Nightmares: an understudied experience

Nightmares are vivid, disturbing dreams that can cause anxiety, fear, or terror and can wake you up from deep sleep. They often occur during rapid eye movement (REM) sleep, which is the stage of sleep associated with intense dreaming. Nightmares can be caused by various factors, including stress, anxiety, trauma, sleep deprivation, and certain sleep disorders. Nightmares can be a symptom of nightmare disorder, which is a distinct sleep disorder that affects about 2%-8% of adults. People with mental health conditions like PTSD, depression, anxiety, bipolar disorder, and schizophrenia are more likely to experience nightmares. Chronic nightmares can lead to insomnia, and individuals may try to avoid sleep out of fear of recurring nightmare experiences. Behavioral changes have proven effective for 70% of adults who suffer from nightmares, including those caused by anxiety. Treatment for nightmares depends on the underlying cause and may include treating the underlying sleep disorder, addressing mental health conditions, and making lifestyle changes to reduce stress and anxiety.

There are several ways to prevent nightmares. One way is to treat any underlying disorders that may be causing the nightmares, such as sleep apnea, narcolepsy, REM disorder, or restless leg syndrome. Reducing stress through activities like yoga, meditation, or reading a good book can also help prevent nightmares. It's important to go to bed with a calm, clear mind. Imagining yourself in a peaceful place and thinking happy thoughts can encourage good dreams. Implementing a relaxing bedtime routine can also help prevent nightmares. If nightmares persist, it may be helpful to talk to a doctor to see if there's an underlying cause. Therapy is one of the main ways to address nightmares, and many of the approaches for nightmares are based in cognitive behavioral therapy (CBT). Other types of therapy for nightmares include imagery rehearsal therapy and eye movement desensitization and reprocessing. Prescription medications used to treat conditions like PTSD, anxiety, or depression can also be effective in reducing the occurrence of nightmares.

How nightmares affect mental health?

Nightmares can affect mental health in various ways. People with mental health disorders like PTSD, depression, general anxiety disorder, bipolar disorder, and schizophrenia often report experiencing nightmares at much higher rates. Frequent or chronic nightmares can lead to insomnia, and individuals may try to avoid sleep out of fear of recurring nightmare experiences. This can lead to sleep deprivation, which can negatively impact mental health. For those experiencing the condition known as nightmare disorder, these disruptive nighttime experiences may occur as often as nightly, disrupting their daily lives and their mental health in a variety of ways. Psychotherapy approaches such as cognitive behavioral therapy or image reversal therapy can help reduce the frequency of nightmares for some patients by helping them manage their stress, anxiety, or response to trauma. Prescription medications used to treat conditions like PTSD, anxiety, or depression can also be effective in reducing the occurrence of nightmares.

Differences between a nightmare and a night terror

Nightmares and night terrors are two different experiences. Nightmares are intense dreams that may provoke terror, anger, or disgust, and you can usually remember them easily. Nightmares happen during REM sleep, and you appear to be sleeping. On the other hand, night terrors are a sleep disorder in which a person quickly awakens from sleep in a terrified state. Night terrors usually happen in the first half of the night, and you have no memory of the event. Night terrors are most common in preadolescent boys, though they are fairly common in children three to five years old. Night terrors are like nightmares, except that nightmares usually occur during rapid eye movement (REM) sleep and are most common in the early morning. Nightmares and night terrors have different characteristics, and it's important to differentiate between them to understand how to manage them.

Night terrors are usually self-limiting and do not require treatment. However, if they are frequent and cause distress or injury, treatment may be necessary. Treatment options for night terrors include addressing or eliminating the trigger, practicing good sleeping habits, and taking medications. Treating the underlying medical conditions that affect sleep can minimize the occurrence of night terrors. Getting about seven to nine hours of sleep every night is crucial, and it's also beneficial to establish a consistent and relaxing bedtime routine. Medication is rarely used to treat sleep terrors, particularly for children. If necessary, however, use of benzodiazepines or certain antidepressants may be effective. Adolescents and adults who experience repeated night terrors may benefit from working with a sleep specialist who can help to identify whether there is an underlying cause that can be treated.