Definition

What is nightmare disorder?

A nightmare is a disturbing dream associated with negative feelings, such as anxiety or fear that awakens you.

Nightmare disorder is when nightmares happen often, cause distress, disrupt sleep, cause problems with daytime functioning or create fear of going to sleep.

How common is nightmare disorder?

Although nightmares are common, nightmare disorder is relatively rare. Nightmares are common in children, but can happen at any age, and occasional nightmares usually are nothing to worry about.

Nightmares may begin in children between 3 and 6 years old and tend to decrease after the age of 10. During the teen and young adult years, girls appear to have nightmares more often than boys do. Some people have them as adults or throughout their lives.

Please discuss with your doctor for further information.

Symptoms

What are the symptoms of nightmare disorder?

The common symptoms of nightmare disorder are:

You’re more likely to have a nightmare in the second half of your night. Nightmares may occur rarely or more frequently, even several times a night. Episodes are generally brief, but they cause you to awaken, and returning to sleep can be difficult.

A nightmare may involve these features:

  • Your dream seems vivid and real and is very upsetting, often becoming more disturbing as the dream unfolds
  • Your dream storyline is usually related to threats to safety or survival, but it can have other disturbing themes
  • Your dream awakens you
  • You feel scared, anxious, angry, sad or disgusted as a result of your dream
  • You feel sweaty or have a pounding heartbeat while in bed
  • You can think clearly upon awakening and can recall details of your dream
  • Your dream causes distress that keeps you from falling back to sleep easily
  • Nightmares are only considered a disorder if you experience:

Frequent occurrences

  • Major distress or impairment during the day, such as anxiety or persistent fear, or bedtime anxiety about having another nightmare
  • Problems with concentration or memory, or you can’t stop thinking about images from your dreams
  • Daytime sleepiness, fatigue or low energy
  • Problems functioning at work or school or in social situations
  • Behavior problems related to bedtime or fear of the dark
  • Having a child with nightmare disorder can cause significant sleep disturbance and distress for parents or caregivers.

There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.

When should I see my doctor?

You should contact your doctor if you have any of the following:

  • Occur frequently and persist over time
  • Routinely disrupt sleep
  • Cause fear of going to sleep
  • Cause daytime behavior problems or difficulty functioning

If you have any signs or symptoms listed above or have any questions, please consult with your doctor. Everyone’s body acts differently. It is always best to discuss with your doctor what is best for your situation.

Causes

What causes nightmare disorder?

Nightmare disorder is referred to by doctors as a parasomnia — a type of sleep disorder that involves undesirable experiences that occur while you’re falling asleep, during sleep or when you’re waking up. Nightmares usually occur during the stage of sleep known as rapid eye movement (REM). The exact cause of nightmares is not known.

Nightmares can be triggered by many factors, including:

  • Stress or anxiety. Sometimes the ordinary stresses of daily life, such as a problem at home or school, trigger nightmares. A major change, such as a move or the death of a loved one, can have the same effect. Experiencing anxiety is associated with a greater risk of nightmares.
  • Trauma. Nightmares are common after an accident, injury, physical or sexual abuse, or other traumatic event. Nightmares are common in people who have post-traumatic stress disorder (PTSD).
  • Sleep deprivation. Changes in your schedule that cause irregular sleeping and waking times or that interrupt or reduce the amount of sleep can increase your risk of having nightmares. Insomnia is associated with an increased risk of nightmares.
  • Medications. Some drugs — including certain antidepressants, blood pressure medications, beta blockers, and drugs used to treat Parkinson’s disease or to help stop smoking — can trigger nightmares.
  • Substance abuse. Alcohol and recreational drug use or withdrawal can trigger nightmares.
  • Other disorders. Depression and other mental health disorders may be linked to nightmares. Nightmares can happen along with some medical conditions, such as heart disease or cancer. Having other sleep disorders that interfere with adequate sleep can be associated with having nightmares.
  • Scary books and movies. For some people, reading scary books or watching frightening movies, especially before bed, can be associated with nightmares.

Risk factors

What increases my risk for nightmare disorder?

