We all know what it is like to wake up from a nightmare. The racing heart. The lifelike, frightening images. Though they arent real, nightmares can be terrifyingly vivid. They can make it difficult to fall asleep, especially for those who experience them often.
A nightmare is a dream with a negative subject matter that invokes fear or other disturbing emotions.An ordinary bad dream is a nightmare. A nightmare can wake you up from your sleep.. Nightmares can trigger strong emotional reactions, such as fear, anger or sadness.
Although they are rare, nightmares are very common. They occur on occasion in approximately 50% of adults around the world, and are even more prevalent in children and adolescents.
Notice: While the content of Sleepopolis may be informative, it should not be taken as medical advice. It should not replace professional medical advice. You should consult your healthcare provider immediately if you suspect you might have a sleep disorder or other medical condition.
The Stuff Of Nightmares
The word nightmare is derived from mare, variations of which appear in many ancient languages. Possible original meanings of mare may be to crush or oppress, to harm, or a sense of doom.The mare appears in Old German and Slavic folklore as a monstrous being that sits on the chest during sleep and causes bad dreams. Henry Fuselis‘ 1781 painting, The Nightmare, is a particularly good example of the mare figure.
The Nightmare of Henry Fuseli (1781), Detroit Institute of Arts
Nightmares are more common in the last stages of REM sleep. This is the stage of sleep where dreams are vividest and brain activity is most similar to wakefulness.Activation of the amygdala, a primitive structure in the brain designed to recognize and respond to potential threats, may explain some nightmares, particularly in those with chronic activation of the amygdala due to stress, trauma, or childhood adversity.
Changes in brain waves may also be responsible for some nightmares, or at least the ability of some dreamers to remember their disturbing dreams.
If they disrupt daily life or cause sleep disruptions more frequently than once, then nightmares can be considered normal..
The following are common themes in nightmares:
- Violence or aggression
- Death
- Physical jeopardy
- Fear
- Betrayal
- Accidents
- Being chased
Another common theme in nightmares is environmental calamity, such as an apocalypse or nuclear disaster. Falling, being trapped, drowning, or being unable to move are other common subjects of nightmares, which may have complex narratives and feel as real to the dreamer as waking life.
FAQ
Do nightmares seem to be more common in certain personalities or groups of people than others?
They may be. They’re known to occur more frequently in people who may feel vulnerable in the world, such as those with eyesight or hearing difficulties.
Signs And Symptoms Of Nightmares
Because of the strong emotions and likelihood that the dreams will be recalled, nightmare symptoms are often obvious.
These are some of the most common signs and symptoms.:
- Experiencing dreams with disturbing or upsetting themes, such as death, threat to physical safety, war, or personal conflict
- After a good dream, you can sit upright in your bed.
- Waking feeling anxious
- Getting up with a higher rate of respiration
- Struggling to realize your dream
- Waking from sleep screaming or shouting
Nightmares may make returning to sleep difficult, particularly if they cause physical symptoms such as increased heart rate, perspiring, or feelings of shakiness due to adrenaline release.
Causes Of Nightmares
Ordinary nightmares may be triggered by such simple causes as a physically uncomfortable sleep position, headache, or fever. Eating before bed may elevate the rate of metabolism, thereby increasing brain activity and triggering nightmares. Nightmares that result from these types of causes are generally not chronic, and only occasionally disrupt sleep.
However, there are other causes of nightmares that can persist for weeks, months or even longer.Children can experience night terrors and ordinary nightmares. This is a disorder that usually occurs in non-REM sleep.
Non-REM Sleep
This stage includes three of the four stages. It is characterised by minimal eye movement, minimal dreaming and a variety of depths of sleep. They range from the light N1 stage to the deep, restorative N3 stage.
Pregnancy And Hormonal Changes
Nightmares can also be caused by hormonal changes or pregnancy. This may be due to sleep disruptions caused by hormonal fluctuations, or by the hormonal fluctuations themselves.REM sleep is the stage in which dreams are most likely to happen. It can be affected by waking up during pregnancy due to discomfort..
