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Nightmare Disorder involves recurring frightening dreams that include anxiety, dysphoria and threats to personal safety. Like other REM parasomnias, nightmares arise out of REM sleep.
The severity of nightmare disorder depends on the frequency of nightmares:
Like many parasomnias, nightmares are more common in children and prevalence decreases with age. Up to 40 percent of children experience occasional nightmares; up to 30 percent experience frequent nightmares. While up to 30 percent of adults report one to two nightmares per month, around two percent of adults experience them most nights.
What Causes Nightmare Disorder?
Unlike other parasomnias like sleepwalking and night terrors, nightmares do not seem to have a genetic cause. Nightmares are linked to psychiatric disorders, including borderline personality disorder and schizophrenia, but they often occur without a psychiatric cause.
Nightmares happen most often during the final third of the night, when sleep cycles contain more REM sleep. Poor sleep hygiene, stress, traumatic events, and sleep disruptions may cause or contribute to nightmare disorder. Sleep disorders like periodic limb movement disorder, restless legs syndrome or obstructive sleep apnea may cause nightmares if these conditions contribute to lighter-stage, fragmented sleep.
Medications and Nightmares
Several types of drugs can cause or worsen nightmare disorder. Nightmares can result from withdrawal from medications or substances that affect REM sleep, including selective serotonin reuptake inhibitors, hypnotics, alcohol, or tricyclic antidepressants. Beta blockers and dopaminergic agonists can trigger nightmares.
To diagnose nightmare disorder, your doctor will review your medical history, sleep patterns, and symptoms. Your doctor will also review any medications you are taking, along with your history of other sleep disorders.
Treatment of nightmare disorder usually involves avoiding stress, correcting sleep deprivation and addressing any underlying sleep disorders. Physicians may recommend discontinuing any medications causing or contributing to nightmares. In some cases, medications including cyproheptadine and prazosin can help severe treat nightmare disorder.