What could be the cause of terrible nightmares?

Ask Dr. Keith Roach M.D

DEAR DR. ROACH: My wife is plagued by terrible nightmares. She is 69 years old. Each night, she has horrible dreams that make her moan out loud. I wake her, but she goes back to the same type of dreams. She has done this for years. It really affects the quality of her sleep, and mine. She is exhausted during the daytime. Her father and aunt had the same symptom. — C.F. ANSWER: The only times in my career that I have heard this complaint have been in the following situations: patients experiencing side effects from medications, those with sleep disorders and those suffering from psychological issues. Medications, especially those prescribed for depression and high blood pressure, can cause this side effect. If she takes any medication, read the literature on it to see if it might be causing her nightmares. Sleep disorders — obstructive sleep apnea particularly, but also restless leg syndrome — can be associated with sleep disturbances. Finally, anxiety disorders, such as post-traumatic stress disorder (PTSD), may frequently include nightmares. However, the family history suggests a distinct disorder, nightmare disorder, which tends to run in families. In nightmare disorder, there are no other known causes. Exercise, such as yoga, is recommended for this. The most effective treatment, as far as I am able to tell, seems to be a form of cognitive behavioral therapy. Psychologists or other mental health professionals would be most likely to do this, but you need to find someone in your area with this expertise. *** DEAR DR. ROACH: My elbow is currently out of alignment due to overexerting it while cleaning. My personal care physician suggested therapy to correct the problem. To date, I’ve had five sessions with the physical therapist, and the forearm area is still not better. Do you believe that continued sessions would help my forearm to become better aligned? I don’t want to continue to pay for sessions that won’t resolve the problem. — S.B. ANSWER: I think what you mean by “out of alignment” is dislocated. If that is the case, the elbow needs to be put back into place. Sometimes, the elbow gets itself back into place, but more often an orthopedic surgeon manipulates the elbow into the proper position. Whether it goes back by itself or is placed there by a doctor, physical therapy often is needed to strengthen the muscles and help the joint regain its range of motion. I am confused, in your situation, whether the elbow is currently out of alignment -i.e., dislocated — or whether it is in the right place. If it’s still out of alignment (and both your primary-care doctor and your physical therapist should be able to answer that), then I would seek help from an orthopedic surgeon. If it’s in the right place, then five sessions may not be enough to return it to normal, although it should be improving. Please let me know what happens. *** Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGood-Health@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.