You can feel it coming. Tapping your phone screen, you curse as you realize the time, 3:02 AM. It has been several hours since you decided to go to bed, the fatigue from not sleeping much last night motivating your decision to at least try to sleep a little earlier than normal. But you can feel it coming. Twiddling your thumbs, you try to calm yourself. “Think…”, you say, “Unicorns, sheep, clouds, happiness, just think.” Yesterday was the third time in a row that you had a nightmare. You had been getting them for months almost every other night now, sometimes recurring, sometimes completely different, but always terrifying, jolting you up in the middle of the night, keeping you awake in fear of them continuing once you tried to drift back to sleep. As you lay, the heaviness of your eyelids proves to be too powerful to resist and you give in, closing them as you float off into sleep, hoping that it isn’t another restless night. Your secret wishes aren’t granted and sure enough, it comes again. For people with nightmare disorder, this experience may be all too familiar, and lack of recognition and understanding ends up contributing to the feeling of a never ending nightmare.
Nightmare disorder is a form of parasomnia, any sleep disorder that causes abnormal behavior while sleeping, where a person experiences frequent nightmares that may cause distress to aspects of their daily life (Sunni, n.d). Nightmares are vivid, frightening dreams that can induce high levels of terror and anxiety (Mandal, n.d.). They typically occur during the rapid eye movement (REM) cycle of sleep where dreams often occur and it is much more difficult to be awakened. Almost everyone has experienced at least one nightmare at some point during their lives, with roughly 80-90% of adults having experienced them at some point (Piedmont Healthcare, n.d.). They are fairly prevalent amongst children, with 10-50% of children ages 3-6 having experienced them (Cleveland Clinic, n.d.). The most common themes in nightmares often involve failure, physical aggression, being chased, and death (Schredl & Göritz, 2018).
Though nightmares are relatively common, it is important to distinguish nightmares from nightmare disorder. Significant differentiating factors between having nightmares and nightmare disorder is the higher frequency of the nightmares and the effect this higher frequency has on sleep quality. While about “one in every two adults” (Web M.D, n.d.) experience occasional nightmares, it is much less common for adults to experience one or more nightmares a week, since nightmares generally decrease as people age (Mayo Clinic, n.d.), thus making the probability of the nightmares to routinely disturb sleep even lower. Subsequently, there is approximately only 4% of the adult population with nightmare disorder (Morgenthaler et al., 2018). Despite its relatively low prevalence, nightmare disorder causes considerable impairments, including anxiety, daytime sleepiness, low energy, and insomnia, as well as impairments to concentration and memory. These symptoms and effects are what often make diagnosis difficult for people with nightmare disorder and health professionals alike. Healthcare practitioners “are often unaware of the fact that chronic nightmares often constitute an independent mental disorder or sleep disorder” and often assume the nightmares to be a symptom of another disorder such as post-traumatic stress disorder (PTSD) or depression (Gieselmann et al., 2019). In addition, due to the fact that the nightmares occur frequently over long periods of time, people with nightmare disorder may not recognize having frequent nightmares as unusual.
The complication between experiencing the stressing symptoms and having the experience potentially misdiagnosed and misidentified creates a continuous cycle for people with nightmare disorder. However, by acknowledging symptoms and providing proper information and education we can begin to understand that nightmares aren’t simply a phase of childhood, and that help and treatment such as counseling and stress-reduction techniques are available. Most importantly, we can become cognizant of the fact that sometimes it’s more than just a bad dream.
Nightmares in children (n.d.). Cleveland Clinic. Retrieved October 7th, 2020, from https://my.clevelandclinic.org/health/articles/14297-nightmares-in-children
Gieselmann, A., Ait Aoudia, M., Carr, M., Germain, A., Gorzka, R., Holzinger, B., Kleim, B., Krakow, B., Kunze, A. E., Lancee, J., Nadorff, M. R., Nielsen, T., Riemann, D., … Pietrowsky, R. (2019). Aetiology and treatment of nightmare disorder: State of the art and future perspectives. Journal of sleep research, 28(4), e12820. https://doi.org/10.1111/jsr.12820
Mandal, A. (n.d.). What are nightmares?. News Medical Life Science. Retrieved October 7th, 2020 from https://www.news-medical.net/health/What-are-Nightmares.aspx
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Morgenthaler, T. I., Auerbach, S., Casey, K. R., Kristo, D., Maganti, R., Ramar, K., Zak, R., & Kartje, R. (2018). Position Paper for the Treatment of Nightmare Disorder in Adults: An American Academy of Sleep Medicine Position Paper. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 14(6), 1041–1055. https://doi.org/10.5664/jcsm.7178
The truth about nightmares (n.d.). Piedmont Healthcare. Retrieved October 10th, 2020, from https://www.piedmont.org/living-better/the-truth-about-nightmares
Schredl, M., & Göritz, A. S. (2018). Nightmare Themes: An Online Study of Most Recent Nightmares and Childhood Nightmares. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 14(3), 465–471. https://doi.org/10.5664/jcsm.7002
Suni, E. (n.d.). Nightmares: symptoms, causes & treatment. Sleep Foundation. Retrieved October 7th, 2020, from https://www.sleepfoundation.org/nightmares
Adult nightmares: Causes and Treatments. Web M.D. (n.d.). Retrieved October 10th, 2020, from https://www.webmd.com/sleep-disorders/nightmares-in-adults