How to deal with (possibly medication-induced) nightmares?

August 5, 2020 1:04 PM

For the last several months I have had terrible, vivid nightmares almost every time I go to sleep. I recently realized it started around the same time that I started a new medication which has vivid dreams as a side effect. I can't go off this medication, but I can't deal with this being my life every time I wake up. Help?

The specific medication is Cymbalta (duloxetine). I have tried many other anti-depressants and this is the best one for managing my depression. So, off the bat, I'd like to say that switching meds is not currently on the table.

I'm really worn out from these nightmares. They happen almost every night and sometimes when I nap. I wake up completely soaked in sweat, heart racing, and in a terrible mood. I do usually feel better after a few hours but I'd love to shorten the recovery time even more if possible.

I have a comfortable bedroom setup. I try to not eat or drink anything within a few hours of bedtime. I go to bed around the same time every night. I don't have trouble falling asleep or getting back to sleep if I wake up in the middle of the night. I've tried doing yoga before and after bed.

Is there anything else that might help reduce the nightmares or help me recover more quickly when I wake up?

posted by joan_holloway to Health & Fitness (15 answers total)

I have had nightmares beyond my control (not medication induced, trauma induced and still frequent to constant sometimes), teaching yourself how to lucid dream can be really helpful for both snapping out of the nightmare while you're still in it, and recovering faster.

There's lots of techniques and supplements out there, and it's really just finding what works for you. Talk to your doctors before adding any supplements. I personally found the FILD technique to work after some practice, but there are several techniques out there. Some take a few weeks of practice to get the hang of.

It's not a surefire bet to solving all your nightmares. For me at least, it has greatly reduced their frequency and intensity upon waking.
posted by furnace.heart at 1:14 PM on August 5, 2020 [1 favorite]

I was going to recommend trying to learn to lucid dream. I do this by asking myself throughout the day the question "wait, am I dreaming?" That practice seems to help me figure out when I am actually in a dream, and then I can usually walk my way out of whatever weird/awful dream situation I'm in.
posted by k8lin at 1:21 PM on August 5, 2020 [1 favorite]

I have to augment my antidepressants with Klonopin to manage my night terrors. It's a benzo. I also sometimes take a very low dose of Xanax before bed if I feel like my dreams are going to be really bad. What has the doctor who prescribed you Cymbalta recommended?
posted by Kitchen Witch at 1:23 PM on August 5, 2020

When do you take your meds? Maybe you could try switching to a different time of day.
posted by hazel79 at 1:34 PM on August 5, 2020 [2 favorites]

I'm a pharmacist. I would definitely believe this is because of the medication. Some classic ways to deal with side effects without discontinuing the med are:
* wait for the side effects to subside
* change the time of day that you take the med
* lower the dose
* decrease the interval (for example if it's something you take once a day, take half in the am and half in the pm)

Don't be afraid to ask your doctor if one of these strategies might work. Drugs that work on the brain vary a lot from person to person so it's not uncommon to have to play with it a bit to find the right treatment. It also can take a ridiculously long time to adjust to new drugs so even though the web sites say side effects go away in "a few weeks" it might be more like months than weeks.
posted by selfmedicating at 2:08 PM on August 5, 2020 [2 favorites]

Response by poster: Thanks for the ideas so far. To answer some questions:

I take my meds in the morning, because my doctor believes it will have the most effect during the day when I need it. I could try switching to night time though. It's a time-release capsule so I can't split the dose.

So far my doctor has suggested I try taking it every other day, but I'm worried about my depression coming back.

My doctor will not prescribe benzos like xanax anymore. Actually, I've been to 4 or so doctors over the years and none of them will prescribe it due to risk of abuse. Even my husband, who was admitted to the ER for a day due to panic attacks, was not able to get a benzo. Not sure if this is Seattle specific or a larger trend.

I'll look up lucid dreaming. Any online recommendations for reading about it are appreciated!
posted by joan_holloway at 2:14 PM on August 5, 2020

I'm an emergency physician/medical toxicologist

Cymbalta belongs to the class of anti-depressant medications called serotonin-noradrenaline reuptake inhibitors (SNRIs).

