What Is Nightmare Disorder?

Nearly everyone has nightmares now and then: bad dreams that you remember after waking up. Nightmares are unpleasant but rarely have an impact on your health. A nightmare disorder is different. A person experiencing nightmare disorder is having bad dreams of an intense nature on a regular basis. Waking up suddenly and remembering these dreams can lead to anxiety, restlessness, and a fear of going back to sleep. A cumulative lack of sleep negatively affects health. Though not a psychological condition, nightmare disorder is considered a parasomnia, or sleep disorder, by medical researchers.

Nightmare disorder can strike at any age and has a range of potential causes. It is estimated that between two and eight percent of the U.S. population experiences nightmare disorder. If you or a loved one is suffering from this or a related parasomnia condition, the sleep specialists at Baptist Health are available to help.

Signs & Symptoms

The nightmarish quality of dreams comes from apparent threats to your physical or psychological safety and well-being. Physiological symptoms include:

• Elevated heart rate
• Profuse sweating
• Labored breathing
• A sense of disorientation

Nightmares have an emotional component as well. While dreaming or on waking, you might experience feelings of:

• Fear
• Anxiety
• Sorrow
• Anger
• Shame
• Revulsion

Causes

The exact causes of nightmares and nightmare disorder remain unknown, despite many years of investigation. That said, researchers have identified a number of possible contributing factors. These factors include medical conditions, medications, and other sleep disorders.

Risk Factors

Risk factors for nightmare disorder:

• Certain medical conditions may predispose individuals to parasomnias.
• Persons with one sleep disorder – sleep apnea, restless legs syndrome, or night terrors, for instance – are prone to developing others, including nightmare disorder.
• The abuse of drugs or alcohol.
• Certain medications, including antidepressants, beta blockers, and some hypertension drugs, are correlated with an increased incidence of nightmare disorder.
• A person’s past traumas can provide the mind with the psychological raw material to fashion vivid nightmares. This often happens in persons diagnosed with depression or post-traumatic stress syndrome (PTSD).

How these factors contribute to nightmares remains in debate. One possibility is hyperarousal, or the generation of above-normal levels of activity in parts of the brain. A second possibility is a reduced ability of the mind to soften the impact of nightmares through a process called fear extinction, the dilution of frightening imagery with less threatening memories.

Diagnoses

If you’re suffering from repeated nightmares, ask yourself the following questions:

• How often am I waking up from vivid or intense nightmares?
• Is my memory of these dreams clear?
• Is my emotional response one of fear, fury, sadness, or shame (or some combination)?
• During what part of the sleep cycle are these nightmares occurring? (Most dreaming takes place during the extended REM phase, in the last third of the sleep period.)
• Am I too anxious or upset to go back to sleep after waking from a nightmare?

Answering yes to these questions suggests that you may be experiencing nightmare disorder. Seeing a physician who specializes in sleep disorders would be your next step. He or she will diagnose your condition by:

• Inquiring about your nightmares and the circumstances surrounding them
• Asking about other possible symptoms (daytime sleepiness, feelings of sluggishness or inattentiveness, etc.)
• Reviewing your medical history
• Documenting what, if any, medications that you’re taking

Depending on the situation, your doctor may ask you to keep a sleep diary, or a written record of your sleep experiences, typically for a period of two weeks. In more serious circumstances, he or she may order a sleep study. A sleep study involves sleeping overnight at a healthcare facility attached to monitoring technology, the data from which is used to determine any deeper, underlying medical causes for nightmare disorder.

Treatment

Because nightmare incidence tends to decline with age, treatment isn’t always required. In those cases where medical intervention makes sense, the following options are available:

• Stress management: Relaxation training and other forms of anxiety reduction can sometimes remove a source of nightmares. A related form of psychotherapy is called exposure, relaxation, and rescripting therapy (ERRT).
• Psychological counseling: Counseling from a licensed therapist can often address the underlying psychological issue or issues driving the nightmare cycle.
• Desensitization training: This form of training aims at reducing the patient’s emotional response to nightmares. It is most often used with individuals suffering from severe trauma.
• Imagery rehearsal therapy: Imagery rehearsal therapy is similar in some ways to desensitization training. Here the focus is on softening the intensity of nightmare imagery through repeated reimaginings, leading to a calmer emotional response.

The treatment of nightmare disorder with medications is mostly limited to individuals diagnosed with PTSD.

The prognosis for nightmare disorder varies by patient. In anything other than the most severe cases, stress management, therapy, and the passage of time are often successful in decreasing or eliminating the role that nightmares play in a person’s life.

Complications

If your nightmares occur on a regular basis, you run the medical risks of:

• Sleep deprivation
• Insomnia
• Anxiety and/or depression
• Inability to focus
• Daytime drowsiness
• Reduced functioning in work or social settings

In the most extreme cases, a habitual lack of sleep can lead to suicidal thoughts and possible suicide attempts.

Prevention

There is no certain method for preventing nightmares or controlling their content. There are, however, steps that you can take to possibly reduce the frequency and intensity of bad dreams:

• Targeted psychotherapy: Certain forms of psychotherapy – for example, IRT and ERRT – have shown success in limiting the effects of nightmare disorder in patients with PTSD.
• Improved sleep hygiene: Better, more restful sleep also seems to decrease the incidence of nightmares. Committing to a regular sleep schedule and avoiding unnecessary stimulation before going to bed (including excessive screen time) are keys to improving your sleep hygiene.

Learn More About Nightmare and Other Sleep Disorders at Baptist Health

For more information about sleep disorders schedule an appointment with your Baptist Health primary care physician.