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A nightmare is a disconcerting dream accompanied by negative emotions such as anxiety or fear that rouses an individual from sleep. While nightmares are prevalent among children, they can occur at any age. Infrequent nightmares are generally considered normal and not a cause for concern.
In children, nightmares may emerge between the ages of 3 and 6, diminishing in frequency after the age of 10. During adolescence and early adulthood, girls tend to experience nightmares more frequently than boys. However, some individuals continue to have nightmares into adulthood or throughout their lives.
While nightmares are a common occurrence, nightmare disorder is a relatively rare condition. Nightmare disorder is characterized by frequent nightmares that lead to distress, sleep disturbances, impaired daytime functioning, or a fear of going to sleep.
Symptoms
Nightmares are more likely to happen in the second half of the night, and they can occur rarely or even several times during the night. They are brief but can make it challenging to go back to sleep. Here are some features of nightmares:
- Vivid and disturbing: Nightmares are vivid and feel real, becoming more distressing as they unfold.
- Themes of threat: The dream usually involves threats to safety or survival, but it can have other disturbing themes.
- Physical symptoms: Sweating or a pounding heartbeat can accompany the dream.
- Clear recall: You can remember details of the dream and think clearly upon awakening.
- Difficulty returning to sleep: Nightmares can cause distress, making it hard to go back to sleep easily.
- Awakening: Nightmares wake you up from sleep.
- Emotional impact: You may feel scared, anxious, angry, sad, or disgusted after the dream.
Nightmares become a concern if you experience:
- Frequent occurrences: If nightmares happen often.
- Behavioral issues: Problems related to bedtime or fear of the dark.
- Functional impairment: Problems with concentration, memory, or difficulties in work, school, or social situations.
- Daytime distress: Major distress during the day, such as anxiety, persistent fear, or bedtime anxiety about having another nightmare.
If your child has nightmares, it may cause significant disturbance for both the child and caregivers. Consult a doctor if nightmares:
- Occur frequently: Happen often and persist over time.
- Lead to daytime issues: Cause behavioral problems or difficulties in functioning during the day.
- Cause fear of sleep: Result in fear of going to sleep.
- Disrupt sleep routinely: Regularly disrupt the sleep cycle.
Causes
Nightmare disorder falls under the category of parasomnias, which are sleep disorders involving undesirable experiences during the process of falling asleep, while asleep, or during waking. Nightmares typically occur during the rapid eye movement (REM) sleep stage, but their exact cause is not precisely known.
Several factors can trigger nightmares, including:
- Sleep deprivation: Irregular sleep schedules or disruptions in sleep patterns, leading to reduced sleep duration, can increase the likelihood of nightmares. Insomnia, characterized by difficulty sleeping, is linked to a higher risk of nightmares.
- Stress or anxiety: Everyday stresses, like issues at home or school, can be a trigger. Major life changes, such as moving or the loss of a loved one, can also induce nightmares. Experiencing anxiety is associated with a higher risk of nightmares.
- Trauma: Nightmares are common after traumatic events like accidents, injuries, or instances of physical or sexual abuse. They are especially prevalent in individuals with post-traumatic stress disorder (PTSD).
- Scary media consumption: Reading frightening books or watching scary movies, especially before bedtime, can be a factor for some individuals in experiencing nightmares.
- Medications: Certain medications, including some antidepressants, blood pressure drugs, beta blockers, and those used for Parkinson’s disease or smoking cessation, may trigger nightmares.
- Substance misuse: The use or withdrawal of substances like alcohol and recreational drugs can induce nightmares.
- Other disorders: Conditions such as depression and various mental health disorders may be associated with nightmares. Additionally, nightmares can be linked to certain medical conditions like heart disease or cancer. Having other sleep disorders that disrupt normal sleep patterns can also contribute to nightmares.
Risk factors
If there is a family history of nightmares or other sleep parasomnias, such as talking in your sleep, then your chances of experiencing nightmares are higher.
Diagnosis
Nightmare disorder is typically not diagnosed through routine tests; instead, it is identified when distressing dreams significantly impact your well-being or disrupt your sleep. To diagnose this disorder, your doctor will conduct a thorough evaluation, which may involve:
- Physical exam: A comprehensive physical examination will be conducted to identify any underlying conditions contributing to the nightmares. If anxiety is suspected as a factor, a referral to a mental health professional may be recommended.
- Symptoms discussion: Diagnosis relies on your detailed description of your experiences. Your doctor may inquire about your family’s history of sleep problems, discuss sleep behaviors with you or your partner, and explore the possibility of other sleep disorders if necessary.
- Nocturnal sleep study (polysomnography): In cases of severe sleep disturbance, an overnight sleep study may be suggested to determine if nightmares are linked to another sleep disorder. This study involves placing sensors on your body to monitor various parameters such as brain waves, blood oxygen levels, heart rate, breathing, eye and leg movements, and may include video recording to document your behavior during sleep cycles.
Treatment
In most cases, treating nightmares is unnecessary. However, treatment may become essential if your dreams start to disrupt your daily life, causing you anxiety or sleep disturbances.
Treatment for nightmare condition is influenced by its underlying cause. Possible course of treatment options include:
- Medication. It is rare to treat nightmares using medication. For severe dreams linked to Post Traumatic Stress Disorder (PTSD), medication could be advised.
- Stress or anxiety treatment. If your doctor concludes that a mental health condition, such as anxiety or stress, is the underlying cause of your nightmares, they might suggest counseling, therapy, or stress-reduction techniques as potential treatment options.
- Medical treatment. If the nightmares are associated with a medical condition, treatment primarily targets addressing the underlying health issue.
- Imagery rehearsal therapy. Imagery rehearsal therapy, commonly used for individuals with PTSD who suffer from nightmares, involves the process of reimagining and altering the outcome of a remembered nightmare while you are awake, making it appear less threatening. Subsequently, you engage in mental rehearsal of the modified ending. This approach has the potential to reduce the frequency of nightmares.
