Migoya sat at his desk, a pen tapping on the side of his pale face. He had thought about what topics he should start writing his research on to aid in the development of the Konoha Buyojin, something… different. Relevant. Something that was not discussed in public, but strongly affected even the strongest in the village.
The life of a shinobi was a difficult one, plagued as it were with visions of the deeds one had to do to ensure the safety of the country. Even worse was the memories of war, and with the possible invasion of another country, Frost, Migoya felt it was important to research a rather sensitive, if not personal, subject.
The paper started with the heading - ‘Nightmare disorders in adults’.
A strange topic, but one that he knew plagued many in the village and to study it, research it, could be beneficial… even if it were only to himself. He began reading...
‘Nightmares are common beginning early in childhood and extending throughout the lifespan. The condition is strongly associated with stress, anxiety, and trauma.
While nightmares are not by definition pathologic, those that are frequent or disabling and impair social, occupational, emotional, and physical wellbeing are considered a disorder and are often a sign of underlying and treatable psychopathology. Common causes include stress, negative life events, the experience of trauma as in posttraumatic stress disorder (PTSD), depression, other psychiatric disorders, and medication side effects’.
So… everyone in this village. Every shinobi.
‘Approximately 85 percent of adults report having a nightmare at least once a year, and 2 to 6 percent report having frequent (weekly) nightmares’.
I wonder what the percentage is for shinobi…
‘Nightmares are more prevalent during periods of stress. They can emerge in association with traumatic experiences, as in posttraumatic stress disorder (PTSD), and in association with other psychiatric diagnoses, including depression, dissociative disorders, and borderline personality disorder. Medications most commonly associated with nightmares include those that affect norepinephrine, serotonin, dopamine, acetylcholine, or gamma-aminobutyric acid (GABA) signaling’.
So - Patients with a history of physical or emotional trauma are at increased risk for nightmares and related symptoms of intrusion, negative mood, dissociation, and avoidance. Noted.
Migoya was more concerned with the link between the average nightmare, and the more… damaging sort. Flipping through the pages in the book, he could not find what he was looking for. He sighed, and reached over to another well-worn book, scanning its contents.
‘Idiopathic frequent nightmares’ — Interesting.
‘Nightmares may occur with increased frequency during times of stress or emotional instability and may disturb the quality and continuity of sleep. Some have proposed that nightmares may initially be about the experience of a stressful event but very soon are replaced by the dominant emotion of the event as a repeating narrative. The theme may be fear followed by guilt and other strong emotions.’
Fear… why is that always the catalyst for our behaviour?
‘Nightmares are dysphoric dreams generally arising out of rapid eye movement (REM) sleep and less commonly out of N2 sleep’. I must research this more. ‘They occur more frequently in the last third of the night, when REM sleep predominates. One exception is nightmares associated with post-traumatic stress disorder (PTSD), which are equally likely during N1/N2 and REM sleep and may occur both early and late in the sleep period.’ - Hmm…
‘Dream content is typically scary and vivid, with negative themes that result in disturbed, fragmented sleep. Common themes include failure and helplessness, physical aggression, accidents, being chased, health-related concerns and death, and interpersonal conflicts’.
‘Nightmares are often associated with a heightened sense of awareness and increased sympathetic tone as evidenced by palpitations, increased blood pressure, increased heart rate, sweating, and symptoms of anxiety and panic upon awakening. Recall of dream content is typically vivid, in contrast with sleep terrors.’
‘Nightmares that recur with enough frequency and distress to impact nighttime or daytime function may meet criteria for nightmare disorder. Nightmare disorder is defined as:
Repeated occurrences of extended, extremely dysphoric, and well-remembered dreams that usually involve threats to survival, security, or physical integrity; on awakening from the dysphoric dreams, the person rapidly becomes oriented and alert, and the dream experience or sleep disturbance produced by awakening from it causes clinically significant distress or impairment in social, occupational, or other important areas of functioning as indicated by the report of at least one of the following:
1. Mood disturbance (eg, persistence of nightmare affect, anxiety, dysphoria)
2. Sleep resistance (eg, bedtime anxiety, fear of sleep or subsequent nightmares)
3. Cognitive impairments (eg, intrusive nightmare imagery, impaired concentration or memory)
4. Negative impact on caregiver or family functioning (eg, nighttime disruption)
5. Behavioral problems (eg, bedtime avoidance, fear of the dark),
6. Daytime sleepiness, fatigue or low energy, impaired occupational or educational function, or impaired interpersonal or social function.
So... everyone in the village. Especially our Academy Students.
Migoya scratched his chin, deeply in thought. So.. Nightmare disorder is a clinical diagnosis. Why are we not treating it as such?
