Reducing nightmares as a 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. 

People wake up because of nightmares. If one wakes up because of 1 nightmare out of 10, we can claim that if someone never woke up because of nightmares, he never had ≈any nightmare.

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.

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!

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. 

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)

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.

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 :) 

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. 

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:

1. 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!
2. 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 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)

What makes you skeptical of the intervention?

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. 




 

That's a good point, thanks 

Perhaps a pedantic point, but re:

It feels like you’ve experienced an entire lifetime, but in actuality, each dream only lasts 5 to 20 minutes

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.

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. 

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. 

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.

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.