Nightmare Disorder

What is Nightmare Disorder?

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.

While nightmares share some characteristics with NREM parasomnias like sleep walking, confusional arousals, and night terrors, nightmares are distinct from these conditions in several ways.

  • First, while some of these conditions involve sitting up in bed, standing, or walking, nightmares generally don’t involve motor activity.
  • Second, most other parasomnias are not recalled afterward, while nightmares are often at least partially remembered.
  • Finally, unlike confusional arousals and other NREM parasomnias, nightmares are not associated with disorientation or confusion. In fact, people who have just had a nightmare often awake feeling alert and aware of their surroundings.

Symptoms of Nightmare Disorder

  • Repeated awakenings from sleep with memories of intense, threatening dreams
  • Feeling alert upon awakening
  • Experiencing nightmares that do not result from a substance, medication or another health condition

The severity of nightmare disorder depends on the frequency of nightmares:

  • Severe nightmare disorder involves nightmares every night.
  • Moderate nightmare disorder involves nightmares more than once per week, but not nightly.
  • Mild nightmare disorder includes one or fewer nightmares per week.

How Common is Nightmare Disorder?

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.

Diagnosis

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

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.

Additional Resources