Nightmare Disorder

1 What is Nightmare Disorder?

Nightmares commonly happen to us, and having them occasionally is pretty normal. Nonetheless, if you are experiencing them more often that makes you afraid of going to sleep, then it may pose some problems. 

Nightmare disorder is diagnosed only when your nightmares seem to bother you that you eventually feel frightened just with the thought of going to sleep. It is also considered a disorder if you experience problem functioning during daytime, which is probably caused by stress and lack of sleep. 

While children aged 3 to 6 years may begin having nightmares, they will eventually decrease in frequency by age 10 and will continue having them occasionally. Some people even have them their whole life.

2 Symptoms

Undesirable dreams that usually occur as you fall asleep, during sleep, and even as you are waking up is the main symptom of nightmare disorder or parasomnia.

Typically, nightmares happen during the REM, or a sleep stage rapid eye movement.

A nightmare is distinctive from other dreams, and is characterized by:

Vivid, life-like dream

  • As it unfolds, dream plot becomes more disturbing
  • The plot is usually about your threatened safety
  • You wake up from your dream feeling scared, angry, sad, anxious, or disgusted
  • Your thinking seems clear upon awakening
  • Details of the dream can be recalled easily upon waking up
  • The dream prevents you from falling asleep again

In addition, the symptoms of a nightmare disorder include:

  • Significant distress cause by frequent sleep disturbance due to nightmares
  • Difficulty functioning at daytime

Nightmares typically vary with age. A younger child may have monsters in their dreams, while an older child may have a bad dream that shows difficulties in school or at home. 

See a doctor if the nightmares routinely become the cause of sleep disruption, make you fearful of going to sleep, or maybe the cause of behavioral problems during daytime. 

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3 Causes

Not everyone having nightmares have a nightmare disorder. It can only be considered as one I the bad dreams are causing distress and fatigue due to lack of sleep. Nightmares are triggered by many different factors, such as:

  • Stress. At times, problems at school or home, other seemingly ordinary stresses, or a major change may trigger nightmares.  
  • Trauma. People who recently had an injury or experienced an accident or traumatic event are more susceptible to nightmares.
  • Lack of sleep. Reduced amount of sleep due to changes in schedule and other factors can increase the risk of having nightmares. 
  • Medications. Certain drugs like antidepressants, beta blockers, blood pressure meds. And medications in treating Parkinson’s disease can be nightmare triggers. 
  • Substance abuse. Drug use and excessive alcohol intake may cause a person to have nightmares.
  • Exposure to scary things. Watching horror movies and reading scary books, particularly prior to bedtime, are also linked to having nightmares.

Apart from the factors mentioned above, some mental disorders and health issues can trigger nightmares. People with anxiety, for instance, are more likely to have nightmares compared to people without similar disorder.

4 Making a Diagnosis

There are no tests routinely done to diagnose nightmare disorder.

Nightmares in children usually decrease during the teenage years. Still, if you or your child is bothered by nightmares, or if you think there are other underlying causes, seeing a doctor is important. A sleep specialist might be needed for a more accurate diagnosis.

The doctor may ask you a few questions, such as the severity of the nightmares and how often they occur. The doctor may also ask if there’s a history of nightmares and other sleeping disorder in the family. 

Information about the sleeping pattern of the patient will also be discussed, as well as probable causes of distress and if there’s any medications or supplements taken recently.

At times, an underlying case of anxiety disorder is the cause of having recurring, disruptive nightmares. If this is the case, the child or patient may be advised to see a psychologist for further assessment and to help manage any underlying disorder. 

Nightmare disorder is different from sleep terror, in which the person usually sits up, talks, screams, kicks and trashes during the dream. On the other hand, the REM sleep behavior disorder involves shouting and acting out.

The doctor may advise conducting a sleep study, in which the patient will be observed overnight in order to determine if there’s a connection between the occurring nightmares and other sleep disorders. During the process, sensors will be attached to key parts of the head and body. These sensors record the brain waves and blood oxygen levels, as well as record the breathing and heart rate, and the movements of eyes and legs.

 Sometimes, in addition to the sensors, a video camera is used to take a video of you while sleeping. The information gathered are reviewed, which will be the basis of your diagnosis. 

5 Treatment

Nightmares alone do not need treatment. However, if they are interfering with your function and causing you to suffer, then it is time to talk to your doctor for treatment. The kind of treatment relies on the main cause of disorder. 

  • Treatment for medical condition: If another condition is causing the nightmare disorder, the medical treatment will target it first.
  • Stress management and anxiety treatment: If the nightmares are caused by stress or anxiety, stress-reducing techniques, therapy, and counseling may be advised. 
  • Medications. While rarely used for treating nightmares, medications can sometimes help reduce REM sleep activity and minimize awakenings when sleeping. Medications are prescribed only when you are experiencing severe sleep disturbance.
  • Imagery rehearsal therapy. This kind of therapy is often used with those who have Post-traumatic stress or PTSD. Image rehearsal therapy is the process of training yourself to have dreams of different endings, so that they are no longer frightening. 

6 Lifestyle and Coping

Lifestyle modifications are necessary in order to cope with nightmare disorder.

Doing a number of relaxation techniques prior to bedtime can help minimize the occurrence of nightmares. Meditation, deep breathing exercises, and sometimes even a warm bath can help you relax.

If a child is suffering from nightmares, you have to be patient as a parent. Offer comfort and reassurance. You have to respond as quickly as possible once your child wakes up from a nightmare. Soothe your child or even consider co-sleeping. 

Talking about the nightmare also helps. Moreover, you can practice imagery rehearsal therapy by rewriting the nightmare’s ending. 

7 Risks and Complications

Complications of nightmare disorder may include:

  • Excessive sleepiness during daytime
  • Behavioral problems
  • Fear of going to sleep
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