What You See at Work & How You Sleep

According to sleep experts, terrifying dreams are caused by the type of emotional stress EMS providers may experience on a regular basis


For many people, sleep is a peaceful way to rejuvenate and prepare for another day. It provides the opportunity to rest and restore energy levels for emotional and physical well-being. But for those who experience nightmares and/or night terrors, it can be one of the most feared parts of the day.

If left unchecked, nightmares and night terrors can severely disrupt sleep patterns, which can lead to depression, anxiety and sleep deprivation, making it difficult to focus. Recurrent nightmares can also lead to insomnia.

"The mind is like a guard. It wants to protect you from noxious things," says William Kohler, MD, director of the Florida Sleep Institute in Spring Hill, FL. "If you're having horrible nightmares, the mind will try to keep you awake to keep the nightmares from happening."

Nightmares are vivid dreams that force you awake during REM (rapid eye movement) sleep, Kohler explains. Their disturbing subject matter is often clearly recalled when you wake up, which can then make it difficult to fall back to sleep. They can also make you afraid to fall asleep, which can lead to daytime sleepiness.

Night terrors, which are often accompanied by yelling and screaming, occur in non-REM sleep. You will have very little, if any, memory of the incident. Loved ones may try to console you, to no avail. Because people who experience night terrors can lash out, talk soothingly to them but don't try to force them awake.

Both events are associated with emotional stress, which can be a common concern for EMS professionals.

"EMTs and paramedics are involved in some very serious and horrible situations," Kohler says. "It's important to recognize the potential for developing nightmares and possible PTSD (post-traumatic stress disorder) when exposed to emotional and physical trauma."

Learn to Restructure

According to information published by NAEMT, research indicates that about 5% of the population will suffer from nightmares at any given time. But for those who witness or survive a trauma, the rates are 50%–88% higher.

"Having nightmares after a trauma is quite common," notes Michael Nadorff, a doctoral student in clinical psychology at West Virginia University. "But it isn't always a bad sign. Some theories suggest that nightmares may be part of the natural process of dealing with a traumatic experience."

They may work similarly to exposure therapy for treatment of anxiety, Nadorff says.

"For example, if someone is anxious about heights, psychologists may slowly build up a person's exposure to heights so he or she isn't as afraid," he says. "Or, if someone has a traumatic experience in a car, we can slowly expose that person to that stimulus until he or she can get back into the vehicle. It's possible that nightmares do the same thing naturally, where they expose someone after a trauma to whatever it is they're afraid of. The hope is that eventually the trauma will no longer strike fear in them. One thing we don't really fully understand is why for some people, nightmares go away, but for others they remain."

If nightmares persist at a rate of more than one a week for more than about a month, Nadorff suggests seeking treatment, which can be based on behavioral or pharmacologic therapies. One common treatment is imagery rehearsal therapy. With this treatment, nightmare sufferers are taught--when they're awake--methods to develop pleasant imagery to create a new dream. Usually sessions are brief, and treatment can be completed in three to four visits.

"You reset the imagery and the trauma," says Kohler. "You restructure the event to try to make it less onerous."

"It's important to realize that if you have persistent nightmares, there are effective treatments available," Nadorff adds. "Having a couple of nightmares after a trauma doesn't necessarily mean you have PTSD. But if they persist, it's worth looking into treatment. It might be a good idea to talk to someone. Medications can also be prescribed. Either way, there is treatment out there. Knowing that can be a great service in and of itself."

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