Perimenopause and the usual menstrual cycle may cause nightmares due to changes in body temperature and progesterone. Such changes can interrupt sleep, which may prompt unusually vivid dreams and increase the chance that dreams will be remembered.
Post-Traumatic Stress Disorder
Nightmares are a common feature of post-traumatic stress disorder, and may be one of the most disturbing aspects of the disorder.PTSD sufferers report that as many as 80% experience regular nightmares.
PTSD is characterized by three clusters of symptoms: intrusion, avoidance, and hyperarousal. Post-traumatic nightmares are part of the intrusion cluster, which includes flashbacks, intrusive thoughts, and physiological distress, also referred to as body memory.
Although nightmares that happen after traumatic events may seem like a replay of past experiences they can also be very different. The emotions are usually the same regardless of how the nightmare is set or told.Nightmares caused by PTSD can occur whenever a person falls asleep. This may cause disturbed sleep, panic attacks, and fear..
Nightmares that occur after trauma may be different from ordinary nightmares, not just in their frequency and intensity, but when they occur. PTSD-related nightmares are more common in sleep stages other that REM. They can occur earlier in the evening, involve body movements, vocalization, shouting, or speaking.
Depression And Other Mood Disorders
Two of the most common reasons for nightmares are anxiety and depression.. People with depression are more likely than others to have nightmares and dreams that contain negative content. Those with mood disorders such as depression, anxiety or other mood disorders may experience distress from nightmares.
Some studies suggests that dream content may change when a person suffering from bipolar disorder changes from a manic to a depressive state or vice versa.
People who experience both insomnia and nightmares may be particularly at risk for depression and other mood disorders.As with depression and mood disorders like bipolar disorder and schizophrena that can cause nightmares, they may also contribute to or worsen mood disorders..
Pre-existing anxiety may be heightened by disturbing and vivid dreams, while nightmares that disturb sleep may worsen depression due to sleep deprivation and fear of falling asleep.
FAQ
?????????? Can anti-depressants cause nightmares?
A: Nightmares may be a side effect of certain antidepressants. Although older tricyclic antidepressants are less well-known for causing nightmares, SSRI’s that have a greater impact on REM sleep may be able to cause them.
Withdrawal Syndromes
A common cause of nightmares is withdrawal from drugs and recreational drugs.REM Sleep rebound is a term that refers to a period of vivid, longer dreams after REM sleep suppression.. Sleep deprivation may also cause REM rebound.
Disruption to sleep architecture may also help explain why nightmares plague people in withdrawal.
Drug, alcohol, and medication use can alter sleep cycles, depressing brain function and changing the length and quality of sleep stages. Once a substance is stopped, shifts between non-REM and REM sleep can become irregular, disturbing sleep and increasing the risk of nightmares.
The brain chemical reductions that occur after the consumption of alcohol are stopped can cause delirium tremens (also known as alcohol withdrawal syndrome). If not treated in a hospital, addiction center, or other medical facility, alcohol withdrawal can cause severe brain damage and nerve system disruptions.
Nightmares are one of the most prominent signs of the syndrome.This can be intense and relentless. Similar to the withdrawal of barbiturate, REM sleep rebound may be responsible for the alcohol withdrawal nightmares.
Other signs include:
- Hallucinations
- Sweating
- Elevated blood pressure
- Fever
- Vomiting
- Seizures
- Increased heart rate
- Tremors
After stopping alcohol, nightmarish dreams and other symptoms of alcohol withdrawal syndrome can begin within two to three working days. They peak between five and seven days. Nightmares may persist for days or even weeks after the other symptoms have subsided.
Medications
Common antidepressants such as SSRIs are known to cause nightmares in addition to other effects on sleep.
Antidepressants can influence neurotransmitters like serotonin and dopamine. These neurotransmitters have a significant impact on sleep and emotions.. The result may be unusually vivid dreams and nightmares.
Although the effects may last for a short time as the body adjusts to the medication, some users may experience nightmares that persist and continue for as long as they are taking the drug.
