Nightmare Disorder

Bad dreams, or nightmares, are upsetting dreams that make you feel anxious or scared and wake you up. These are pretty normal, especially for kids. Most people have the occasional nightmare, and it's usually nothing to worry about.

Nightmares often start when kids are around 3 to 6 years old, and they typically become less frequent after age 10. During teenage and young adult years, girls seem to have nightmares more often than boys. However, some people experience nightmares as adults, throughout their lives.

While having nightmares is common, a condition called nightmare disorder is less common. Nightmare disorder means you have nightmares very frequently. These nightmares are so bad that they cause you a lot of distress, disrupt your sleep, make it hard to function during the day, or even make you afraid of going to bed.

Nightmares are more common during the second half of the night. They can happen rarely or quite often, even multiple times in one night. These episodes are usually short, but they wake you up, making it hard to fall back asleep.

Nightmares often have these characteristics:

• The dream feels very real and intense: It can be upsetting and sometimes gets worse as the dream continues.
• The dream is often about danger: It might be about threats to your safety or survival, but it can also involve other disturbing topics.
• The dream wakes you up: You're jolted from sleep.
• You feel strong emotions: You might feel scared, worried, angry, sad, or disgusted after the dream.
• Your body reacts: You might feel sweaty or have a fast heartbeat during the dream.
• You remember the dream clearly: You can recall details of the nightmare when you wake up.
• The dream makes it hard to go back to sleep: The distress from the dream keeps you from falling back asleep easily.

Nightmares are only a problem if they happen frequently and cause significant issues. This means more than just occasional nightmares. A nightmare disorder exists when:

• Nightmares happen often: They occur repeatedly.
• You have trouble in daily life: This might include anxiety, persistent fear, or worrying about having another nightmare before bed. It could also involve trouble concentrating, remembering things, or constantly thinking about images from the dreams.
• You feel tired during the day: This could involve daytime sleepiness, fatigue, or low energy.
• You struggle with everyday activities: You might have problems at work, school, or in social situations.
• Your behavior changes: This could include trouble getting to sleep, a fear of the dark, or other behavioral issues.

Having a child who has frequent nightmares can be very stressful for parents. Occasional nightmares aren't usually a reason to worry. If your child has nightmares, you can talk about them during a regular check-up with their doctor. However, you should see a doctor if the nightmares:

• Are happening often and lasting a long time: They're not just occasional.
• Keep interrupting sleep regularly: They're a consistent problem.
• Cause a fear of going to bed: Your child is afraid of sleeping.
• Cause problems with their daily activities: This could include problems behaving or difficulty functioning at school or home.

Nightmares, a common sleep problem, are called parasomnias by doctors. These are unusual events that happen while you're falling asleep, sleeping, or waking up. Nightmares typically occur during REM (rapid eye movement) sleep, a stage of deep sleep where your brain is very active. Scientists don't fully understand why nightmares happen, but several things can trigger them.

Stress and Anxiety: Everyday worries, like problems at work or school, or major life changes like moving or losing a loved one, can lead to nightmares. Feeling anxious generally increases the risk of having them. Stress can make your brain more easily react to the images and feelings that nightmares involve.

Trauma: If you've been through a difficult experience like an accident, injury, abuse, or something else upsetting, you might have nightmares. These disturbing experiences can be very common in people with PTSD (Post-Traumatic Stress Disorder). The trauma effectively "rewires" the brain's response to certain situations, and nightmares can be a symptom of this re-wiring.

Poor Sleep: Changes to your sleep schedule, such as irregular bedtimes and wake-up times, or not getting enough sleep, make you more likely to have nightmares. If you have trouble sleeping (insomnia), nightmares are more likely. A good night's sleep is important for many aspects of health, and a lack of it can impact your emotional well-being and increase your susceptibility to nightmares.

Medications: Some medicines can cause nightmares as a side effect. This includes certain types of antidepressants, blood pressure drugs, beta blockers, medications for Parkinson's disease, and quit-smoking aids. If you're taking any new medication and having nightmares, talk to your doctor.

Substance Use: Using alcohol or recreational drugs, or going through withdrawal from these substances, can also lead to nightmares. These substances can disrupt normal brain function, making nightmares more likely.

Other Health Conditions: Depression and other mental health problems can be linked to nightmares. Some medical conditions, like heart disease or cancer, might also contribute. Other sleep disorders, which make getting enough quality sleep difficult, can also increase the chance of nightmares. Your physical health and mental well-being are connected, and disruptions in one area can affect the other.

Scary Media: For some people, watching scary movies or reading scary books, especially right before bed, can trigger nightmares. The excitement and fear from the media can sometimes carry over into your sleep.

If nightmares are a persistent problem, it's important to talk to a doctor or therapist. They can help you understand the possible causes and find ways to manage them.

Having a family history of nightmares, or other sleep problems like sleepwalking or talking in your sleep, can make you more likely to have nightmares yourself. If your parents or other close relatives frequently experienced nightmares or similar sleep issues, you might be more prone to them as well. This suggests a possible genetic or inherited link to these sleep disturbances.

Night terrors, or nightmare disorder, can lead to a number of problems during the day and night. People experiencing this condition might feel very tired and sleepy during the day. This fatigue can make it hard to focus at school or work, and even affect everyday activities like driving or concentrating. The fear of having more nightmares can make it difficult to fall asleep or even get into bed. In some cases, nightmare disorder can be linked to thoughts of suicide or even suicide attempts. It's important to remember that these are serious symptoms and seeking help is crucial.

There's no single test to diagnose nightmare disorder. Doctors consider nightmares a disorder only if they're causing you significant problems, like making it hard to sleep well. To figure out if you have nightmare disorder, your doctor will:

1. Talk to you and review your health history: They'll ask about your overall health, any other medical problems you have, and your sleep habits. They'll also want to know about any family history of sleep issues. This helps them understand if there's anything else going on that might be contributing to the nightmares. If your nightmares seem linked to anxiety, they might refer you to a therapist or counselor for help.

2. Ask about your nightmares: Your doctor will want details about the nightmares themselves—what happens in them, how often they occur, and how they make you feel. They'll also want to know about your sleep patterns, including how long it takes you to fall asleep, how often you wake up during the night, and how you feel when you wake up. They might ask a partner or family member about your sleep behaviors to get a more complete picture. This helps determine if there could be other sleep disorders involved.

3. Possible sleep study (polysomnography): If your sleep is significantly affected by the nightmares, your doctor might suggest an overnight sleep study. This study involves wearing sensors on your body that monitor various things while you sleep. These sensors record your brain waves, how much oxygen is in your blood, your heart rate, your breathing, and your eye and leg movements. You may also be videotaped during the night to observe your behavior. This helps to determine if another sleep problem might be causing or contributing to the nightmares. For example, it can help identify other sleep disorders like sleep apnea or restless legs syndrome.