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Dreams can take you to unknown places and make the most awesome things available to you at your mind’s doorstep. But when those sweet dreams turn into bizarre adventures, you might wonder what led to such unrelated occurrences reaching out to you.
Bad Dreams vs. Nightmares
So, nightmares are just unpleasant dreams, right?
According to MedlinePlus, “A nightmare is a bad dream that brings out strong feelings of fear, terror, distress, or anxiety.”
A science columnist for the New York Times, Natalie Angier, shared in a podcast, Talk of the Nation, that most of our dreams fall under the negative category of nightmares, which may wake us up in a fearful state.
The fear element in the nightmares can be traced back to ancient times when people used to associate them with some evil spirit, but modern research has yet to find many answers, Angier shared.
1. Nightmare Disorder
According to the American Academy of Sleep Medicine, “Nightmares can happen to anyone,” and 50 to 85 percent of grown-ups reported occasional nightmares.
This common phenomenon becomes a cause of concern when:
- You tend to have frightening dreams time and again.
- They start interfering with your bedtime routine.
- Your nightmares affect sleep.
All these things help in diagnosing the nightmare disorder, which was earlier known as dream anxiety disorder, as per the Diagnostic and Statistical Manual of Mental Disorders (DSM–5) of the American Psychological Association (APA). Nightmare disorder shows up in 2 to 8 percent of people commonly dealing with sleep problems.
Symptoms of Nightmare Disorders
- Sleep-related problems.
- Anxiety before, during, and after experiencing nightmares.
- Persistent fear of sleeping because of frequent nightmares or trouble falling asleep.
- Recurrent nightmares.
- Sleep disruptions.
- Trouble dealing with daytime functioning.
- Physical symptoms such as increased heartbeat and sweating.
2. Are Nightmares Parasomnia?
Nightmare disorder is part of a sleep disorder called parasomnia. Parasomnia – a sleep disorder – involves many unusual sleep activities or troubles such as sleep paralysis, sleepwalking, teeth grinding, speaking while sleeping, or sleep apnea, as described by the National Cancer Institute.
Sometimes, nightmare disorder is mixed up with other parasomnias, such as night terrors and sleep paralysis.
Sleep paralysis or muscle atonia is a normal function in rapid eye movement (REM2) sleep (a usual state to experience vivid dreams) where muscles get paralyzed to prevent the enactment of dreams, but when your muscles remain paralyzed on your awakening, it becomes a problem.
Sleep paralysis (parasomnia) happens when you alternate between the sleep stages.
Suggested Reading: How to Prevent Sleep Paralysis: Get Sound 8 Hours of Sleep
3. Nightmares vs. Night Terrors (Sleep Terrors)
Mayo Clinic states that sleep terrors affect about 40 percent of children, but they outgrow them upon reaching adulthood.
Night terrors may be confused with nightmares but have notable differences, which are as follows:
- Night terrors happen in the first half of the sleep, whereas nightmares usually occur in the second half.
- A night terror involves shouting or moving wildly, but a nightmare only involves strong feelings of fear and anxiety, which may wake you up.
- Night terrors may not be recalled after awakening, but the person remains conscious of what they are doing during the episodes, whereas nightmares may be recalled to a certain extent.
- Sleep terrors mostly occur in kids, but it’s not the case with nightmares.
4. What’s the Role of Nightmares?
Nightmares can serve as appalling events that you may want to avoid. What can you do to avoid these nightmares? Would you stop dreaming? Well, that’s not in your hands, given that it has some emotional responsibilities to discharge, which ultimately enhance your overall health.
Consistent sleep patterns have noticeable benefits and enhance the quality of your life, but what purpose do dreams serve?
What you do throughout the day manifests itself into dreams. Dealing with a particular trauma may show up in dreams that, in turn, take charge of healing emotional wounding and making memories out of them to be remembered from a distance, said a Clinical Psychologist, Michael J. Breus, Ph.D in a sleep column.
A Ted-Ed video explains the possible theories behind dreaming:
- The dreaming process fulfills your subconscious urges while you dream. Freud proposed that your repressed desires find their way through dreams.
- Dreams are responsible for some memory processes, so they can help memorize tricky stuff.
- Nightmares can help prepare you for negative situations by reenacting them in dreams.
5. Nightmare Causes
Researchers are not yet done finding the exact causes of nightmare disorder, but below are some of the plausible causes of ND –
5.1. Posttraumatic Stress Disorder (PTSD)
Post-traumatic stress disorder (PTSD) is considered to be one with chronic nightmares as it’s said to be the telltale sign of someone having PTSD.
Sleep research claims that more than half of PTSD patients cope with nightmares, which are linked with suicidal behaviour as well – a tendency of PTSD.
