Definition of Nightmare Disorder
Nightmare disorder is also often called ‘dream anxiety’ disorder. It should be noted that nightmares are not the same thing as night terrors, as they happen in completely different phases of the sleep cycle.
In order to be classified as a nightmare, the dream must be bad enough to wake the sleeper. If the sleeper doesn’t wake up, this is classified as a bad dream.
The basis for nightmare disorder is that the sufferer is woken from sleep after experiencing extremely vivid, frightening dreams. They can recall the details clearly, as the dream seems so real.
In most cases, the nightmares involve being in a life-threatening situation that is so scary the person often wakes feeling intense fear, anxiety, and even terror.
People reading this type of nightmare disorder overview may wonder if they have the problem. This is because nightmares are common for most people from time to time. 85% of adults will have a nightmare occasionally. Yet, in order for it to be a disorder, a person will experience these frightening dreams several times a week. In severe cases, it can even be multiple times in one night.
Nightmare Disorder Symptoms
Nightmares most often occur during the REM phase of sleep. However, those with nightmare disorder tend to have bad dreams during the second half of their sleep pattern.
During the nightmare, the person will sometimes moan or move around in bed. Many people also experience leg twitches, as if they’re trying to run in the dream.
Once the sleeper has been woken up by a frightening nightmare, they may feel symptoms of anxiety. These include sweating, breathing heavily and faster than normal heartbeat.
Many people will have trouble falling back to sleep. They fear another nightmare, or they continue to replay the details of the first nightmare, which keeps the mind very alert.
This usually leads to a lack of proper sleep in sufferers. People with nightmare disorder will often be tired and irritable during the day. They may even develop a fear of going to bed at night, as they worry about more nightmares occurring.
Nightmare Disorder Causes: Situational
Medication is often linked to nightmares. The side effects of some medications and drugs can bring on particularly vivid dreams that dredge up awful images and situations. Bad dreams are a common side effect of anti-depressant medication and blood pressure medication.
Cocaine and amphetamines are also known to cause nightmares that are somewhat hallucinatory.
Nightmares are very common in people who are going through the withdrawal symptoms of alcohol dependency. The same symptoms are also present in patients withdrawing from barbiturates and other high-dependency drugs.
There are some other conditions and disorders that can trigger nightmare disorder. Sleep apnea is a common link in people who experience regular vivid nightmares. Restless leg syndrome is also thought to be more common in people with nightmare disorder.
Nightmare disorder case studies show that people are more likely to have a nightmare if they’re overheating during sleep. Falling asleep with heavy blankets, thick pajamas, an electric blanket switched on, or the heating turned on can cause overheating.
People with very low cholesterol levels are prone to nightmare disorders. A low cholesterol level is thought to interfere with the body’s serotonin levels, which can interfere with sleep patterns.
Nightmare Disorder Causes: Mental Disorders
There are multiple things that can cause people to have vivid nightmares. Extreme stress is known to bring about bad dreams that can be easily recalled after waking up. This is made worse after a particularly stressful event, such as the death of a family member.
Post-Traumatic Stress Disorder
Post-traumatic stress disorder has also been linked to the frequency of nightmares. Research shows that 52% of combat Veterans suffering from Post-traumatic stress disorder also have a form of nightmare disorder. There are some other mental disorders that can cause regular nightmares as well.
Some people working in jobs where they witness trauma regularly often have trouble with regular frightening dreams. These include ambulance officers, paramedics, police officers, and some doctors.
Recent nightmare disorder case studies show that 57% of people with nightmare disorder also suffer from a form of dissociative disorder. This is a psychological disorder where the memory breaks down or is disrupted. This can cause identity problems and a feeling of living in unreality.
People with dissociative disorder feel confused and sometimes detached from their surroundings. This can cause many sufferers to self-harm or experience thoughts of suicide.
Nightmares in people with this disorder can often be a way for them to escape the detached and confused feelings they have when they’re awake. Unfortunately, the onset of nightmare disorder can also make the symptoms of dissociative disorder worse.
Borderline Personality Disorder
More than 75% of people with Borderline Personality Disorder also have Nightmare Disorder. This is because the sleep phases for those with Borderline Personality Disorder are different from normal sleep phases.
This disorder usually includes extreme mood swings, unstable relationships, chaotic self-image thoughts and behavior, and a confused sense of self. Frequent vivid nightmares are an extension of the symptoms.
Bipolar Disorder is also known as manic-depressive disorder. This is where a person experiences extreme depressive episodes as well as periods of unusually manic behavior.
It’s thought more than 80% of people with Bipolar Disorder also experience frequent bizarre nightmares. These dreams have a common theme of death, mutilation or injury in them and are often terrifying.
Research shows that nightmares most often occur right before they shift to a manic phase in these people.
Attention Deficit Hyperactivity Disorder
23% of children with ADHD also suffer with Nightmare Disorder.
Research shows that many children are diagnosed with ADHD after displaying classic symptoms that include hyperactivity, low concentration levels, behavioral problems, easily distracted, and often impatience. Children with ADHD may also be prone to daydreaming and can become easily confused. They also have difficulty containing their emotions.
