Cannabinoids Eliminate Nightmares

NIGHTMARES

A nightmare is an unpleasant dream that can cause a strong negative emotional response from the mind, typically fear and/or horror, but also despair, anxiety and great sadness. The dream may contain situations of danger, discomfort, psychological or physical terror.  Sufferers usually awaken in a state of distress and may be unable to return to sleep for a prolonged period.

One definition of "nightmare" is a dream that causes one to wake up in the middle of the sleep cycle and experience a negative emotion, such as fear.  This type of event occurs on average once per month.  They are not common in children under five,  but they are more common in young children (twenty five percent experiencing a nightmare at least once per week),  most common in teenagers, and less common in adults (dropping in frequency about one third from age 25 to 55).
Nightmares in adults are often spontaneous.  However, can also be caused by a variety of factors and underlying disorders.

Causes

Some people have nightmares after having a late-night snack, which can increase metabolism and signal the brain to be more active.  A number of medications also are known to contribute to nightmare frequency.  Drugs that act on chemicals in the brain, such as antidepressants and narcotics, are often associated with nightmares.  Non-psychological medications, including some blood pressure medications, can also cause nightmares in adults.
Withdrawal from medications and substances, including alcohol and tranquilizers, may trigger nightmares.  If you notice a difference in your nightmare frequency after a change in medication, talk with your doctor.
Sleep deprivation may contribute to adult nightmares, which themselves often cause people to lose additional sleep.  Though it is possible, it has not been confirmed whether this cycle could lead to nightmare disorder.

There can be a number of psychological triggers that cause nightmares in adults.  For example, anxiety and depression can cause adult nightmares.  Post-traumatic stress disorder (PTSD) also commonly cause people to experience chronic, recurrent nightmares.
Nightmares in adults can be caused by certain sleep disorders.  These include sleep apnea and restless leg syndrome.  If no other cause can be determined, chronic nightmares may be a distinct sleep disorder.  People who have relatives with nightmare disorder may be more likely to have the condition themselves.

What Are the Health Effects of Nightmares in Adults?
Nightmares become much more than bad dreams when they have a significant effect on your health and well-being.  Among people who experience nightmares, those who are anxious or depressed are more likely to be distressed about the experience and suffer even more psychological ill effects.  Though the relationship is not understood, nightmares have been associated with suicide.  Because nightmares may have a significant impact on your quality of life, it is important to consult a medical professional if you experience them regularly.

Sleep deprivation, which can be caused by nightmares, can cause a host of medical conditions, including heart disease, depression, and obesity.
If nightmares in adults are a symptom of untreated sleep apnea or post-traumatic stress disorder, the underlying disorders can also have significant negative effects on physical and mental health.
Treatments for Nightmares in Adults
Fortunately, there are steps you and your doctor can take to lessen the frequency of your nightmares and the effect they are having on your life.  First, if your nightmares are the result of a particular medication, you may be able to change your dosage or prescription to eliminate this unwanted side effect.
If your nightmares are not illness- or medication-related, do not despair.  Behavioral changes have proven effective for seventy percent of adults who suffer from nightmares, including those caused by anxiety, depression, and PTSD.

Imagery rehearsal treatment is a promising cognitive behavioral therapy for recurrent nightmares and nightmares caused by PTSD.  The technique helps chronic sufferers change their nightmares by rehearsing how they would like them to transpire while they are awake.  In some cases, medications may be used in conjunction with therapy to treat PTSD-related nightmares, though their efficacy has not been demonstrated as clearly as that of imagery rehearsal treatment.

There are a number of other steps you can take on your own that may help reduce your nightmare frequency.  Keeping a regular wake-sleep schedule is important.  So is engaging in regular exercise, which will help alleviate nightmare-causing anxiety and stress.  You may find that yoga and meditation are also helpful.
Remember to practice good sleep hygiene, which will help prevent the sleep deprivation that can bring on nightmares in adults.  Make your bedroom a relaxing, tranquil place that is reserved for sleep and sex, so that you do not associate it with stressful activities.  Also, be cautious about the use of alcohol, caffeine, and nicotine, which can remain in your system for more than 12 hours and often disrupt sleep patterns.

In general, stress, trauma, fears, insecurities, feelings of inadequacy, health problems, marital issues, etc may all be reasons for having nightmares:

Childhood and Family

Present nightmares can be rooted in past neglect and trauma from childhood.  From lack of love, neglect, alcoholism, to severe abuse, family members can be the most destructive influence on a person's life.  Nightmares may be a sign of such inner turmoil.

Life

The way your life is going and the larger society as a whole can contribute to nightmares.  Your perception of the world, heath, natural disasters, criticism about politics, finances, crime in the streets and your inability to control such events may sometimes lead to nightmares.

