finding and embodying help
  • Dreaming the dream onward
  • Consolidate new dream and resulting transformation

12 of 13

Clinical Considerations

  • NM treatment best as an adjunctive treatment, ideally within the course of trauma therapy
  • Consider the two very different responses to traumatic injury: activation/hyperarousal and dissociative sub-type (about 30%)
  • Frequent NMs are robustly associated with higher suicide risk
  • Ask about nightmares and learn to treat them, even if you do no other kind of dream therapy
  • When NMs are reduced, sleep improves and daytime symptoms dissipate (the reverse isn’t true)
  • Instil a sense of safety and mastery

13 of 13

For more information

  • Email: leslie@drleslieellis.com
  • Web site resources (blog, courses): drleslieellis.com
  • Article (under review): Solving the Nightmare Mystery: The Autonomic Nervous System as Missing Link in the Aetiology and Treatment of Nightmares
  • 2-hour talk Jan. 28 GoodTherapy.com