Perhaps it had more to do with the difficulty of how to treat them, rather than the lack of interest. Migoya put down that book, and picked up what appeared to be a relatively untouched volume. Dr. Hinklestein… what can you provide me? He scanned the book, and begun to take notes.
‘Nightmares do not always require treatment. Even individuals who meet criteria for nightmare disorder may find that symptoms resolve over time without specific intervention. For patients who require intervention, we recommend a top-down approach, starting with a broad general evaluation of sleep and any predisposing trauma, psychiatric disorders or medications and then moving on to more specific treatment of nightmares when needed.’
Well thats helpful… Migoya sighed.
‘For patients who require nightmare-specific treatment, behavioral and pharmacologic approaches are best. Among these, imagery rehearsal therapy (IRT), a form of cognitive behavioral therapy has the largest success rate.
Wait… so the use of genjutsu in revering the images is shown to have beneficial effects? I must research more into this…
‘The choice between psychotherapy and medication can be individualized according to patient preferences and access to a therapist. In our experience, the majority of chronic persistent nightmares in adults are related in some way to underlying psychopathology or past trauma, and we encourage most patients to engage in psychotherapy prior to or in conjunction with medication’.
So… the use of genjutsu along with medication has the greatest effect. What medications are we currently using, if any? What other treatments are available? Migoya quickly skimmed through the book, taking in more information before finding another relevant chapter.
‘Lifestyle modifications that promote good sleep can help to decrease the frequency and severity of nightmares and enhance the overall quality of sleep. These interventions have demonstrated efficacy in treating nightmares in children and young adults. Although sleep hygiene has not been studied on its own in patients with nightmare disorder, it is often a component of studies involving other treatments and is a low-cost, low-risk intervention’.
He continued to read throughout the next few days, requiring no sleep. Noting his findings, he wrote a very simplified explanation of what shinobi could do who suffered from recurrent nightmares, a ‘checklist’ so to speak that he would present to Mikasa, and see if this could be incorporated to all med-nin training.
Migoya put down his pen, clearly intrigued at the possibilities this particular branch and method could provide to the village. Whilst he had no particular interest in psychology, as a skilled medical practitioner any sort of malady was considered a challenge that he would need to overcome. The fact that he himself suffered from it was a bonus.
He folded up his notes, along with a request for a more formal meeting to present his findings to the med-nin, addressed to the Medical Sennin. Let us hope people will take this seriously.
WC: 1428
The life of a shinobi was a difficult one, plagued as it were with visions of the deeds one had to do to ensure the safety of the country. Even worse was the memories of war, and with the possible invasion of another country, Frost, Migoya felt it was important to research a rather sensitive, if not personal, subject.
The paper started with the heading - ‘Nightmare disorders in adults’.
A strange topic, but one that he knew plagued many in the village and to study it, research it, could be beneficial… even if it were only to himself. He began reading...
‘Nightmares are common beginning early in childhood and extending throughout the lifespan. The condition is strongly associated with stress, anxiety, and trauma.
While nightmares are not by definition pathologic, those that are frequent or disabling and impair social, occupational, emotional, and physical wellbeing are considered a disorder and are often a sign of underlying and treatable psychopathology. Common causes include stress, negative life events, the experience of trauma as in posttraumatic stress disorder (PTSD), depression, other psychiatric disorders, and medication side effects’.
So… everyone in this village. Every shinobi.
‘Approximately 85 percent of adults report having a nightmare at least once a year, and 2 to 6 percent report having frequent (weekly) nightmares’.
I wonder what the percentage is for shinobi…
‘Nightmares are more prevalent during periods of stress. They can emerge in association with traumatic experiences, as in posttraumatic stress disorder (PTSD), and in association with other psychiatric diagnoses, including depression, dissociative disorders, and borderline personality disorder. Medications most commonly associated with nightmares include those that affect norepinephrine, serotonin, dopamine, acetylcholine, or gamma-aminobutyric acid (GABA) signaling’.
So - Patients with a history of physical or emotional trauma are at increased risk for nightmares and related symptoms of intrusion, negative mood, dissociation, and avoidance. Noted.
Migoya was more concerned with the link between the average nightmare, and the more… damaging sort. Flipping through the pages in the book, he could not find what he was looking for. He sighed, and reached over to another well-worn book, scanning its contents.
‘Idiopathic frequent nightmares’ — Interesting.
‘Nightmares may occur with increased frequency during times of stress or emotional instability and may disturb the quality and continuity of sleep. Some have proposed that nightmares may initially be about the experience of a stressful event but very soon are replaced by the dominant emotion of the event as a repeating narrative. The theme may be fear followed by guilt and other strong emotions.’
