Nightmares Explained!

Nightmares scare and disturb us and can even interrupt our sleep. Even though the theme of the dream differs from person to person, nightmares often cause the same feeling of intense dread along with the following emotions:

Sadness
Guilt
Anxiety

Although the nightmare may be over, the emotions generated by it may linger even after you wake up.

Around 50% to 85% of adults and 50% of young children experience nightmares occasionally.

While most people experience them at some point in their life, nightmares are more common in children and in adults with PTSD (post-traumatic stress disorder).

Nightmares vs Bad Dreams

While bad dreams don’t cause you to wake up, nightmares do. Because of their threatening and upsetting nature, nightmares can distress a person and cause serious anxiety.

Nightmares often occur during the REM (rapid eye movement) stage, which is characterized by rapid movements of the eyes and vivid dream experiences. This is usually referred to as the deep sleep stage.

Types of Nightmares

One study noted that there are 12 common themes of nightmares:

Theme	Description
Being chased	The dreamer is chased by another character.
Physical aggression	Dreamer is physically attacked: includes murder, kidnapping, sexual agression, etc.
Interpersonal conflicts	Conflict between two characters. Involves hostility, opposition, insults, infidelity, lying, rejection, humiliation, etc.
Environmental abnormality	Contains implausible events in the dream’s environment.
Evil presence	Experiencing the presence of an evil force. Involves possession by spirit and contains characters like vampires, spirits, ghosts, etc.
Accidents	Involves accidents such as from vehicles, falling, drowning, etc.
Disaster/calamity	Disasters such as fires, floods, earthquakes, wars, etc.
Failure or helplessness	Experiencing a failure or inability to attain a particular goal. Also contains incapacity to talk or make something happen.
Insects/vermin	Infestation or presence of insects. Often contains elements of biting and stinging.
Health-related concern and death	A character in the dream may suffer from an illness or die.
Apprehension/worry	An objective threat is present. The dreamer is afraid of someone or something.
Others	Includes some infrequent themes such as the dreamer being self critical, drunk, or naked.

And they further classified the dreams into seven categories based on emotions:

Fear
Anger
Sadness
Confusion
Disgust
Guilt
Frustration

Nightmare vs Nightmare Disorder

In most cases, a few nightmares don’t impact your health, but in the long-run, they can interrupt your sleep regularly and cause anxiety.

Nightmare disorder causes recurring nightmares that have a serious impact on your quality of life. Recurring nightmares can lead to:

Irritability
Anxiety
Depression
Sleep disorders, such as insomnia
Excessive daytime sleepiness

Nightmare Causes

Experts still don’t have a consensus about the cause of nightmares.

However, causes of nightmare may include:

Fever or infection
Medications, such as antidepressants and narcotics
Sleep medications
Withdrawal from medication
Sleep disorders

Apart from these, there may be other serious conditions that can cause nightmares:

Post-traumatic Stress Disorder

While it is completely natural to feel afraid or anxious during or after a traumatic event, recurrence of these symptoms is anomalous.

Experiences from various traumatic events, such as crimes, death, abuse, accidents, and fires, can recur from time to time.

After experiencing a traumatic event, a person may suffer from PTSD, which leads to:

Anxiety
Irritability
Flashbacks
Sleep disorders, such as insomnia
Nightmares

PTSD affects 7-8 percent of the population. Women are more likely than men to suffer from PTSD.

Sleep Apnea

Both central and obstructive sleep apnea interrupt sleep. Interruption to sleep may lead to vivid dreams, including nightmares.

Sleep apnea types:

Obstructive sleep apnea: the upper airway gets blocked, leading to an obstruction of airflow. Person suffering from this condition usually snores loudly and wakes up repeatedly while gasping for air.
Central sleep apnea: the CNS fails to communicate to muscles to breathe, so the breathing process stops because of which the person wakes up.

In fact, some studies have correlated obstructive sleep apnea(OSA) with nightmares.

Drug or Alcohol Abuse

While there is some connection between substance abuse and nightmare disorder, experts are still exploring this connection and finding ways to effectively treat nightmare disorders in people who abuse substances.

