Although terrifying dreams are not uncommon, nightmares as a sleep disorder, according to the Manual of Diagnostic and Statistical Classification of Mental Disorders, are a rare medical problem.
Between 10% and 50% of children between the ages of 3 and 5 have nightmares intense enough to cause parental concern. Most will overcome this phase and only a small percentage of cases present a persistence of scary dreams in adult life, turning into a sleep disorder.
In the category of adolescents and young adults, females seem to have nightmares more often than males.
What are nightmares?
Nightmares are the bad dreams that lead to awakening from sleep. Upon awakening, the dream sequence and content can be described in detail, people remember in detail what they dreamed.
The dream sequence has the following characteristics: it is elaborate, long and causes anxiety.
The content of dreams is most often centered on imminent physical dangers for the individual:
- the person in question is being followed
- attack
- suffers a bodily injury.
There are also cases in which the perceived threat can be more subtle, involving failures or personal difficulties.
Nightmares that appear after emotional traumas sometimes reproduce the dangerous or threatening situation that the individual went through, but in most situations the nightmares do not replicate real facts.
People can experience several nightmares during a single night , often with the same reason. Nightmares appear almost exclusively during REM sleep, the stage of sleep that repeats during the night for approx. 4-5 times.
Normally, nightmares end with waking up from sleep associated with a quick return to wakefulness, accompanied by a persistent feeling of fear, stress. These factors often contribute to difficulty returning to sleep. When night awakenings are frequent or if the individual avoids falling asleep for fear of having nightmares, undesirable consequences specific to sleep deprivation may appear. Among them are excessive daytime sleepiness, decreased ability to concentrate, the onset of depressive states, anxiety or irritability, thus affecting daily activities.
What triggers the appearance of nightmares?
The exact cause that determines the appearance of nightmares is not known, but among the triggering factors are:
- Stress and anxiety - including excessive everyday worries, problems at work or at home, at school, major changes - resignation, moving house, death of a loved one. People with anxious tendencies seem to be more susceptible to experiencing nightmares.
- Physical and/or emotional trauma - nightmares appear more frequently after an unfortunate event, an accident, sexual abuse.
- Sleep deprivation - too little sleep or sleep of unsatisfactory quality can favor the appearance of nightmares. Insomnia increases the risk of frightening dreams.
- The use of certain medications - certain medications, such as some antidepressants, medication to treat hypertension, beta-blockers and medications used in the treatment of Parkinson's disease or those that help to quit smoking.
- Alcohol and prohibited substances.
- The presence of other mental illnesses and emotional disorders such as depression, post-traumatic stress, schizophrenia, affective disorders, other anxiety disorders . Also, the existence of severe diagnoses, such as cancer, can be a source of bad dreams.
- Books and horror movies - for some people, the consumption of libation and horror movies, especially before bedtime, can be a cause of nightmares.
Nightmares from a medical perspective
Nightmares constitute a sleep disorder only when:
- They appear frequently
- It causes major stress and causes suffering during the day - anxiety, persistent fear and anxiety before sleep
- It causes concentration difficulties and memory problems or when the person thinks obsessively about the content of the dream
- Drowsiness occurs during the day due to insufficient and restless sleep during the night
- It causes difficulties at work, at school or in other social situations
- It gives rise to behavioral problems related to bedtime or fear of the dark.
When do we contact a specialist?
- Nightmares occur often (several per week) and persist over time
- Nightmares interrupt normal sleep
- Nightmares are a cause for fear of going to bed
- Nightmares cause difficulties in functioning during the day.
Nightmare disorder is part of the category of parasomnias - sleep disorders that involve unusual behaviors, movements or events that occur during the phase of falling asleep, during sleep or upon waking.
Nightmare or night terror?
Nightmares and sleep terrors are distinct sleep disorders, but they have in common:
- Awakenings or partial awakenings
- Awakenings accompanied by fear and vegetative activation.
Nightmares, in general, occur during the REM sleep phase, usually late at night . They produce intense dream images, full awakenings, mild vegetative arousal and a detailed evocation of the event.
Instead, night terrors usually occur in the early hours of the night, during stages 3 or 4 of NREM (non-REM) sleep . Night terror produces incomplete awakenings that cause a state of confusion, disorientation and partial reactions, with a significant vegetative excitation.
Unlike the nightmare, the sleep terror is associated with amnesia about the respective event when waking up from sleep in the morning.
The majority of the adult population, regardless of age, goes through terrifying dreams at certain moments in their lives. However, nightmare disorder is a condition that requires diagnosis and treatment when the frequency and severity cause significant suffering in the patient's life and a deterioration of personal, professional, social life, etc.
