What are the causes and treatment for nightmares?

Question

Hello doctor,

I continued to have multiple nightmares for four months after initiating Metoprolol 25 mg daily that awakened me every night two to four times with elevated heart rate (120 to 167 bpm that takes 15 to 30 minutes to resolve) and extreme fear, shaking, sweaty palms. I stopped taking Metoprolol two weeks ago thinking that it was the cause. However, I continued to have multiple nightmares that awakened me as described. During the day I am growing increasingly tired, anxious, cognitively impacted, and getting more concerned as they are now increasing in severity, waking to a 167 heart rate. Last night I used deep breathing, laying on the left side, ice over the neck, bearing down on the Valsalva maneuver, 0.25 mg Xanax, and 25 mg Metoprolol due to the severity and intensity of the episode. I am at a loss and have no clue what is happening. In the past four months, I have had a sleep study with three episodes of apnea which was considered normal, and a heart monitor, EKG, and echo that were all normal. I had intermittent panic attacks at night for 20 years without nightmares but now I have severe nightmares with crazy dreams. Kindly suggest.

Answer 1

Hello,

Welcome to icliniq.com.

I have read your query and understand your concern. Beta-blockers like Metoprolol (Microcrystalline and Maize starch) and Propranolol (Microcrystalline cellulose and Methylcellulose) have been shown to improve nightmares and panic attacks. In my opinion, it was not the cause of your nightmares. In patients with anxiety disorders, their subconscious fears and worries reflect in the form of nightmares at night which may be the cause in your case. I would suggest you start some breathing exercises during the daytime and try physical activity as well. Practice mindfulness, and Jacobson's progressive muscle relaxation technique, as these will definitely help. I do not think you were given any SSRI (selective serotonin reuptake inhibitors) medication in the past. I think you must start one to combat your anxiety and panic issues. This will ultimately result in good sleep at night. Benzodiazepine is another alternative on a daily basis but it may have some abuse potential. I hope you find this helpful.

Thank you.