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.
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)