Other medications may cause nightmares, as well. These include:
- Antihistamines
- Certain antibiotics
- Blood pressure medication
- Dopamine receptor antagonists
- Beta-blockers
- Stimulants
Sedatives and hypnotics, some of which are prescribed for insomnia or other sleep difficulties, may increase the risk of disturbing dreams and nightmares once they are stopped due to their suppression of REM sleep.A less sedated sleep may lead to better dreams recall, both normal and disturbing..
Hypnotics
A class of psychoactive sleep medications that include Ambien, Halcion, Lunesta, and Sonata.
Diagnosis
Nightmares can be diagnosed with only symptoms. If sleep disturbance is severe, a physical exam and/or an overnight sleep study may need to be done. This will help rule out other possible contributing factors like sleep disorders or other medical conditions.
Sometimes a sleep study can be conducted at home, but often this type of diagnostic tool requires a polysomnography performed in a sleep study lab. Polysomnography is the use of sensors to monitor brain waves, blood oxygen levels and body movements. It also records heart rate and breathing rates.
The test may be videotaped, as well.
Children’s Nightmares
Nightmares occur frequently in children and adolescents, and considered normal unless they persist, cause fear during waking hours, or create chronic sleep disturbanceThey can be very common. These may occur more frequently in children who recently have experienced a change of life circumstances, the death of a loved one, or another stressor.
The following are common causes of nightmares among children:
- Anxiety and stress
- Fever
- Medications
- Trauma
- Family conflict
- Disruptions to routine
- Important life events like moving, the birth of a sibling or divorce
Night Terrors
Night terrors are not like a normal nightmare. They occur during non-REM sleep.. They are a parasomnia and most often occur in children aged between two and four.
These symptoms may be caused by night terrors:
- Screaming or shouting in bed
- Propped up in bed
- Move or thrash in bed
- Appearing agitated after awakening or while you’re asleep
- Seeming inconsolable during or after a night terror
- Appearing confused when awakened
- Sleepwalking or getting out of bed
A child who is having a nightmare can be easily woken up and consoled. However, it’s more difficult for a child with a night terror to get up.Night terrors can also cause sleep-related injuries or bedwetting in children. Researchers believe that night terrors are caused by normal childhood changes such as being left alone to sleep or having trouble sleeping with parents.
Treatments for night terrors include scheduled awakenings to avoid long periods spent asleep and dreaming, medications, and a machine designed to lightly vibrate when it senses night terrors beginning, awakening the child just enough to interrupt the cycle of frightening dreams.
FAQ
??????? What is parasomnia?
A: Abnormal movements, behaviors, emotions, perceptions, or dreams that occur while falling asleep, sleeping, between sleep stages, or during arousal from sleep.
Nightmare Disorder
Also known as Dream Anxiety Disorder, Nightmare Disorder causes frequent nightmares that trigger distress, disrupt sleep, interfere with daytime functioning, and/or lead to fear of falling asleep. Approximately 4% of adults in the US have nightmares frequent and disruptive enough to qualify as nightmare disorder. The disorder is considered a parasomnia.
The diagnostic criteria described in the The Diagnostic and Statistical Manual of Mental Disorders (DSM5) are as follows:
- Multiple awakenings during sleep, or naps that include a detailed recall of disturbing dreams. These are often related to threats to security, survival, or well-being. The awakenings typically occur in the second half of a period of sleep.
- The person quickly becomes alert and oriented upon awakening. This contrasts with the confusion and disorientation of night terrors
- The nightmare causes distress or impairment in social and other essential areas of functioning
- The nightmares do not occur exclusively during the course of another mental disorder, and are not due to another medical condition, substance, or medication
Persistent nightmares may be classified by:
- When they occur. Are they associated with sleep onset or later in the cycle?
- Their association with a sleep disorder such as narcolepsy, another medical condition, or substance use disorder
- When they began. Nightmares that have lasted 1 month or less are considered acute, between 1 and 6 months are considered subacute, 6 months or longer are considered persistent
- Severity. Severity. Nightmares that happen on average less often than once per week can be considered mild. However, if they occur more than once per week, but less than nightly, they are considered moderate.