Relationships

Your intimate relationships and your daily interactions with people can also be a source of your nightmares.  Marital difficulties or pregnancies are other possible causes.  You may be paranoid about how you think others perceive you or fear that others do not understand and see who you really are.  Isolation and unhappiness may appear in nightmares as abandonment and loneliness.

Stress

The way you handle and deal with stress can trigger nightmares.  Nightmares are a normal response to unacceptable levels of fear and stress.  People diagnosed with Post Traumatic Stress Disorder frequently have nightmares about their traumatic event, like war, rape, death of a loved one, car accident, plane crash, terrorism, etc.

Work

Since most of us spend the majority of our day at work, it is no surprise that work-related issues are a common source for your nightmares.  Stress, job security (or lack of), change in jobs, co-workers, unresolved work problems, or general dissatisfaction with what you do can manifest into a nightmare.  The nightmare may reflect feelings of frustration and an inability to control your work-related issues.  People in high-stress level or high-risk jobs often report having nightmares.  Nightmares of this nature may manifest as if you are being attacked, chased, or of you being out of control.

Having nightmares are normal, but a high frequency of nightmares is a sign of being overwhelmed and of excessive stress.  These things should be dealt with directly.  Nightmares can be an important resource for self-knowledge and emotional discovery.  They convey an important message and help clear up the conflict in your life.  It is important to distance yourself, work past the emotional content (fear, grief, anger, etc.) of your nightmare, and analyze it from an objective perspective.  The disturbing emotions may be a way for your unconscious to prevent you from digging deep into the meaning of your nightmares.  Sometimes rehearsing or reliving the nightmare while you are awake and then changing the nightmare's content or outcome helps to dismantle the nightmare.  It also helps to write your nightmares down in a journal.

A nightmare is a dream that occurs during sleep that brings out strong feelings of fear, terror, distress, or anxiety.  Nightmares usually happen in the second part of the night and wake up the sleeper, who is able to remember the content of the dream. 

  1.    Generalized anxiety disorder
  2.   Night terror
  3.   Post-traumatic stress disorder
  4.   Sleep disorders

Other causes of nightmares include:

  •   Abrupt alcohol withdrawal
  •   Breathing disorder in sleep (sleep apnea)
  •   Death of a loved one (bereavement)
  •   Excessive alcohol consumption
  •   Illness with a fever
  •   Recent withdrawal from a drug, such as sleeping pills
  •   Side effect of a drug
  •   Sleep disorder (for example, narcolepsy or sleep terror disorder)
  •   Eating just before going to bed, which raises the body's metabolism and brain activity.

Nightmares can also occur after a trauma.  These nightmares may indicate post-traumatic stress disorder.

When Do Nightmares Occur?

Sleep is divided into 2 stages:  rapid eye movement (REM) and nonrapid eye movement (non-REM).  REM and non-REM sleep alternate in ninety to one hundred minute cycles.  Most dreaming occurs during REM sleep.  Nightmares usually occur in the middle of the night or early morning, when REM sleep and dreaming are more common.

Cannabinoids May Eliminate Nightmares

Research

The study relied on a patient-reported subjective assessment of nightmare severity and
frequency.  The study did not include a placebo control group.  These factors may represent
limitations of the study.  The author concluded that nabilone had reduced the severity and
frequency of treatment-resistant nightmares in patients with PTSD.  The author suggested that
More studies should be done to further evaluate the clinical effectiveness of nabilone for the treatment of PTSD-associated symptoms.

Published Research Articles:

The Use of a Synthetic Cannabinoid in the Management of Treatment-Resistant Nightmares in Posttraumatic Stress Disorder (PTSD).  CNS Neurosci Ther.  2009 winter; 15(1):84-8.  Fraser GA.
A clinical trial performed in Canada reviewed the use of nabilone to treat nightmares in individuals suffering from post-traumatic stress syndrome.  The study found that nighttime administration of nabilone reduced the frequency and/or intensity of nightmares in 34 out of 47 (72%) of patients, with 28 reporting complete cessation of nightmares.  This study is limited to the extent that there was no placebo control, but warrants future investigation into the use of cannabinoid therapy in the treatment of post-traumatic stress syndrome and other disorders involving recurrent nightmares.

This is the report of an open label clinical trial to evaluate the effects of nabilone, an endocannabinoid receptor agonist, on treatment-resistant nightmares in patients diagnosed with posttraumatic stress disorder (PTSD).  Methods:  Charts of 47 patients diagnosed with PTSD and having continuing nightmares in spite of conventional antidepressants and hypnotics were reviewed after adjunctive treatment with nabilone was initiated.  These patients had been referred to a psychiatric specialist outpatient clinic between 2004 and 2006.  The majority of patients (72%) receiving nabilone experienced either cessation of nightmares or a significant reduction in nightmare intensity.  Some patients also noted subjective improvement in sleep time, the quality of sleep, and the reduction of daytime flashbacks and night sweats.  The results of this study indicate the potential benefits of nabilone, a synthetic cannabinoid, in patients with PTSD experiencing poor control of nightmares with standard pharmacotherapy.  This is the first report of the use of nabilone (Cesamet; Valeant Canada, Ltd., Montreal, Canada) for the management of treatment-resistant nightmares in PTSD.

