Nightmare disorder refers to a condition in which a person experiences recurring nightmares. These nightmares may cause feelings of anxiety, depression or fear for one’s personal safety.  Facts about nightmare disorder differentiate this condition from other sleep disorders. Some common distinguishing features include:

  • Nightmare disorder does not involve motor activity; unlike other sleep disorders, someone with nightmare disorder is unlikely to sleepwalk
  • A person with nightmare disorder usually remembers at least portions of the nightmares, unlike a person who experiences night terrors  
  • Nightmare disorder does not cause disorientation or confusion

Prevalence of Nightmares

While nearly everyone is likely to experience a nightmare at some point in their life, nightmare disorder statistics show this condition is much rarer than the commonly experienced nightmares. Like nightmares in general, nightmare disorder becomes less common as a person ages. While the overall percentage of the population who experience one or more nightmares per month as an adult may be as high as 30%, these nightmares are less frequent or less intense than childhood nightmares. As many as 5% of young adults and 2% of older adults report nightmares on most nights. Differences in the frequency of nightmares in women vs. men show that women are more likely to have nightmares than men. However, there is insufficient evidence to explain this gender disparity.

Nightmare Disorder by Duration and Severity

Nightmare disorder is categorized by both duration and severity. The three categories of duration are:

  • Acute: At this level, nightmares have occurred for less than one month.
  • Subacute:  Experiencing nightmares for more than one month but less than six months
  • Persistent: Experiencing nightmares consistently for more than six months

In addition to the duration category, nightmare disorder intensity can also be categorized in one of the three levels of severity:

  • Mild: While nightmares are frequent, they do not occur every week.
  • Moderate: Nightmares occur at least once a week but often occur several times during a week. At this intensity, nightmares do not occur every night.
  • Severe: Severe intensity nightmare disorder involves experiencing severe nightmares nightly or nearly every night.

Nightmare Disorder Risk Factors

In some cases, it may seem that there is no explanation of why some people are prone to nightmares and others are not. While nightmares may sometimes be related to mental health conditions, this is not always true. Nightmare disorder does not appear to have a genetic link and does not consistently run in families.

Some factors that may increase a person’s risk of nightmare disorder include:

  • Poor Sleep Habits: Factors that influence a person’s overall ability to sleep restfully may be related to the experience of nightmares. These nightmare disorder risk factors include excessive stress, experiencing a traumatic event or frequent disruption of sleep. Other sleep disorders, such as restless leg syndrome or sleep apnea, may make nightmares more likely by causing sleep disruptions.
  • Substance Use and Medications: Some medications and substances may cause nightmares. For example, selective serotonin reuptake inhibitors (SSRIs) and alcohol impact REM sleep and trigger nightmares during the withdrawal period.
  • Thinking Style: A person who tends to work excessively may be more likely to experience nightmares. This is due to the repetitive negative thoughts associated with worrying, especially if it occurs near bedtime.
  • Dissociation: Someone who avoids consciously dealing with stressors through dissociation has an increased risk of experiencing nightmares.

Nightmare Disorder and Related Conditions

In some cases, nightmare disorder may accompany other conditions. Some of these conditions precipitating conditions are medical while others are psychiatric. Nightmares and post-traumatic stress disorder (PTSD) are frequently associated with each other because distressing nightmares are one of the main symptoms of PTSD. Other disorders including epilepsy, Parkinson’s Disease, depression, anxiety, or migraine headaches are also associated with a higher risk of developing nightmare disorder.

Nightmare disorder and substance abuse may co-occur due to the effects of substance use on sleep. For example, alcohol causes a person to experience a longer duration of dream-related sleep stages providing the opportunity for longer or more vivid nightmares.

Even prescription medications can influence whether a person experiences nightmares. Medications such as antihypertensives and antihistamines may trigger the onset of nightmare disorder.

Some medications, including SSRIs, used to treat mental health conditions like depression and anxiety may also cause nightmares. An added challenge for these patients is the potential of nightmare disorder worsening pre-existing depression or anxiety by disrupting sleep.

Night terrors are frequently thought to be related to nightmare disorder but the two disorders have some key differences. These factors distinguishing nightmare disorder vs. night terrors are largely due to the different stages of sleep during which frightening dreams occur. The sleep stage that is associated with night terrors prevents a person from being able to distinctly recall aspects of the dream. Further, being woken during this sleep stage usually results in feelings of confusion and disorientation.

Statistics on Nightmare Disorder Treatment and Prognosis

When nightmare disorder is not caused by another condition, treatment often consists of cognitive behavioral therapy. As a part of this treatment, a person rehearses how to respond when woken by a nightmare. In cases where nightmares are caused by other disorders such as PTSD, other treatments such as eye movement rapid desensitization therapy may be used.

When another disorder causes nightmares, a medication used to treat the underlying condition may provide relief from nightmares. For example, prazosin is a medication often used to relieve nightmares associated with PTSD.

Some forms of nightmare disorder treatment focus on improving healthy sleep habits. Getting an adequate amount of sleep each night — and not oversleeping — may help to remedy nightmares. Nightmare disorder prognosis can be improved by increasing daytime activity, especially exercise. Individuals who engage in exercise seem to experience less frequent nightmares than those who are not physically active.

If you or a loved one engage in substance use and have a sleep disorder, such as nightmare disorder, help is available. The Recovery Village provides comprehensive treatment for substance use and co-occurring disorders. Reach out to a representative today to learn more.