Nightmares are more common when family members have a history of nightmares or other sleep parasomnias, such as talking during sleep.

Diagnosis & treatment

The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.

How is nightmare disorder diagnosed?

There are no tests routinely done to diagnose nightmare disorder. Nightmares are only considered a disorder if disturbing dreams cause you distress or keep you from getting enough sleep. To diagnose nightmare disorder, your doctor reviews your medical history and your symptoms. Your evaluation may include:

  • Exam. You may have a physical exam to identify any conditions that may be contributing to the nightmares. If your recurrent nightmares indicate underlying anxiety, the doctor may refer you to a mental health professional.
  • Symptoms discussion. Nightmare disorder is usually diagnosed based on your description of your experiences. Your doctor may ask about your family history of sleep problems. Your doctor may also ask you or your partner about your sleep behaviors and discuss the possibility of other sleep disorders, if indicated.
  • Nocturnal sleep study (polysomnography). If your sleep is severely disturbed, your doctor may recommend an overnight sleep study to help determine if the nightmares are connected to another sleep disorder. Sensors placed on your body will record and monitor your brain waves, the oxygen level in your blood, heart rate and breathing, as well as eye and leg movements while you sleep. You may be videotaped to document your behavior during sleep cycles.

How is nightmare disorder treated?

Treatment for nightmares isn’t usually necessary. However, treatment may be needed if the nightmares are causing you distress or sleep disturbance and interfering with your daytime functioning.

The cause of the nightmare disorder helps determine treatment. Treatment options may include:

  • Medical treatment. If the nightmares are associated with an underlying medical condition, treatment is aimed at the underlying problem.
  • Stress or anxiety treatment. If a mental health condition, such as stress or anxiety, seems to be contributing to the nightmares, your doctor may suggest stress-reduction techniques, counseling or therapy with a mental health professional.
  • Imagery rehearsal therapy. Often used with people who have nightmares as a result of PTSD, imagery rehearsal therapy involves changing the ending to your remembered nightmare while awake so that it’s no longer threatening. You then rehearse the new ending in your mind. This approach may reduce the frequency of nightmares.
  • Medication. Medication is rarely used to treat nightmares. However, medication may be recommended for severe nightmares associated with PTSD.

Lifestyle changes & home remedies

What are some lifestyle changes or home remedies that can help me manage nightmare disorder?

The following lifestyles and home remedies might help you cope with nightmare disorder:

  • Establish a regular, relaxing routine before bedtime. A consistent bedtime routine is important. Do quiet, calming activities — such as reading books, doing puzzles or soaking in a warm bath — before bed. Meditation, deep breathing or relaxation exercises may help, too. Also, make the bedroom comfortable and quiet for sleep.
  • Offer reassurances. If your child is struggling with nightmares, be patient, calm and reassuring. After your child awakens from a nightmare, respond quickly and soothe your child at the bedside. This may prevent future nightmares.
  • Talk about the dream. Ask your child to describe the nightmare. What happened? Who was in the dream? What made it scary? Then remind your child that nightmares aren’t real and can’t hurt you.
  • Rewrite the ending. Imagine a happy ending for the nightmare. For your child, you may encourage him or her to draw a picture of the nightmare, “talk” to the characters in the nightmare or write about the nightmare in a journal. Sometimes a little creativity can help.
  • Put stress in its place. If stress or anxiety is an issue, talk about it. Practice some simple stress-relief activities, such as deep breathing or relaxation. A mental health professional can help, if needed.
  • Provide comfort measures. Your child might feel more secure if he or she sleeps with a favorite stuffed animal, blanket or other comfort object. Leave your child’s door open at night so that he or she won’t feel alone. Leave your door open, too, in case your child needs comfort during the night.
  • Use a night light. Keep a night light on in your child’s room. If your child wakes up during the night, the light may be reassuring.

If you have any questions, please consult with your doctor to better understand the best solution for you.

Hello Health Group does not provide medical advice, diagnosis or treatment.

Sources

Review Date: November 1, 2017 | Last Modified: November 1, 2017

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