Many bad dreams can be treated
Beta-blockers can transform people’s lives for the better, but their long-term use isn’t a good idea
The interpretation of dreams – or Freud’s “Royal Road to the Unconscious” – is long since dead and buried. The practice was “a scientific fairy tale”, observes philosopher and retired gerontologist Professor Raymond Tallis, “whose peculiar ideas confuse and undermine the vulnerable.” None the less distressing nightmares certainly merit “analysis” as they may have some remediable cause.
As reported in this newspaper last week, Dr John Peever of the University of Toronto has drawn attention to the link between Rapid Eye Movement (REM) sleep behaviour disorder – characterised by violent dreams and jerking of the legs – and the subsequent development of neurological disorders such as Parkinson’s. Treatment with Clonazepam is reputedly highly effective.
Prozac and similar antidepressants may also be responsible for night terrors, as in the case of a 50-year-old man reported in the Journal of Clinical Sleep Medicine whose recurrent dreams of “hand-to-hand combat with Saddam Hussein” ceased on stopping the drug.
Nightmares may also be an early sign of obstructive sleep apnoea, and these are usually (if predictably) concerned with the threat of imminent asphyxiation, as reported by one patient: “I am buried under the sand and fighting my way to the surface that I can’t seem to reach. I wake gasping for air.”
And the most readily correctable of all – though not as widely appreciated – nightmares are a side-effect of several widely prescribed drugs for the treatment of raised blood pressure (Clonidine and beta-blockers), Parkinson’s (Levodopa) and smoking cessation (Champix).
Beta not better
It would be good to think that the recent report confirming that beta-blockers do not prolong survival following a heart attack might discourage doctors from prescribing them in such circumstances. Though they are of value in the immediate postoperative period after bypass surgery and for up to six months following coronary angioplasty, those sentenced to take them indefinitely should certainly now discuss with their family doctor the possibility of stopping them – in anticipation of being spared their enervating effects.
Similar considerations apply to the not unusual situation of the 87-yearold mother of a reader, whose active gardening and social life has been seriously compromised (“they make her very tired”) by taking a betablocker to control the rapid heart rate of her atrial fibrillation. Here the alternative, in the form of the calcium channel blocker Diltiazem, works just as well and is much better tolerated.
There are, of course, several situations in which beta-blockers can transform people’s lives for the better: indispensable for the control of essential tremor, preventing blindness in those with glaucoma, and abolishing the distressing symptoms of panic attacks and stage fright. But in general their long-time prescribing, especially to those of advancing years, is not a good idea.
Lifting the gloom
The account of the lady (recently featured in this column) whose gloomy thoughts on waking persist throughout the day – until six in the evening, when her mood improves dramatically – has prompted a reader to recall his “longish period” in the Priory 25 years ago and how his fellow depressives tended to cheer up no end after tea time. The reasons for this “diurnal variation” in mood remain elusive, despite much research into the possible role of the circadian rhythm in the secretion of cortisol and other hormones.
A couple of readers, from personal experience, suggest it could indicate under-treatment, warranting an increase in dose or switch to a “stronger” antidepressant. Several hints on minimising this early morning gloom include playing one’s favourite music loudly, going for an energetic walk (as fast as possible), and ensuring there is always one useful task to accomplish during the day, prepared during the “good times” of the preceding evening.