Nightmare disorder

Overview

A nightmare is a disconcerting dream accompanied by negative emotions such as anxiety or fear that rouses an individual from sleep. While nightmares are prevalent among children, they can occur at any age. Infrequent nightmares are generally considered normal and not a cause for concern.

In children, nightmares may emerge between the ages of 3 and 6, diminishing in frequency after the age of 10. During adolescence and early adulthood, girls tend to experience nightmares more frequently than boys. However, some individuals continue to have nightmares into adulthood or throughout their lives.

While nightmares are a common occurrence, nightmare disorder is a relatively rare condition. Nightmare disorder is characterized by frequent nightmares that lead to distress, sleep disturbances, impaired daytime functioning, or a fear of going to sleep.

Symptoms

Nightmares are more likely to happen in the second half of the night, and they can occur rarely or even several times during the night. They are brief but can make it challenging to go back to sleep. Here are some features of nightmares:

• Vivid and disturbing: Nightmares are vivid and feel real, becoming more distressing as they unfold.
• Themes of threat: The dream usually involves threats to safety or survival, but it can have other disturbing themes.
• Physical symptoms: Sweating or a pounding heartbeat can accompany the dream.
• Clear recall: You can remember details of the dream and think clearly upon awakening.
• Difficulty returning to sleep: Nightmares can cause distress, making it hard to go back to sleep easily.
• Awakening: Nightmares wake you up from sleep.
• Emotional impact: You may feel scared, anxious, angry, sad, or disgusted after the dream.

Nightmares become a concern if you experience:

• Frequent occurrences: If nightmares happen often.
• Behavioral issues: Problems related to bedtime or fear of the dark.
• Functional impairment: Problems with concentration, memory, or difficulties in work, school, or social situations.
• Daytime distress: Major distress during the day, such as anxiety, persistent fear, or bedtime anxiety about having another nightmare.

If your child has nightmares, it may cause significant disturbance for both the child and caregivers. Consult a doctor if nightmares:

• Occur frequently: Happen often and persist over time.
• Lead to daytime issues: Cause behavioral problems or difficulties in functioning during the day.
• Cause fear of sleep: Result in fear of going to sleep.
• Disrupt sleep routinely: Regularly disrupt the sleep cycle.

Causes

Nightmare disorder falls under the category of parasomnias, which are sleep disorders involving undesirable experiences during the process of falling asleep, while asleep, or during waking. Nightmares typically occur during the rapid eye movement (REM) sleep stage, but their exact cause is not precisely known.

Several factors can trigger nightmares, including:

• Sleep deprivation: Irregular sleep schedules or disruptions in sleep patterns, leading to reduced sleep duration, can increase the likelihood of nightmares. Insomnia, characterized by difficulty sleeping, is linked to a higher risk of nightmares.
• Stress or anxiety: Everyday stresses, like issues at home or school, can be a trigger. Major life changes, such as moving or the loss of a loved one, can also induce nightmares. Experiencing anxiety is associated with a higher risk of nightmares.
• Trauma: Nightmares are common after traumatic events like accidents, injuries, or instances of physical or sexual abuse. They are especially prevalent in individuals with post-traumatic stress disorder (PTSD).
• Scary media consumption: Reading frightening books or watching scary movies, especially before bedtime, can be a factor for some individuals in experiencing nightmares.
• Medications: Certain medications, including some antidepressants, blood pressure drugs, beta blockers, and those used for Parkinson’s disease or smoking cessation, may trigger nightmares.
• Substance misuse: The use or withdrawal of substances like alcohol and recreational drugs can induce nightmares.
• Other disorders: Conditions such as depression and various mental health disorders may be associated with nightmares. Additionally, nightmares can be linked to certain medical conditions like heart disease or cancer. Having other sleep disorders that disrupt normal sleep patterns can also contribute to nightmares.

Risk factors

If there is a family history of nightmares or other sleep parasomnias, such as talking in your sleep, then your chances of experiencing nightmares are higher.