Nightmare disorder Health Article

Diagnosis

A diagnosis of nightmare disorder is usually made because the person reports the problem to their family physician or a psychiatrist. There are no laboratory tests for nightmare disorder, although the doctor may give the patient a physical examination to rule out any medical conditions that may be causing anxiety or stress.

Nightmares are characterized by awakening with a sense of fear, a clear recollection of the dream, and physical symptoms of anxiety. Nightmares can occur during nighttime sleep or daytime naps. A patient experiencing nightmares must meet the criteria listed in the Diagnostic and Statistical Manual of Mental Disorders to be diagnosed with nightmare disorder. The manual, which provides guidelines used by the American Psychiatric Association for diagnosing psychiatric disturbances, gives four distinct criteria:

• • The patient must experience repeated awakenings from frightening dreams.
• • When the patient awakes, he or she must wake fully and be aware of his or her surroundings.
• • The nightmares must cause the patient distress in important areas of his or her life.
• • The nightmares cannot be directly attributed to another disorder, or be the direct effects of medications, substance abuse, or a medical condition.

Nightmare disorder can be confused with sleep terror disorder. Both disorders are characterized by an arousal during sleep when the patient shows symptoms of anxiety or fear. Sleep terror, however, is characterized by a partial arousal from sleep during which the patient is generally nonresponsive. After a nightmare, the patient becomes fully awake and is aware of his or her surroundings. During an episode of sleep terror, a patient often gets out of bed and is active, and often screams or cries. During a nightmare, the patient may move slightly or moan but does not display such dramatic or active symptoms. Patients do not remember either the sleep terror episode or what caused the fear, but patients who have nightmares remember them with great clarity and often in considerable detail. Such symptoms of fear or anxiety as increased heart rate, dilated pupils, and sweating are not as dramatic in patients with nightmare disorder as they are in patients experiencing sleep terrors.

Treatments

Nightmares that are associated with a psychiatric disorder are managed by treating the underlying disorder. For patients without psychiatric disorders, psychological counseling to deal with any recurring themes in the nightmares may be helpful. Children may not require treatment for nightmares unless the dreams are causing significant distress, as nightmares generally resolve as children mature.

Because stress is thought to be the most common cause of nightmares, stress reduction techniques may prove to be effective complementary treatments. Typical relaxation techniques such as yoga, meditation, or exercise may be helpful. Psychotherapy can be an effective way to identify major stressors in the person's life, and to explore ways in which they may be reduced or eliminated.

Prognosis

Nightmare disorder can be a lifelong disorder. A general improvement in symptoms often takes place, however, as the patient gets older. Treatment for any underlying psychological disorders can be very successful.

BOOKS

Aldrich, Michael S. Sleep Medicine. New York: Oxford University Press, 1999.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th edition, text revised. Washington DC: American Psychiatric Association, 2000.

Chokroverty, Susan, ed. Sleep Disorders Medicine: Basic Science, Technical Considerations, and Clinical Aspects. 2nd ed. Boston: Butterworth-Heinemann, 1999.

Sadock, Benjamin J., and Virginia A. Sadock, eds. Comprehensive Textbook of Psychiatry. 7th ed. Vol. 2. Philadelphia: Lippincott Williams and Wilkins, 2000.

PERIODICALS

Krakow, Barry, and others. "Imagery Rehearsal Therapy for Chronic Nightmares in Sexual Assault Survivors with Posttraumatic Stress Disorder." Journal of the American Medical Association 286, no. 5 (August 1 2001).

ORGANIZATIONS

American Academy of Sleep Medicine. 6301 Bandel Road NW, Suite 101, Rochester, MN 55901. (507) 287-6006. <www.asda.org>.

Tish Davidson, A.M.