Nightmares

[David Baxter PhD]

Nightmares
By Mayo Clinic staff
Aug. 15, 2009

Nightmares are disturbing dreams associated with anxiety, fear or terror. Nightmares are common. They begin in childhood and tend to decrease after about age 10. However, some people have them as teens or adults, or throughout their lives.

Until age 13, boys and girls have nightmares in equal numbers. At age 13, nightmares become more prevalent in girls than boys.

Nightmares seem real, often becoming more disturbing as the dream unfolds. But nightmares usually are nothing to worry about. They may become a problem if you have them frequently and they cause you to fear going to sleep or keep you from sleeping well.

Symptoms
Nightmares are parasomnias ? undesirable experiences that occur during sleep. You've had a nightmare if:

• Your dream wakes you up
• You feel scared, anxious, angry, sad or disgusted as a result of your dream
• You can think clearly upon awakening, and can recall details of your dream
• Your dream occurs near the end of your sleep time
• Your dream keeps you from falling back to sleep easily

When to see a doctor
Occasional nightmares aren't usually a cause for concern. If your child has nightmares, you can simply mention them at a routine well-child exam.

Talk to your doctor earlier if your or your child's nightmares:

• Become more frequent
• Routinely disrupt sleep
• Cause you or your child to fear going to sleep

Causes
Most nightmares occur during rapid eye movement (REM) sleep. You normally go through four to six sleep cycles a night, cycling through the sleep stages in about 90 minutes. Your REM stage lengthens with each cycle, from several seconds in the first cycle to up to an hour in the last. You're more likely to have a nightmare in the last third of your night.

Another disorder can be associated with nightmares. Many other factors can trigger nightmares, including:

• Stress. Sometimes the ordinary stresses of daily life, such as a problem at home or school, trigger nightmares. A major change, such as a move or the death of a loved one, can have the same effect.
• A traumatic event. Nightmares are common after an accident, injury or other traumatic event. Nightmares are prominent in post-traumatic stress disorder.
• Scary books and movies. Reading scary books or watching scary movies, especially before bed, can cause nightmares.
• Bedtime snacks. For some, eating right before bed ? and the resulting boost in metabolism and brain activity ? leads to nightmares.
• Illness. Sometimes being sick triggers nightmares, especially if the illness is accompanied by a fever.
• Medications. Some drugs ? including certain antidepressants, narcotics and barbiturates ? can trigger nightmares.

Complications
Occasional nightmares usually aren't a concern, but regularly disrupted sleep can be. It can cause excessive daytime sleepiness, which can lead to difficulties at school or work, or problems with everyday tasks such as driving.

Preparing for your appointment
For children, nightmares tend to decrease by the time they're adolescents. However, if you have concerns about safety or underlying conditions, you may want to see your doctor. Your doctor may refer you to a sleep specialist.

Your doctor also will need to know:

• When the nightmares began
• How often the nightmares occur and what they're about
• Your medical history
• Any medications you're taking or have taken
• Whether you have or have had any other sleep problems
• Whether you have family members with sleep problems

It's a good idea to keep a sleep diary for two weeks before your appointment to help your doctor understand your sleeping pattern. In the morning, you record as much as you know of your or your child's bedtime ritual, quality of sleep, and so on. At the end of the day, you record behaviors that may affect your or your child's sleep, such as caffeine consumption (chocolate and cola count) and any medications taken.

Tests and diagnosis
There are no tests routinely performed for nightmares, but if your or your child's sleep is severely disturbed, your doctor may recommend an overnight sleep study to help determine if the nightmares are connected to another sleep disorder. During the study, technicians monitor your brain waves, heart rate, breathing and movement while you sleep.

Treatments and drugs
Treatment for nightmares isn't usually necessary. If the nightmares are associated with an underlying medical or mental health condition, treatment is aimed at the underlying problem. If stress or anxiety seems to be contributing to the nightmares, your doctor may suggest stress-reduction techniques, counseling or therapy.

Medication is rarely used to treat nightmares. However, medications that reduce REM sleep or reduce awakenings during sleep may be recommended if you have severe sleep disturbance.

Lifestyle and home remedies
If you're having nightmares, try some relaxation techniques before bedtime. Take a warm bath, meditate or practice deep breathing. If your child is struggling with nightmares, be patient, calm and reassuring. Sometimes a little creativity helps, too.