Nightmare disorder sufferers may scream or shout during sleep. It could be due to many conditions, such as common nightmares, or it may be idiopathic or unrelated.
You can distinguish nightmare disorder nightmares from other nightmares by their vividness, frequency, and tendency to disrupt daytime functioning. Nightmare disorder may lead to insomnia due to chronic anxiety and the fear of falling asleep.
Sleep Disorders
Nightmares can be caused by sleep disorders like narcolepsy and restless legs syndrome.. Sleep-wake disorders such as narcolepsy can degrade the boundaries between the sleep and wake states, causing them to overlap. These poor boundaries may cause other parasomnias, as well, such as sleep paralysis and hypnagogic hallucinations.
Sleep apnea and restless legs syndrome may cause REM sleep to be interrupted, which can lead to frequent awakenings and strange or unsettling dreams. Due to their tendency to disrupt REM sleep, sleep disorders can increase the recollection and recall of nightmares and other dreams.
REM sleep behavior disorder causes sufferers to act out dreams and nightmares due to loss of muscle paralysis during REM sleep. Dreamers are usually protected from such activity due to widespread muscle paralysis. If this paralysis does not occur, it can lead to injury or damage to the surrounding environment. REM sleep behavior disorder is strongly associated with a greater risk of Parkinsons and other degenerative neurological diseases.
Treatment For Nightmares
Treatment of nightmares may include certain types of medications, hypnosis, and desensitization therapy. Psychologists may also use Cognitive Behavioral Therapy variations such as Self-Exposure Therapy to help nightmare sufferers open up to disturbing memories or events at their own pace.
These therapies often combine elements of stimulus control therapy and sleep hygiene to help sufferers of nightmares control their emotions and address the causes of their disturbing dreams..
Stimulus Control Therapy, or SCT
SCT is a method to remove conditioned negative associations that sleep and the environment have with it. The SCT protocol involves reserving the bedroom as a place for sleep and only sleeping when you are tired.
One of the most effective treatments for nightmares of all types may be Imagery Rehearsal Therapy, or IRT. A type of cognitive behavioral therapy, IRT trains nightmare sufferers to alter the ending of nightmares while awake so the dream becomes non-threatening. This ending is then rehearsed for 10-20 minutes each day, becoming part of the dream narrative and changing its outcome. IRT may also help to improve daytime symptoms in PTSD sufferers.
Imagery rehearsal therapy can be especially effective for PTSD sufferers who have nightmares.While some studies have shown Prazosin to reduce PTSD-related nightmares in some cases, others show little or no effect..
Meditation, yoga, and guided relaxation therapy may reduce stress and anxiety. This can help to lessen the likelihood of nightmares and the fear that they will occur.Cognitive behavioral therapy may help nightmare sufferers explore the emotions behind their dreams and address the fear of nightmares occurring again. A relaxing bedtime routine may also help reduce anxiety and help reduce the risk of disturbing dreams.
Here are some strategies to help children who have experienced ordinary nightmares.:
- Be comforting and reassuring A calm parental presence can help a child learn to self-soothe and feel less fearful after waking from a nightmare. A child might feel more secure if they have a favorite blanket or stuffed animal.
- Discuss the dream. Ask the child to describe the dream and who was in it. Talking about frightening dreams can make them less fearful.
- Help the child rewrite the nightmare. Imagining a happy or funny ending to a nightmare may help diminish the dreams power in a childs mind, and add an element of play to the experience
- Use a night light. A night light can help a child wake up from nightmares or frighten them.
- A child’s anxiety and stress can be addressed. Moving, starting a new school or adding a sibling to the family can disrupt sleep and increase the likelihood of nightmares.
Last Word From Sleepopolis
Even though they can be frightening and have negative subject matter, the vividest and most well-remembered type nightmares are possible.. These conditions can occur in children, adolescents, as well as adults.
Though they may be disturbing, nightmares can be reduced or altered by a number of effective treatments, including altering the course of dream events and changing how they turn out. Nightmares may highlight emotions or experiences that need to be addressed, and in that way, offer enlightening glimpses into the subconscious.
