Nightmare disorder Health Article

Definition

Nightmare disorder, which is also called dream anxiety disorder, is characterized by the occurrence of repeated dreams during which the sleeper feels threatened and frightened. The sense of fear causes the person to awake.

Description

Nightmares are dreams that cause intense fear. These dreams are often complex and fairly long. During the dream, the sleeper usually encounters or experiences a threat to their life or safety. Nightmares are also reported that do not involve physical danger.

As the dream progresses, the threat to the person usually increases, as does their sense of fear. Waking usually occurs just as the threat or danger reaches its climax. It is often difficult for a person to return to sleep after waking from a nightmare. Nightmares usually occur during the second half of the night's sleep.

Causes and symptoms

During the course of a nightmare the sleeper may moan, talk, or move slightly, although these signs do not always appear. The person wakes from the nightmare with a profound sense of fear. Waking is complete, and usually accompanied by increased heart rate, sweating, and other symptoms of anxiety or fear. Once fully awake, the person usually has a good recall of the dream and what was so frightening about it. Because of the physical symptoms of anxiety and because clarity is achieved immediately upon waking, returning to sleep after a nightmare is often difficult. The vividness of the recall and the prominence of the dream images in the person's mind can also make it difficult to calm down and return to sleep.

Sometimes people may avoid going to sleep after a particularly intense nightmare because of the fear of having another bad dream. In addition, people may have problems falling asleep if they are experiencing anxiety caused by the fear of having nightmares. As a result, these people may have the signs and symptoms associated with mild sleep deprivation, such as decreased mental clarity, problems paying attention, excessive daytime sleepiness, irritability, or mild depression.

The causes of nightmares are not known for certain. Adults who have nightmares on a regular basis are a small minority of the American population. About half of these people are thought to suffer from psychiatric disorders that cause the nightmares. Nightmares may also be triggered by major psychological traumas, such as those experienced by patients with post-traumatic stress disorder. For most patients who do not have an underlying mental disorder, the nightmares are attributed to stress. Nightmares that occur on an irregular and occasional basis are usually attributed to life stressors and associated anxiety.

Some researchers think that artistic or creative people are at greater risk for nightmares, as are people who are generally sensitive. These people are considered to have well-developed imaginations and are very sensitive to environmental and social factors.

Nightmares can be a side effect of some medications or drugs of abuse, including drugs given for high blood pressure; levodopa and other drugs given to treat Parkinson's disease; amphetamines, cocaine, and other stimulants; and some antidepressants. Withdrawal from alcohol and other medications can also sometimes cause nightmares.

Demographics

The actual percentage of people that suffer from nightmare disorder is not known, as many people do not seek treatment for it. There are, however, estimates of the proportion of the population that experience occasional nightmares. Many children suffer from nightmares that concern their parents. Estimates on the number of children who have recurrent nightmares range from 10–50%. In children, however, nightmares are not usually associated with psychiatric illness.

The number of children experiencing nightmares decreases as they get older. More than 3% of young adults have frequent nightmares, but only about 1% of mature adults experience nightmares once or twice a week. Half of the adults in the United States who experience regular nightmares have diagnosable psychiatric illnesses. Women are estimated to have nightmares two to four times more frequently than men. There is some uncertainty as to whether this figure reflects an actual difference between the sexes in the frequency of nightmares, or whether women are simply more likely than men to report nightmares. Nightmares typically decrease in frequency as people grow older.