Substances that can lead to nightmare disorder include:

Antidepressants: these are notorious for causing nightmares. Antidepressant medications that are associated with nightmares include:

Paxil
Prozac
Viibryd
Zoloft

Antihistamines: over-the-counter and prescription medications that deal with allergies may cause nightmares and vivid dreams, medications that include:

Labetalol
Propranolol
Metoprolol

Steroids: prednisone and methylprednisolone can alter the chemicals in the brain, causing recurring nightmares.
Cholesterol medication: Zocor, Pravachol, and Lipitor can cause nightmares in rare cases.
Blood pressure medications: Beta-blockers alter the manner in which our body reacts to certain chemicals. This alteration may lead to nightmares.
Parkinson’s medication: Amantadine is associated with intense dreams, generally of sexual nature.

Withdrawing from certain substances can lead to nightmares:

Alcohol
Marijuana
Illicit substances such as cocaine and methamphetamine
Prescription medications

But the nightmares generally disappear after the completion of the withdrawal process.

Narcolepsy

A rare disease affecting 1 in 2,000 people, narcolepsy causes sleep attacks, which cause an overwhelming urge to sleep.

This may lead to excessive daytime sleepiness or continually falling asleep during the day.

Although it isn't life threatening, the episodes may lead to injuries and accidents, which can be life threatening.

Nightmare Diagnosis

Although we all experience nightmares sometimes, you should consult a doctor if you or your child experience it quite frequently. Recurring nightmares interrupt your sleep and interfere with your life. They can even cause serious mental health conditions, such as anxiety and depression.

To diagnose nightmare disorder, your doctor will enquire about your use of substances such as:

Alcohol
Caffeine
Supplements
Over-the-counter and prescription medications
Any other substances

If a medication is causing your frequent nightmares, then your doctor may put you on an alternate medication.

Although there are no tests to diagnose nightmare disorders, your doctor may still prescribe a sleep study, which requires you to sleep at a sleep laboratory while machines record your:

Heartbeat
Breathing
Brain waves
Muscle tension
Eye movement
Limb movement

After your doctor pinpoints the underlying reason for your recurring nightmares, he or she will provide you with a treatment option.

Nightmare Treatment

Treatment of recurring nightmares depends upon the underlying condition.

Here’s how nightmares may be treated in different health conditions:

Anxiety and Depression

Your doctor will recommend a psychiatrist or a psychologist for treatment of depression and anxiety. Treatment of the mental health condition is essential for resolving nightmares.

Here are a few treatment options for these mental health conditions:

Psychotherapy: cognitive behavioral therapy has proven effective and become the most common method for treatment of anxiety and depression
Antidepressants: your doctor may prescribe antidepressants, which alter the levels of neurotransmitters in your brain.
Group therapy: group therapies enable you to stay connected and grounded. Further, it provides a safe outlet, in which you can discuss your problems.
Relaxation techniques: you can use various relaxation techniques to calm down your mind and distract yourself from anxiety-inducing thoughts, techniques that include yoga and meditation.
Exercise: Upon exercising, your body releases endorphins, chemicals that make you feel good.

PTSD

If your nightmares result from PTSD, then you may need professional help. PTSD treatment options to resolve nightmares include:

Imagery rehearsal therapy: IRT, a part of CBT (cognitive behavioral therapy), is used to treat frequent nightmares in those suffering from PTSD. It requires one to simply change the narrative of a recurring nightmare.
Visual-kinesthetic dissociation: it requires you to review the traumatic event visually from a different perspective. By creating different perspectives, the person suffering from PTSD can relive the trauma.

CBT can be effective for treating PTSD induced nightmares. In one study, 77 percent of people with PTSD no longer experienced recurring nightmares after 20 weeks of CBT.

In a few cases, your psychiatrist may prescribe medications to relieve the symptoms of this disorder.

Dealing with Nightmares

If you wake up after a nightmare, you should employ the following tactics to get immediate relief:

Relax with the 4-7-8 breathing technique: simply inhale for 4 seconds, hold the breath for 7 seconds, and then exhale for 8 seconds. Repeat this for a few minutes while your mind calms down.
Grounding: when you feel a little calm, simply look at five different objects in your room one at a time. Take in the dimension, shape, and color of the object. Then touch a few items, feeling their texture and weight. Next use smell, taste, and hearing senses. This will calm your mind.
Rewrite the dream: this is part of the CBT treatment meant for recurring nightmares. By simply rewriting the narrative, you can calm your mind and create positivity in your life.
Discuss with someone: if you’re still scared, you should call someone and discuss the dream with them.

