A nightmare is a bad dream comprised of imagery that induces fright, worry or unhappiness. Nightmares usually contain distressing themes that associate with danger and risk to safety. Nightmares occur during rapid eye movement (REM) sleep and frequently take place in childhood but can also continue into adulthood. Nightmares usually happen in the latter part of the evening and rouse the sleeper, who can generally remember the gist of the dream. Nightmares are a common response to stress, with some professionals believing that it is a way for individuals to process traumatic events.

Occasional nightmares are common, but when it causes distress and impairs a person’s functioning, it can be indicative of a more problematic sleep disorder.

What is Nightmare Disorder?

Nightmare disorder is an uncommon condition and characterized by nightmares that are recurrent, disturb sleep, and cause mental anguish. Nightmare disorder classifies as a parasomnia, or a category of sleep disorders that arise while sleeping, falling asleep or awakening from sleep.

Nightmare disorder can negatively impact daytime functioning by impairing academic, occupational or social performance. Nightmare disorder and the fear of having a nightmare can generate considerable anxiety while going to sleep. Individuals may also have great difficulty returning to sleep after awakening from a nightmare.

Nightmare Disorder Symptoms

Nightmare disorder is characterized by several symptoms including:

  • Recurrent frequency and persistence
  • Regularly disrupts sleep
  • Significant worry and fear during the day or anxiety at bedtime about the prospect of having another nightmare
  • Impaired concentration due to constant recall of a nightmare’s images
  • Difficulties functioning in academic, occupational or social settings
  • Behavior troubles associated with nighttime or apprehension about the dark

Causes of Nightmare Disorder

The precise cause of nightmare disorder remains unknown but various factors can trigger them including:

  • Stress or worry
  • Traumatic episodes
  • Insomnia or sleep deficiency
  • Medications
  • Substance abuse
  • Other mental health or medical disorders
  • Television, movies or books with frightening content.

Diagnosing Nightmare Disorder

There are no routine tests to diagnose nightmare disorder. Nightmares are only deemed to be a disorder when they cause mental anguish, prevent sleep and cause impairment in areas of daily functioning.

A physician will likely review an individual’s symptoms, family history and medical background. Additionally, a medical practitioner will conduct a physical exam to rule out physical or medical conditions that might be causing the nightmares. Moreover, an overnight sleep study, or a polysomnogram, may also be recommended to rule out any other sleep disorders.

Nightmare Disorder Statistics

  • About four percent of adults have nightmare disorder
  • About one to four percent of preschool children, ages 3-5, have habitual nightmares
  • Children are more likely to experience nightmares than teenagers or adults
  • Children who have recurrent nightmares scale from 10 to 50 percent

Nightmare Disorder Treatment

The origin of the nightmare disorder will assist in shaping treatment. Treatment options may include:

  • If nightmares are caused by a medical issue, such as heart disease, cancer or pain, the medical condition will be treated to alleviate nightmares
  • Psychotherapy to target stress and anxiety reduction
  • Imagery rehearsal therapy to reduce the incidence of nightmares
  • Individuals may use psychotropic medication for nightmares high in severity that relate to post-traumatic stress disorder (PTSD)

Medications for Treating Nightmare Disorder

Medication is not usually utilized to treat nightmares. However, doctors may recommend medication for nightmares that are high in severity and related to PTSD. Prazosin is a medication that obstructs norepinephrine, a stress hormone, at receptor sites in the brain. Prazosin can be prescribed to treat nightmares that arise from PTSD.

Other medications such as selective serotonin reuptake inhibitors (SSRIs), including fluoxetine and paroxetine and tricyclic antidepressants can be prescribed to halt REM sleep. Medications may also be utilized to diminish nighttime awakenings.

Therapy for Nightmare Disorder

Psychotherapy can help individuals target stress and anxiety that might be contributing to nightmares. A licensed professional can teach stress reduction and anxiety management techniques to lessen tension, strain and worry.  Systematic desensitization and progressive deep muscle relaxation are two methods often utilized in stress and anxiety reduction. Counseling can help people to treat underlying themes in their nightmares. Additionally, individuals can process and discuss distress, feelings and impact of nightmares on daily functioning.

Imagery Rehearsal Therapy

Image rehearsal therapy is a cognitive-behavioral treatment utilized to treat nightmare disorder and nightmares linked with post-traumatic stress disorder. Image rehearsal therapy is a method that helps a person change the content of their nightmares by devising positive images and rewriting the ending to include happier conclusions. Individuals are awake during this therapy so that nightmares will be less frightening should they occur again. This technique assists people to change their nightmares by practicing how they would like them to conclude.

Nightmare Disorder and Substance Abuse

Nightmares are widespread in those with substance abuse disorders. Substance abuse can precipitate nightmares and alter normal brain mechanisms of sleep, especially when alcohol, cocaine and amphetamines are used.  Marijuana diminishes REM sleep, which can reduce the occurrence and intensity of dreams. There is a high occurrence of child abuse and trauma in those struggling with substance abuse.

Treating Nightmare Disorder and Co-Occurring Substance Abuse

Treatment for nightmare disorder and co-occurring substance abuse must occur simultaneously. Terminating alcohol and drug usage will assist in the reduction and elimination of substance-induced nightmares. Also, psychotherapy can help individuals address underlying themes in nightmares to assist them in staying abstinent.

When a nightmare disorder is co-occurring with a substance use disorder, individuals must treat both conditions concurrently. If you or a loved one have a substance use disorder and experience regular nightmares, consider contacting The Recovery Village, for more information. The Recovery Village can help you to address your sleep disorder and addiction so that you can lead a healthier, happier and more fulfilling life.

Nightmare Disorder
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