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. If nightmares are caused by a medical issue, such as heart disease, cancer or pain, the medical condition will be treated to alleviate nightmares. If no underlying medical condition can be found, treatment options for nightmare disorder may include:

  • Psychotherapy to target stress and anxiety reduction
  • Imagery rehearsal therapy to reduce the incidence of nightmares
  • Psychotropic medication for nightmares high in severity that relate to post-traumatic stress disorder (PTSD)
  • Practicing good sleep hygiene is a lifestyle change that changes a person’s bedtime routine to improve the quality and quantity of sleep

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.

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.