Faculty Editor: Professor Jeffrey DaCosta
Most of us can recall a time where we’ve had a seriously disturbing nightmare. For trauma survivors and victims of PTSD, having nightmares is a chronic problem that causes major sleep deprivation and distress. Interestingly, researchers have theorized that nightmares are less of a side effect of trauma and more of a self-healing mechanism; they are a way for the brain to revisit and reprocess the original trauma, integrating (or contextualizing) it into a series of logically-flowing events. It is believed that once the brain can pinpoint the traumatic moment or outlier, after continuous revisting and reprocessing of events in nightmares, it is easier for the person to accept and overcome his or her trauma (Hartmann, 1998).
The problem with this process, however, is that it can take a long time, and in many cases, people continue to have trauma-induced nightmares throughout their life. Exposure-based therapies that mimic the brain’s natural mechanism of reprocessing and revisiting help, but they aren’t fast or direct enough. What is needed is an accelerant, a catalyst that will force the brain to consciously take control and resolve the traumatic nightmare on the spot (Sparrow et al., 2018). In other words, people need to resolve their nightmare while they are asleep—they need to be able to control their own dreams. This is possible through a phenomenon called lucid dreaming.
In lucid dreaming, not only are people aware that they are dreaming, they are able to actually control the sequence of events in their dreams. Past research has shown the potential for lucid dreaming (particularly, its “dream control” component) as a treatment option for chronic nightmare sufferers. In a 2006 pilot study on lucid dreaming as a possible therapy, it was found that lucid dream training caused a reduction in nightmare frequency (Spoormaker & van den Bout, 2006). This research has been expanded upon in more recent years. For example, Harb et al. (2016) found that an increase in dream content control lowered nightmare-related suffering in war veterans with PTSD. The participants were either just given a therapy called Cognitive-Behavioral Therapy for Insomnia (cCBT-I) or Image Rehearsal (IR) and cCBT-I. cCBT-I is a program that helps patients recognize and change thoughts that cause insomnia, while simultaneously helping them to develop better sleeping habits (Insomnia Treatment, 2016). IR involves “rescripting” a nightmare scene during waking hours, which essentially gives patients more control over their dreams. For participants given cCBT-I with IR, there was an increase in dream control content, and this control was “strongly and significantly related to decreased nightmare distress” (Harb et al., 2016, p. 245). Interestingly, one year later, a related study actually revealed the specific methods that lucid dreamers used to overcome threatening figures in nightmares, defending themselves by fighting, flying away, or working towards resolution (Stumbrys & Erlacher, 2017).
Some people are naturally good at lucid dreaming. Others have to practice diligently to attain lucidity, which is extremely difficult and oftentimes unsuccessful. Researchers have been looking for a direct method of lucid dream induction, and Gregory Sparrow, Ryan Hurd, Ralph Carlson, and Ana Molina have theorized that the supplement galantamine is the answer. Galantamine is a cholinesterase inhibitor, which means it blocks the breakdown of the neurotransmitter acetylcholine (ACh). Galantamine is unique among cholinesterase inhibitors because it exhibits a dual mechanism. First, it temporarily slows the breakdown of ACh. Second, it increases the affinity of ACh to its nicotinic receptor in the hippocampus and frontal lobe, which causes a “boost” of ACh activity in these regions of the brain (Lilienfield, 2002; Sparrow et al., 2018). The role of greater ACh activity in achieving lucidity is not completely understood, but leading theories suggest that increased ACh activity is tied to increased cognitive function. Research shows that ACh and nicotinic receptor activity increases alertness and excitability in the brain (Yackel, 2012; Becchettia & Amadeo, 2016). Based on this research, a theory might be that if galantamine increases alertness by increasing ACh activity in the hippocampus and frontal lobe, it may also heighten the levels of vividness, awareness, and, by extension, the likelihood of lucid dreaming. Another plausible theory is that galantamine also improves memory; this is supported by its use as a treatment for Alzheimer’s disease. Because the ability to lucid dream relies heavily on the ability to remember to recognize when one is dreaming, enhancing memory could raise the likelihood of this recognition (Laberge et al., 2018). Further research is needed, however, to better characterize the links between galantamine and lucid dreaming.
Consequently, Sparrow et al. (2018) explored galantamine’s effects on lucidity and a number of other factors (e.g., reflectiveness, interactive behavior, role change, constructive behavior, and presence of fear, threat, and violence) in a double-blind study. It was found that for the sleeping conditions that involved galantamine, there was a higher average rating of lucidity compared to placebo conditions. In fact, the placebo effect was virtually nonexistent. Interestingly, it was also found that the presence of fear, threat, or violence increased with the ingestion of galantamine. At first, this may seem counterintuitive to the idea of galantamine being a nightmare resolution supplement. However, the object of galantamine isn’t to reduce fear, but to increase lucidity. The participants reported higher ratings of fear because their lucid dreams tapped directly into their own phobias or trauma. Importantly, it is with their lucidity, aided by the ingestion of galantamine, that they could control and overcome these fears. This process cannot occur without the initial step of having the nightmare.
The study by Sparrow and his colleagues provides experimental evidence for galantamine’s effectiveness of inducing lucid dreams, and is supported by a similar study by LaBerge et al. (2018). In this study, 57% of participants that ingested galantamine reported having lucid dreams, some for the first time ever. While these results appear promising, there is some controversy attached to the idea of using drugs as a treatment option for mental illnesses. Skeptics may cite low efficacy and side effects as possible downsides. However, galantamine’s unique dual mechanism of inhibiting cholinesterase and exciting nicotinic receptors causes its effects to last months longer than other drugs in its class. Additionally, galantamine has little to no known side effects, is available over the counter, and is currently being used to treat Alzheimer’s disease (Sparrow et al., 2018). Although lucid dreams may be induced in other ways, when it comes to treating chronic nightmares that lead to sleep deprivation, general uneasiness, and even substance abuse, galantamine may be the best option.
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