What is nightmares?
Nightmares refer to complex dreams that cause high levels of anxiety or terror. In general, the content of nightmares revolves around imminent harm being caused to the individual (e.g., being chased, threatened, injured, etc.). When nightmares occur as a part of posttraumatic stress disorder (PTSD), they tend to involve the original threatening or horrifying set of circumstances that was involved during the traumatic event. For example, someone who was in the Twin Towers on Sept. 11, 2001, might experience frightening dreams about terrorists, airplane crashes, collapsing buildings, fires, people jumping from buildings, etc. A rape survivor might experience disturbing dreams about the rape itself or some aspect of the experience that was particularly frightening (e.g., being held at knifepoint).
Nightmares can occur multiple times in a given night, or one might experience them very rarely. Individuals may experience the same dream repeatedly, or they may experience different dreams with a similar theme. When individuals awaken from nightmares, they can typically remember them in detail. Upon awakening from a nightmare, individuals typically report feelings of alertness, fear, and anxiety. Nightmares occur almost exclusively during rapid eye movement (REM) sleep. Although REM sleep occurs on and off throughout the night, REM sleep periods become longer and dreaming tends to become more intense in the second half of the night. As a result, nightmares are more likely to occur during this time.
What causes nightmares?
There are a number of possibilities. Some nightmares can be caused by certain drugs or medications, or by rapid withdrawal from them, or by physical conditions such as illness and fever. The nightmares of early childhood likely reflect the struggle to learn to deal with normal childhood fears and problems. Many people experience nightmares after they have suffered a traumatic event, such as surgery, the loss of a loved one, an assault or a severe accident. The nightmares of combat veterans fall into this category. The content of these nightmares is typically directly related to the traumatic event and the nightmares often occur over and over. Other people experience nightmares when they are undergoing stress in their waking lives, such as difficulty or change on the job or with a loved one, moving, pregnancy, financial concerns, etc. Finally, some people experience frequent nightmares that seem unrelated to their waking lives. These people tend to be more creative, sensitive, trusting and emotional than average.
What is the Treatment of Nightmares?
If you are experiencing severe stress, you should seek out the support of friends and relatives. Talking about what is on your mind can go a long way. It is also recommended that you follow a regular fitness routine, including aerobic exercise if possible. You will find yourself able to fall asleep faster, having a deeper sleep and waking up feeling more refreshed. Learn techniques to reduce muscle tension (relaxation therapy), which will also help lessen anxiety.
Avoid long-term use of tranquilizers, and avoid caffeine and other stimulants.
If your nightmares started shortly after beginning a new medication, contact your health-care provider. He or she will advise you on discontinuing that medication if necessary and recommend an alternative.
For nightmares resulting from the effects of "street drugs" or persistent alcohol use, seek counsel on discontinuing usage. Alcoholics Anonymous, for example, might suggest a safe way for you to stop drinking. You can also attend their regularly scheduled meetings. In addition, look at your lifestyle—friends, work and family—to rid yourself of factors that encourage substance abuse.
Call your health-care provider if nightmares occur more often than weekly, or if they prevent you from getting a good night's rest and persist for a prolonged period. Your medical history will be obtained and a physical examination performed.
Medical history questions documenting nightmares in detail may include:
- Do the nightmares occur repeatedly (recurrent)?
- Do they occur in the second half of the night?
- Is there a sudden full awakening from sleep?
- Does the nightmare cause intense fear and anxiety?
- Is there memory of a frightening dream (one with vivid visual imagery and story-like plot)?
- Has an illness or fever occurred recently?
- Has an emotionally stressful situation occurred recently?
- Is alcohol used? How much?
- Are medications or "street drugs" used? Which ones?
- Are natural supplements or alternative medicine remedies used?
- What other symptoms are present?
Physical examination may include physical, neurological and psychological assessments.
If treatment options addressing stress and anxiety, side effects of medication and substance use, do not resolve the problem, your health-care provider may send you to a sleep specialist who will perform a sleep study (polysomnography). In extremely rare cases, a patient will need to take special medications that suppress or reduce REM sleep, thus preventing nightmares.
After an examination by your health-care provider, you may want to add a diagnosis related to recurrent nightmares to your personal medical record.