Nightmares

Alternative names 
Dreams - bad; Bad dreams

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

Considerations

Nightmares tend to be more common among children and decrease in frequency toward adulthood. About 50% of adults experience occasional nightmares, women more often than men.

Eating just prior to going to bed, which raises the body’s metabolism and brain activity, may cause nightmares to occur more often. Adults who experience repeated nightmares that become a significant problem 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 really help. 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 muscle tension (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       o Do the nightmares occur repeatedly (recurrent)?       o Do they occur in the second half of the night?  
  • quality       o Is there a sudden full awakening from sleep?  
  • associated complaints       o Does the nightmare cause intense fear and anxiety?       o Is there memory of a frightening dream (one with vivid visual imagery and story-like plot)?  
  • aggravating factors       o Has there been a recent illness?       o Has there been a fever?       o Has an emotionally stressful situation occurred recently?  
  • other       o Is alcohol used? How much?       o What medications are used?       o Are “street drugs” being taken? Which?       o Are natural supplements or alternative medicine remedies used?       o What other symptoms are also present?

Physical examination may include a physical, neurological, and psychological examination.

Diagnostic tests that may be performed include:

     
  • blood tests (such as CBC or blood differential)  
  • liver function tests  
  • thyroid function tests  
  • EEG

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.

Johns Hopkins patient information

Last revised: December 6, 2012
by Simon D. Mitin, M.D.

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All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.