Nightmare Disorder

What is Nightmare Disorder?

Nightmare Disorder, also called parasomnia, is a condition in which a person experiences frequent vivid nightmares. During the night, we go through the sleep cycle four to six times, with the length of REM sleep becoming longer each time. Nightmares occur most often during the REM stage, so patients are more likely to have them during the last half of the night.

Everyone experiences nightmares from time to time. It is when they become recurrent and create problems for the patient that the situation needs to be addressed. There are numerous triggers that can serve as a catalyst for frequent nightmares, including trauma, stress, medications, sleep deprivation, scary movies and books, and substance abuse.

Additionally, certain medical and mental health conditions such as anxiety have been linked to the disorder.

What are the Symptoms of Nightmare Disorder?

Parasomnia does not necessarily occur every night.

When a person does have nightmares, they typically experience:
  • Disturbing, vivid dreams
  • Dreams related to personal safety or survival
  • Dreams that wake the patient
  • Feelings of fear, anxiety, sadness, anger, or disgust in response to the dream
  • Waking in a cold sweat with a racing heartbeat
  • Easily recalling details from the dream
  • Inability to fall back to sleep
  • Distress or difficulty functioning during the day

When nightmare disorder manifests in children, the content of the dreams will vary depending on age and gradually becomes more complex. A younger child may often dream of monsters, while older children have nightmares related to difficulties at home or school.

Nightmare Disorder Causes

Nightmare disorder often co-occurs with other psychological conditions, the most common of which being depression, schizophrenia and post traumatic stress disorder (PTSD). Of these three, PTSD has the greatest link to nightmare disorder, with around 60% of sufferers also experiencing frequent nightmares.

However, not all people who suffer from nightmare disorder suffer from another disorder. In people who don’t, the cause of nightmare disorder is not well understood. Researchers believe that ‘affective load’, which is the amount of emotional stress an individual experiences day-to-day, may play a role. There is also a substantial hereditary component to the experience of nightmares, meaning that it tends to run in families. People who take recreational and some prescription medicines are at greater risk.

Psychologists have also noted that nightmare disorder is slightly more common in females, and slightly less common in people over 40, although the reasons for this have not yet been established.

How is Nightmare Disorder Treated?

Most of the time, nightmares do not require treatment. However, if sleep disruptions are interfering with the patient’s ability to function during the day or creating undue stress, doctors may recommend a variety of therapies. Dreams associated with other health issues will usually improve once the condition is treated. Medications can be used to reduce REM sleep, while counseling and therapy help relieve anxiety and stress. Imagery rehearsal therapy is often used for patients with nightmares related to PTSD and other trauma.

Nightmare Disorder Prevention

Researchers have not yet established proven preventative measures that are effective against nightmare disorder.

However, if the research conducted to date is correct, and affective load is the primary cause of nightmares in people without clinical psychological conditions, this could suggest some potential options. Avoiding sources of stress would be the first line of defense as this would prevent the affective load from becoming too great.

However, if this is not possible or practical, there are several effective treatments:
  • Cognitive behavioural therapy is a proven method for reducing psychological distress that is most effective as a treatment for anxiety.
  • Mindfulness meditation is a well-established treatment for stress, and is used as a treatment for depression relapse.
  • Progressive relaxation and deep-breathing techniques are also effective in reducing stress and anxiety.

Your doctor will be able to advise you on the course of treatment that is most appropriate in your own personal situation.