PTSD, earlier known as ‘shell shock‘ after WWI because of the horrific reality of the war, can be found in anyone who has ever dealt with a traumatic event such as the death of a beloved, as stated by the APA. Its presence is found in 3.5 percent of the U.S. population each year.
People dealing with post-traumatic stress disorder (PTSD3) repeatedly encounter harrowing details of the excruciating reality they’ve lived once. They relive those disturbing episodes in the daytime, which may follow them through their dreams as nightmares, because of which they may face sleep disturbances as well.
5.2. Other Mental Health Disorders
Although the prevalence of nightmare disorder is 70 percent in post-traumatic stress disorder and personality disorders, its relationship isn’t well known in other mental health conditions.
An article in the Journal of Clinical Medicine presented a systematic review of 24 studies to assess the relationship between nightmares and psychotic and mood disorders, which found that the presence of frequent nightmares in psychotic patients was more than twice that of healthy ones, and there was an increase in suicidal tendencies in patients with regular nightmares.
The review proved that anxiety and stress resulting from nightmarish dreams are more likely to aggravate mood and psychotic disorders than nightmare frequency.
As per the American Academy of Family Physicians, the use and inhibition of certain medications may trigger nightmares. These include antidepressants (tricyclic), beta-blockers, alpha agonists, antiparkinsonian agents (levodopa), and ketamine 4(ketalar).
Withdrawal of ethanol, barbiturates, and benzodiazepines may also cause terrifying dreams.
5.4. Sleep Disorders
An observational study was conducted with 1,233 heart patients (one-fourth of women) with an average age of 64 at the Keio University School of Medicine, Tokyo, Japan.
The study aimed to assess the relationship between nightmares and sleep and psychological disorders in heart patients, which was already proven in the general population, as the study claimed.
The findings stated that there’s a strong link between nightmares and insomnia, depression, and anxiety.
6. Treatment for Recurrent Nightmares
Nightmare disorder is diagnosable, but mostly, the reasons for having nightmares remain ambiguous. Going to the root of the causes by undergoing a sleep study or solving them first can do the job if nightmares persist for a longer time. Otherwise, you have other options available.
6.1. Tips for Dealing with Children’s Nightmare Frequency
If the situation isn’t severe, parents can follow the tips shared by a clinical psychologist, Eileen Kennedy-Moore, Ph.D.
- Discussing their stress issues.
- Maintaining a sleep routine.
- Teaching basic relaxation techniques like deep breathing.
- Talking about how dreaming works.
- Give them a comforting partner like a soft toy.
- Letting them give nightmares a happy ending.
A position paper to treat nightmares was prepared by the American Academy of Sleep Medicine (AASM5) by hiring experts in sleep medicine and with a systematic review in the Journal of Clinical Sleep Medicine.
Following are the medications and therapies listed in the paper, but the patients must consider the help of a concerned clinician for the desired results.
6.2. Therapies and Medications for Nightmare Disorders
- Image rehearsal therapy is confirmed to work well by the study for nightmare disorder and PTSD-related nightmares.
- Cognitive-behavioural therapy, relaxation, and exposure therapies may work for post-traumatic nightmares.
- CBT, relaxation, exposure, lucid dreaming therapies, systematic desensitization, and self-exposure therapy may work for nightmare disorders.
- Medicines such as tricyclic antidepressants, prazosin6, and risperidone may work for post-traumatic nightmares.
- Nitrazepam, prazosin, and triazolam may work for nightmare disorder.
- Clonazepam and venlafaxine aren’t recommended for nightmare disorder treatment.
Frequently Asked Questions (FAQs)
1. Do only kids have frightening dreams?
Nightmares start in childhood, and children aged 3-6 mostly deal with them, which is about 50 percent of the total, Statista showed in its study, making it a familiar occurrence during the childhood stage.
Nightmares are completely normal in children and may be caused by any regular activity of waking life that seems purely harmless, said Dr. Benjamin Chan, a child psychiatrist from the University of Utah, in a podcast, The Scope.
Horror shows, and movies, sleeping more than adults (which means more dreams and nightmares), and the poor sleep routine may be the nightmare causes for kids, but nightmares become rare when they turn into adulthood, he added.
2. Are nightmares always scary?
Nightmares are usually defined as frightful dreams, but there’s a lack of evidence on this claim. Though fear is the most reported feeling but not the only emotion experienced during nightmares, other emotions such as anger and sadness were also reported, a study revealed.
Dreaming is important, and so are nightmares, as long as they don’t mess up with your beauty sleep. And when they do, you know treatment is the option.
Is there any nightmare that you’d like to share?
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