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Nightmares
Definition:
A dream occurring during rapid eye movement (REM) sleep that brings out feelings of strong, inescapable fear, terror, distress, or extreme anxiety. This phenomenon typically occurs in the latter part of the night and usually awakens the sleeper who is able to recall the content of the dream. See also night terror; sleep disorders.

Alternative Names:
Dreams - bad; Bad dreams

Considerations:
Nightmares tend to be more common among children and decrease in frequency toward adulthood. Nevertheless, about 50% of adults experience occasional nightmares, women more often than men, and do not require any treatment. Eating just prior to going to bed, which raises the body's metabolism and brain activity, may cause nightmares to occur more often. Approximately 1% of adults however will experience repeated nightmares and should seek help.
Common Causes:
  • anxiety or stress are the most common cause: a major life event precedes the onset of nightmares in 60% of cases
  • illness with a fever
  • death of a loved one (bereavement)
  • adverse reaction to or side effect of a drug
  • recent withdrawal from a drug such as sleeping pills
  • effect of alcohol or excessive alcohol consumption
  • abrupt alcohol withdrawal
  • breathing disorder in sleep (sleep apnea)
  • sleep disorders (narcolepsy, sleep terror disorder)
Home Care:

If you are under severe stress, you should seek out the support of friends and relatives. Talking about what is on your mind can go a long way. Also, following a regular energetic fitness routine, using aerobic exercise if possible, will help. You will find that you will be able to fall asleep faster, benefit from deeper sleep, and wake up feeling more refreshed. Learn techniques to reduce muscletension (relaxation therapy), this will also help reduce your anxiety.

Practice good sleep hygiene. Avoid long-term use of tranquilizers, and avoid caffeine and other stimulants.

If you noticed that your nightmares started shortly after you began taking a new medication, contact your health care provider. He or she will advise you on how to discontinue that medication if necessary and recommend an alternative.

For nightmares resulting from the effects of "street drugs" or persistent alcohol use, seek counsel on the best way to discontinue use. An Alcoholics Anonymous group, for example, might suggest a safe way for you to stop drinking without putting your health at risk. You can also attend their regularly scheduled meetings (see alcoholism - support group). Also, reassess lifestyle -- friends, work, family -- to identify and alter factors that encourage substance abuse.
Call your health care provider if:
  • nightmares occur more often than on a weekly basis, or if they prevent you from getting a good night's rest and keep up with your daily activities for a prolonged period.
What to expect at your health care provider's office:
The medical history will be obtained and a physical examination performed.

Medical history questions documenting nightmares in detail may include:
  • time pattern
    • Do the nightmares occur repeatedly (recurrent)?
    • Do they occur in the second half of the night?
  • quality
    • Is there a sudden full awakening from sleep?
  • associated complaints
    • Does the nightmare cause intense fear and anxiety?
    • Is there memory of a frightening dream (one with vivid visual imagery and story-like plot)?
  • aggravating factors
    • Has there been a recent illness?
    • Has there been a fever?
    • Has an emotionally stressful situation occurred recently?
  • other
    • Is alcohol used? How much?
    • What medications are used?
    • Are "street drugs" being taken? Which?
    • Are natural supplements or alternative medicine remedies used?
    • What other symptoms are also present?
Physical examination may include a physical, neurological, and psychological examination.

Diagnostic tests that may be performed include:

If treatment options addressing stress and anxiety, medication side effects, and substance use do not resolve the problem, your health care provider may want to send you to a sleep medicine specialist who will perform a sleep study (polysomnography). In extremely rare cases, a patient needs to take special medications that suppress or reduce REM sleep, thus preventing nightmares.

After seeing your health care provider:
You may want to add a diagnosis related to recurrent nightmares to your personal medical record.
Review Date: 12/6/2001
Reviewed By: Benoit Dubé, M.D., Department of Psychiatry, University of Pennsylvania Medical Center, Philadelphia, PA. Review provided by VeriMed Healthcare Network.
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