(Nabilone is a relatively weak compound; the authors note that the whole cannabis plant would likely have a more potent effect.)

Results
For 47 patients, standard PTSD medications being maintained, the usual starting dose was 0.5 mg and was titrated up or down to effect.  The average effective dose of Nabilone was 0.5 mg. one hour before bedtime, with an effective dose range of 0.2 mg to 4.0 mg nightly.  Thirty-four (72%) patients experienced total cessation or lessening of severity of nightmares (28 patients had total cessation of nightmares and 6 had satisfactory reduction).  The discontinuation of medication was successful in four patients following 4–12 months of nabilone therapy (nightmares did not return at a reduced level, not needing further medication control), whereas the other patients experienced a recurrence of nightmares upon Nabilone withdrawal (usually within the ?rst two nights).  These patients experienced control of nightmares once nabilone treatment was reinitiated.  These patients were asked to attempt withdrawal at least every 6 months, but the therapy was ongoing at the time of this chart review.

Cannabinoids block stress hormone & may be therapeutic in treatment of inappropriate retention of aversive memories & stress-related disorders
Filed under: Hormones,Hypothalamic Pituitary Adrenal Axis ,Research,Stress hormones — cbdresearch @
“The endocannabinoid system has recently emerged as important in the regulation of extinction learning and in the regulation of the hypothalamic–pituitary–adrenal axis.”
Israeli scientists injected an agonist of the CB1 cannabinoid receptor into the basolateral amygdala (BLA) which significantly reduced elevations in corticosterone levels in response to scary stressors.  They found the CB1 receptor in the BLA is crucially involved in the extinction of inhibitory avoidance (IA) conditioning, because the CB1 receptor antagonist… microinjected into the BLA significantly blocked extinction.  To get the effect, however, they had to inject into the BLA before exposing the rats to a stressor.
They conclude: “our findings may support a wide therapeutic application for cannabinoids in the treatment of conditions associated with the inappropriate retention of aversive memories and stress-related disorders.”

The use of a synthetic cannabinoid in the management of treatment-resistant nightmares in posttraumatic stress disorder (PTSD).

Abstract

This is the report of an open label clinical trial to evaluate the effects of nabilone, an endocannabinoid receptor agonist, on treatment-resistant nightmares in patients diagnosed with posttraumatic stress disorder (PTSD).  METHODS: Charts of 47 patients diagnosed with PTSD and having continuing nightmares in spite of conventional antidepressants and hypnotics were reviewed after adjunctive treatment with nabilone was initiated.  These patients had been referred to a psychiatric specialist outpatient clinic between 2004 and 2006.  The majority of patients (72%) receiving nabilone experienced either cessation of nightmares or a significant reduction in nightmare intensity.  Some patients also noted subjective improvement in sleep time, the quality of sleep, and the reduction of daytime flashbacks and night sweats.  The results of this study indicate the potential benefits of nabilone, a synthetic cannabinoid, in patients with PTSD experiencing poor control of nightmares with standard pharmacotherapy.  This is the first report of the use of nabilone (Cesamet; Valeant Canada, Ltd., Montreal, Canada) for the management of treatment-resistant nightmares in PTSD.

Most people with posttraumatic stress disorder repeatedly relive the trauma in the form of nightmares and disturbing recollections during the day, the nightmares or recollections may come and go, and a person may be free of them for weeks at a time, and then experience them daily for no particular reason.  They may also experience sleep problems, depression, feeling detached or numb, or being easily startled, has trouble feeling affectionate.  They may feel irritable,   more aggressive than before, or even violent. 

This is the report of an open label clinical trial to evaluate the effects of nabilone, an endocannabinoid receptor agonist on treatment resistant nightmares diagnosed with PTDS.

Charts of 47 patients diagnosed with PTSD and having continuing nightmares in spite of conventional
antidepressants  and  hypnotics  were reviewed  after  adjunctive  treatment  with nabilone  was initiated.  These patients had been referred to a psychiatric outpatient clinic between 2004 and 2006.
Receiving nabilone experienced either cessation of nightmares or a significant reduction in nightmare intensity.
Some patients also noted subjective improvement in sleep time, the quality of sleep, and the reduction of daytime flashbacks and night sweats.  The results of study indicate the potential benefits of nabilone, a synthetic cannabinoid.on patients experiencing poor control of nightmares with standard Pharmacotherapy. 

To review the main advances related to the potential therapeutic use of cannabinoid compounds in psychiatry. Cannabidiol was found to have therapeutic potential with antipsychotic, anxiolytic, and antidepressant properties, in addition to being effective in other conditions.

"Cannabinoids may be of great therapeutic interest to psychiatry. "

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