SNRIs can cause a syndrome called Rapid Eye Movement Sleep Behavior Disorder (RBD) in a small subset of patients. Nightmares per se are not a known symptom of it, but vivid dreams have been reported in several case reports

The condition appears to be self-limiting, ie, it tends to go away on its own in 1 to 2 weeks. You can also just stop taking the drug and the RBD should clear up. If I were you, that's what I'd do--stop taking it and call my psychiatrist. You can't beat depression if you're not getting enough sleep
posted by BadgerDoctor at 2:17 PM on August 5, 2020 [4 favorites]

I'm not sure why this is, but there's a phenomenon where you are far more likely to have nightmares when you sleep on your left side. If you're sleeping on that side, it could be worth changing your setup to sleep in a different position.
posted by quince at 2:54 PM on August 5, 2020 [1 favorite]

I take anti-depressants, but not Cymbalta. I also struggle with night terrors. I am currently taking prazosin to ward those off, which has helped a little but has not completely solved the problem. Just a data point, IANAD.
posted by zeusianfog at 3:39 PM on August 5, 2020 [1 favorite]

Have you considered that your nightmares might instead be related to our crazy times? I almost never have nightmares and they're almost always tied to indigestion, but the last few months I've been having more of them,mostly when I take naps and they're not related to indigestion or any other physical symptom. Almost everyone is going through serious stress these days.

I don't know anything about the drug ou're taking but I wonder if it's possible to get it in a formthat's not time release so that the amount in your body is waning when you go to bed.
posted by mareli at 3:40 PM on August 5, 2020

I've been having really vivid nightmares and practice ujjayi breathing to calm myself down afterwards. My therapist just introduced EFT tapping yesterday when I mentioned my nightmares to her; I haven't had a nightmare to practice it with but it did help with an anxiety episode I had while awake.
posted by assenav at 4:10 PM on August 5, 2020 [1 favorite]

I take my meds in the morning, because my doctor believes it will have the most effect during the day when I need it. I could try switching to night time though. It's a time-release capsule so I can't split the dose.

If you want to try splitting the dose, you'd have to get your doctor to write you a new Rx (eg, 30mg twice a day instead of 60mg daily) to get the smaller capsules but honestly it might be worth it. It looks like nightmares are sometimes a withdrawal effect, so it seems possible that the dose you're taking in the morning is wearing off overnight. It's supposed to be a 24-hr time release, but timed release doesn't always work perfectly for everybody.

Or if you wanted to use up what you had you could try taking it at night first. I'm always surprised when little tweaks like this work, but they often do work.
posted by selfmedicating at 5:10 PM on August 5, 2020 [1 favorite]

My nightmares and night terrors existed before Cymbalta, but it definitely made them worse. After a month or so, it settled down to some extent. But my therapist still ended up recommending a very low dose of Prazosin (3mg a day) and that's what finally wiped them out.
posted by headspace at 5:22 PM on August 5, 2020

I have medication induced night terrors (not from an anti depressant though) and I find having something that plays music/or sound as I'm falling asleep/asleep helps. I don't know why and it doesn't seem to matter what the sound is (music podcast movie) as long as I find it relaxing. Why it works I don't know. Maybe going to bed with a more relaxed mind? Or something about sound and sleep?

Also if I do wake up screaming my head off there is some comforting babble playing to help me calm down. Can't hurt to try :)
posted by wellifyouinsist at 6:13 PM on August 5, 2020 [1 favorite]

As a lifelong nightmare sufferer, I also recommend lucid dreaming but with the caveat that it can get annoying in other dreams because you're bringing too much rationality into them. Still, being able to stop, redirect, or wake yourself up from nightmares is worth the occasional "wait, why isn't anyone wearing a mask? We're all going to get covid and die!" dream.
posted by bile and syntax at 10:51 AM on August 6, 2020