What the same research also showed is that a very large percentage of children diagnosed with ADHD also have an associated sleep disorder. Vivid and violent nightmares are commonly reported by children with ADHD.
ADHD symptoms are made worse when that child is also getting poor quality sleep, due to sleep disorders and frequent nightmares. When treatment for the sleep disorder is successful, many of the behaviors that classify that child as ADHD are reduced.
It stands to reason, then, that perhaps many of the symptoms of ADHD can be addressed by treating the underlying sleep disorder that could be aggravating the condition.
Is Nightmare Disorder Hereditary?
Everyone dreams. From time to time, we all have nightmares. However, the incidence of Nightmare Disorder can be present in people with no family history of the problem. It can also arise in families where other members may experience it.
While Nightmare Disorder on its own is not hereditary, Bipolar Disorder, Borderline Personality Disorder and Dissociative Disorder can be passed on genetically.
As frequent and vivid nightmares are symptoms of these conditions, it can be assumed that some aspects of Nightmare Disorder can be passed down in families.
Nightmare Disorder Statistics
Nightmare Disorder is far more common in children than in adults. 23% of children diagnosed with ADHD also have Nightmare Disorder. As a child ages, the number and severity of nightmares may begin to decrease.
32% of people diagnosed with Nightmare Disorder are in their teenage years or are young adults in their early 20s.
As further evidence that the disorder does fade with age, the incidence of people with Nightmare Disorder drops to approximately 11% by their 30s.
Of the people diagnosed with Post-Traumatic Stress Disorder, 52% of these also have Nightmare Disorder.
Studies show that an estimated 8% of adults over 40 have chronic lifetime Nightmare Disorder.
Nightmare Disorder Diagnosis
In the majority of cases, a diagnosis of Nightmare Disorder is made after symptoms are reported to a doctor or psychiatrist. There may be a series of questions or quiz tests conducted to work out the extent of the problem. A doctor may also try to rule out any other underlying mental or medical conditions that could be causing nightmares.
Some physicians may refer patients to a sleep center to have further sleep patterns or behaviors tested while they stay overnight under observation. However, this may not always be effective. This is simply because the nightmares may not occur every night. Rather, sleep clinics may be the preferred option for treatment after the initial diagnosis is made.
Treatment for Nightmare Disorder
Medications and Therapy
Nightmare Disorder Treatments are highly dependent on the underlying cause.
For symptoms brought on by post-traumatic stress disorder, anxiety, stress, or depression, some doctors may try to prescribe Prozac. Unfortunately, many anti-depressant medications can cause the nightmares to get even worse in some people. Prazosin is also often prescribed in patients with anxiety or Panic Disorder.
Psychotherapy is a more natural treatment for Nightmare Disorder that doesn’t require medication. Instead, treatment is conducted by a trained psychotherapist. Treatment usually includes working to find any underlying causes of the problem, and then works to find ways to reduce the symptoms.
For patients with an underlying mental disorder, such as Dissociative Disorder or Borderline Personality Disorder, a trained psychotherapist may need to work through a combination of therapy and the right medications to bring the problem under control.
Hypnosis is a branch of psychotherapy that has shown positive results in treating Nightmare Disorder in some case studies. Hypnosis can help increase relaxation and reduce anxiety, making nightmares less frequent.
Specialists within sleep centers have conducted case studies where a patient will sleep in the clinic overnight. During the REM phase of sleep, where dreams and nightmares happen, the patient is monitored.
Light Therapy is used in part of sleep clinic treatments. This involves shining light at the patient’s eyelids throughout the night, especially using REM sleep. Before the patients fall asleep, they are told that any lights they see flashing on and off in a specific rhythm signal that they are only dreaming and that they can do anything they like.
Once the patient has entered the REM phase of sleep and nightmares are likely, the light patterns begin. Many patients report that the nightmares do start, but they are much easier to control. This makes them less frightening, and turns them into a regular dream, rather than a horrible nightmare.
Regular treatment of this type has helped many sufferers of Nightmare Disorder to control their dreams even after treatment has ended.
Many people are unwilling to see a therapist for treatment. Instead, there are other ways to help reduce the number and severity of nightmares. One of the most positive steps in self-treatment is to find ways to cope with and reduce stress symptoms. Exercise and relaxation techniques are known to be very effective with controlling stress levels.
Increasing daily exercise levels is also known to help patients sleep better and experience fewer nightmares. Raising the body’s natural serotonin levels through moderate exercise can help to reduce stress and reduce depression symptoms as well.
As cholesterol levels are known to cause nightmares, it’s also worth working on improving diet and nutrition.
Nightmare Disorder Help and Support
The Internet offers people the best possible way to seek out support and help from others suffering from Nightmare Disorder. Online support groups are a very helpful place to seek support. There are also specific community forums and message boards set up to allow people a place to talk about their symptoms.
Many of these community-based forums and groups are ideal places to learn about effective treatments. Discussing what has worked for others may offer patients other things to try to reduce the symptoms.
Rather than continue to live through constant hellish nightmares alone, these types of support groups offer positive ways to discuss options. They also provide an excellent place to meet others going through similar things, which helps many people to realize they’re not alone with their disorder.