Fear… why is that always the catalyst for our behaviour?
‘Nightmares are dysphoric dreams generally arising out of rapid eye movement (REM) sleep and less commonly out of N2 sleep’. I must research this more. ‘They occur more frequently in the last third of the night, when REM sleep predominates. One exception is nightmares associated with post-traumatic stress disorder (PTSD), which are equally likely during N1/N2 and REM sleep and may occur both early and late in the sleep period.’ - Hmm…
‘Dream content is typically scary and vivid, with negative themes that result in disturbed, fragmented sleep. Common themes include failure and helplessness, physical aggression, accidents, being chased, health-related concerns and death, and interpersonal conflicts’.
‘Nightmares are often associated with a heightened sense of awareness and increased sympathetic tone as evidenced by palpitations, increased blood pressure, increased heart rate, sweating, and symptoms of anxiety and panic upon awakening. Recall of dream content is typically vivid, in contrast with sleep terrors.’
‘Nightmares that recur with enough frequency and distress to impact nighttime or daytime function may meet criteria for nightmare disorder. Nightmare disorder is defined as:
Repeated occurrences of extended, extremely dysphoric, and well-remembered dreams that usually involve threats to survival, security, or physical integrity; on awakening from the dysphoric dreams, the person rapidly becomes oriented and alert, and the dream experience or sleep disturbance produced by awakening from it causes clinically significant distress or impairment in social, occupational, or other important areas of functioning as indicated by the report of at least one of the following:
1. Mood disturbance (eg, persistence of nightmare affect, anxiety, dysphoria)
2. Sleep resistance (eg, bedtime anxiety, fear of sleep or subsequent nightmares)
3. Cognitive impairments (eg, intrusive nightmare imagery, impaired concentration or memory)
4. Negative impact on caregiver or family functioning (eg, nighttime disruption)
5. Behavioral problems (eg, bedtime avoidance, fear of the dark),
6. Daytime sleepiness, fatigue or low energy, impaired occupational or educational function, or impaired interpersonal or social function.
So... everyone in the village. Especially our Academy Students.
Migoya scratched his chin, deeply in thought. So.. Nightmare disorder is a clinical diagnosis. Why are we not treating it as such?
Perhaps it had more to do with the difficulty of how to treat them, rather than the lack of interest. Migoya put down that book, and picked up what appeared to be a relatively untouched volume. Dr. Hinklestein… what can you provide me? He scanned the book, and begun to take notes.
‘Nightmares do not always require treatment. Even individuals who meet criteria for nightmare disorder may find that symptoms resolve over time without specific intervention. For patients who require intervention, we recommend a top-down approach, starting with a broad general evaluation of sleep and any predisposing trauma, psychiatric disorders or medications and then moving on to more specific treatment of nightmares when needed.’
Well thats helpful… Migoya sighed.
‘For patients who require nightmare-specific treatment, behavioral and pharmacologic approaches are best. Among these, imagery rehearsal therapy (IRT), a form of cognitive behavioral therapy has the largest success rate.
Wait… so the use of genjutsu in revering the images is shown to have beneficial effects? I must research more into this…
‘The choice between psychotherapy and medication can be individualized according to patient preferences and access to a therapist. In our experience, the majority of chronic persistent nightmares in adults are related in some way to underlying psychopathology or past trauma, and we encourage most patients to engage in psychotherapy prior to or in conjunction with medication’.
So… the use of genjutsu along with medication has the greatest effect. What medications are we currently using, if any? What other treatments are available? Migoya quickly skimmed through the book, taking in more information before finding another relevant chapter.
‘Lifestyle modifications that promote good sleep can help to decrease the frequency and severity of nightmares and enhance the overall quality of sleep. These interventions have demonstrated efficacy in treating nightmares in children and young adults. Although sleep hygiene has not been studied on its own in patients with nightmare disorder, it is often a component of studies involving other treatments and is a low-cost, low-risk intervention’.
He continued to read throughout the next few days, requiring no sleep. Noting his findings, he wrote a very simplified explanation of what shinobi could do who suffered from recurrent nightmares, a ‘checklist’ so to speak that he would present to Mikasa, and see if this could be incorporated to all med-nin training.
Migoya put down his pen, clearly intrigued at the possibilities this particular branch and method could provide to the village. Whilst he had no particular interest in psychology, as a skilled medical practitioner any sort of malady was considered a challenge that he would need to overcome. The fact that he himself suffered from it was a bonus.
He folded up his notes, along with a request for a more formal meeting to present his findings to the med-nin, addressed to the Medical Sennin. Let us hope people will take this seriously.
WC: 1428