• Talk about the dream. Ask your child to describe the nightmare. What happened? Who was in the dream? What made it scary? Then remind your child that nightmares aren't real and can't hurt you.
• Put stress in its place. If your child seems anxious or stressed, talk about what's bothering him or her. Practice some simple stress-relief activities, such as deep breathing.
• Rewrite the ending. Help your child imagine a happy ending for the nightmare. Encourage your child to draw a picture of the nightmare, "talk" to the characters in the nightmare or write about the nightmare in a journal.
• Provide company. Your child might feel more secure if he or she sleeps with a favorite stuffed animal, blanket or other comfort object.
• Enlist a guard. If your child is very young, you might assign a doll or stuffed animal the job of "staying awake" all night to guard against nightmares.
• Brighten up. Use a night light in your child's room. If your child wakes up during the night, the light might be reassuring.
• Open the doors. Leave your child's door open at night so that he or she won't feel alone. Leave your door open, too, in case your child needs comfort during the night.

Safety counts, too. If your child has frequent nightmares, make sure his or her bedroom is safe. Skip the bunk beds, and consider blocking doorways or stairways with a gate in case your child tries to run after he or she wakes up.

Symptoms References

• Nightmares and other disturbing parasomnias. American Academy of Sleep Medicine. http://www.aasmnet.org..ces/FactSheets/NightmareParasom.pdf
• Nightmares. American Academy of Sleep Medicine. SleepEducation.com
• Sleepiness diary. National Sleep Foundation.
• Simard V, et al. Longitudinal study of bad dreams in preschool-aged children: Prevalence, demographic correlates, risk and protective factors. Sleep. 2008;31:62.DS01010

 

[Banned]

Good article. I have had nightmares my entire life, and have several per week (that I remember. I'm sure I have more that I don't).

I usually have the same three-four recurring themes in my nightmares, so I should, by now, be used to them and not get so scared as easily. But they still scare and terrify me, waking me up and leaving me afraid to go back to sleep.

Several years back I was diagnosed with PTSD and while it seems that that has been dealt with in my life and is no longer an issue, I wonder if the nightmares will ever dissipate.

 

[ladylore]

I still get them Turtle. My dreaming is also very lucid. But what has changed is how they effect me. Many still bother me when I wake up but not nearly as bad as they use to. On the upside, I can now sleep in my bed at least 90% of the time.

 

[NicNak]

I still get nightmares too. I use to get them bad as a kid, but they came back when I was diagnosed.

Mine are quite vivid too. Even some of the dreams, even if they are not nightmares per say are actually bothersome too cause they seem so real.

I do find though, if I am laying in bed, thinking too much and cannot sleep I am more prone to the nightmares. So I tend to stay up and occupied until I am so tired I am suprised sometimes I make it into bed :lol:

I too am doubtful I will ever stop having them now.

 

[Retired]

As the article states:

Medications. Some drugs — including certain antidepressants, narcotics and barbiturates — can trigger nightmares.

This (adrenergic) side effect cannot be under estimated and the nightmares should be reported to the doctor. Sometimes changing to a different medication within the same class of meds can correct the problem, if no other factor is involved.

Even some heart medications are known for producing vivid dreams that some people interpret as nightmares. Similar changes in medication can alleviate the problem, again, if no other factor is present.

 

[David Baxter PhD]

I think the key is "vivid dreams".

I have never seen any evidence that SSRIs change the content of dreams, only that they make dreams more vivid. It's like going from black and white to color... As a result, you may find yourself remembering your dreams more often when you wake up.

 

[NicNak]

I think the key is "vivid dreams".

I have never seen any evidence that SSRIs change the content of dreams, only that they make dreams more vivid. It's like going from black and white to color... As a result, you may find yourself remembering your dreams more often when you wake up.

That is exactly it! I remember telling my Psychiatrist that sometimes my dreams are like in techo-colour.

I compared it almost to like in the Wizzard of Oz, how it is black and white at first and then turns to colour.

The nicotine patch, when I tried that, made my dreams even more vivid. It was pretty scary too.

 

[boi]

Does anybody know the difference between nightmares and night terrors?

 

[Jazzey]

Hi boi,

Dr. Baxter posted an article last night on both of these: nightmares and night terrors. Just see the new posts and you should find it here http://forum.psychlinks.ca/sleep-dreams-insomnia/18996-night-terrors.html.

 

[boi]

whoops sorry didnt look! thanks Jazzey