Lifestyle Changes for Nightmare Disorder

Lifestyle changes are one of the easiest ways to reduce the frequency of recurring nightmares and to alleviate the symptoms.

Here are a few changes that you should consider:

Practice Relaxation Techniques

Relaxation techniques help to calm your mind and decrease anxiety. You can follow these techniques to deal with anxiety, depression, and trauma.

Breathing Techniques

These techniques simply help you to deal with anxious thoughts in the moment. By removing your focus from your thoughts and focusing on your breath, you can reduce the amount of stress and anxiety that your mind is experiencing.

Here are a few breathing techniques that can help you relax in the moment:

4-7-8 breathing technique: inhale for 4 seconds, hold breath for 7 seconds, exhale for 8 seconds.
4-4-4-4 breathing method (box breathing): inhale for 4 seconds, hold for the next 4 seconds, exhale for the next 4 seconds, hold for the next 4 seconds.
6-2 technique: inhale for 6 seconds and exhale for the next two. Practice it in the morning to increase alertness after you wake up.

Journaling

Nightmares often create a negative perspective of life in our mind. In order to deal with these thoughts, you should create positive perspectives whenever possible.

Journaling is an effective method to change narratives of your past experiences and your nightmares.

When journaling, you can follow the common prompts of:

What
When
Where
Who
Why
How

Explore the event in detail and then create a positive spin on the narrative. Upon creating a positive view of an event, you’ll feel less anxious and stressed.

Now use your journal to deal with nightmares effectively.

Follow Good Sleep Hygiene

Good sleep hygiene is essential, despite the fact that you’re getting recurring nightmares. Sleep hygiene helps in building habits that enable you to improve your productivity and enjoy your life.

Here’s how you can follow good sleep hygiene to combat nightmares:

Avoid stimulants: don’t drink caffeine at least 6-8 hours before going to sleep. Also, avoid alcohol as it can induce nightmares.
Avoid electronics: put down your electronic devices at least 1 hour before heading to bed, as blue light emitted by these devices keep you awake.
Create an ideal environment: ensure that you have appropriate pillows and mattresses that support your joints and help with good alignment of the spine. Also, use earplugs to get rid of noises from your environment.
Dim the lights: dark is better for falling asleep faster.

Good sleep hygiene can help you to deal with nightmares. Read more about sleep hygiene.

When to see a Doctor?

Most of us don’t experience nightmares on a frequent basis, so we generally don’t require expert guidance when it comes to dealing with nightmares.

However, for those suffering from recurring nightmares, getting help from experts is essential.

So you should talk to your doctor about your recurring nightmares if:

You experience nightmares more than once a week.
Nightmares regularly interrupt your sleep and keep you from getting a good night’s rest.
Nightmares initiate on starting a new medication or supplement.

When the symptoms become too severe, it isn’t a good idea to deal with nightmares on your own. You should consult a doctor without any hesitation.

Nightmares vs Night Terrors

Nightmares and night terrors are different. While people suffering from recurring nightmares wake up from the dream, people suffering from night terrors don’t wake up and seldom remember the dream.

Unlike nightmares, night terrors are usually associated with vocal or physical behaviors. An episode of a night terror generally causes a person to flail their limbs around and shout.

Nightmares vs Lucid Dreams

Unlike nightmares, lucid dreams are pleasant experiences but just as immersive. In a lucid dream, the dreamer can often control multiple aspects of the dream world.

It’s a little like the movie inception.

According to specialists, “A lucid dream is defined as a dream during which dreamers, while dreaming, are aware they are dreaming.”

Experts believe that lucid dreams can be used as a treatment option for recurring nightmares.

Conclusion

Dreams are an immersive experience that convince us that we’re experiencing reality. This makes nightmares an awful experience. If you’re suffering from recurring nightmares, then you should consult a psychiatrist or psychologist and use the tips provided in this post to deal with nightmares.