Nightmare disorder

Nightmare disorder
The Nightmare, by Johann Heinrich Füssli
Specialty Psychiatry Edit this on Wikidata
Frequency c. 4%[1]

Nightmare disorder, also known as 'dream anxiety disorder', is a sleep disorder characterized by frequent nightmares. The nightmares, which often portray the individual in a situation that jeopardizes their life or personal safety, usually occur during the REM stages of sleep. Though such nightmares occur within many people, those with nightmare disorder experience them with a greater frequency. The disorder's DSM-IV number is 307.47.

The treatment depends on if it is due to PTSD or not.[1] About 4% of people are affected.[1]

Signs and symptoms

During the nightmare, the sleeper may scream and yell out things. The victim is often awakened by these threatening, frightening dreams and can often vividly remember their experience. Upon awakening, the sleeper is unusually alert and oriented within their surroundings, but may have an increased heart rate and symptoms of anxiety, like sweating. They may have trouble falling back to sleep for fear they will experience another nightmare.

A person experiencing nightmare disorder would have trouble going through everyday tasks; the anxiety and lack of sleep caused by the fearful dreams would hinder the individual from completing everyday jobs efficiently and correctly. Upon experiencing this, these victims should consult with a psychiatrist.

The sleeper may have recurring episodes of awakening while recalling the intensely disturbing dream manifestations which usually result from fear or anxiety, but can also be triggered from anger, sadness, disgust, and other dysphoric emotions. The sleeper also can endure at least one of the following two features: delayed return of going back to sleep after episodes, and having episodes in the latter half of the patients sleep. [2]

Causes

Nightmares can be caused by extreme pressure or irritation if no other mental disorder is discovered. The death of a loved one or a stressful life event can be enough to cause a nightmare but mental conditions like post-traumatic stress disorder and other psychiatric disorders have been known to cause nightmares as well.

If the individual is on medication, the nightmares may be attributed to some side effects of the drug. Amphetamines, antidepressants, and stimulants like cocaine and caffeine can cause nightmares. Blood pressure medication, levodopa and medications for Parkinson's disease have also been known to cause nightmares.[3]

The nightmares may be idiopathic or could be associated with mental disorders like post-traumatic stress disorder, schizophrenia, and borderline personality disorder. Nightmares can also be triggered by stress and anxiety and substance abuse, Drugs that can lead people to having nightmares are drugs that affect the neurotransmitters norepinephrine and dopamine. Eighty percent of patients who suffer from PTSD report nightmares. Patients suffering from PTSD have symptoms that are classified in three clusters: intrusive/re-experiencing, numbing, and hyperarousal. Nightmares are usually considered to be part of the intrusive/re-experiencing symptom. [2]

Consequences

The disorder is common, it affects about 4% of the adult population, the disorder has a higher percentage when it comes to children and adolescents. Nightmare disorder can impair the quality of life for the people who are affected with the condition. It can make the patient avoid sleep, which leads to sleep deprivation which could lead to even more intense nightmares for the patient. Some other consequences of the nightmare disorder are fatigue and insomnia.[2]

Treatment

Stress reduction techniques such as yoga, meditation and exercise may help to eliminate stress and create a more peaceful sleeping atmosphere.[4]

Diagnosis and medication can only be given to patients that report the recurring nightmares to a psychiatrist or other physician. Medications like prazosin are sometimes used to treat nightmares in people with PTSD.[5][6] Therapy usually helps to deal with the frightening themes of the nightmares and alleviate the recurrence of the dreams. The persistent nightmares will usually improve as the patient gets older. Treatments are generally very successful.[7]

Research has been undertaken to investigate if sufferers of nightmares could benefit from the ability to be aware they are indeed dreaming, a process known as lucid dreaming,[8][9] but so far evidence for this treatment is weak.[10]

Epidemiology

About 4% of people are affected.[1] Children are more apt to experience nightmares than teenagers and adults. Young children normally have nightmares once or twice a week and will usually not develop a nightmare disorder unless they are under severe psychological stress. Children who have persistent nightmares range from 10% to 50%.[7] It is more common for a child to be diagnosed with nightmare disorder since children usually experience many nightmares when they are young.

Research

  • Dissociative disorders are usually paired with Nightmare Disorder 57% of the time. Nightmare disorder is believed to be associated with Dissociative Disorders as a defense mechanism that is used to escape from the traumatic event that caused the Dissociative Disorder. People with Dissociative Disorder and Nightmare disorder are more likely to self-mutilate, attempt suicide, and have Borderline Personality Disorder.[11]
  • Borderline Personality Disorder with Nightmare Disorder is very common, since the stages of sleep vary from that of a normal person (i.e. increased stage one sleep, and less stage four sleep). People with Borderline Personality disorder and Nightmare Disorder are usually the severest of those who have Borderline Personality Disorder; therefore, treating those with Nightmare Disorder may also help some with Borderline Personality Disorder.[12]
  • Hypnosis seems to be a new and effective treatment for those with Nightmare Disorder, since it increases relaxation.[13]
  • Nightmare disorder is also associated with those who have lower cholesterol. This connection is unclear; however, cholesterol may affect other hormones in the body (such as serotonin) which may affect one’s sleep.[14]

References

  1. 1 2 3 4 Morgenthaler, Timothy I.; Auerbach, Sanford; Casey, Kenneth R.; Kristo, David; Maganti, Rama; Ramar, Kannan; Zak, Rochelle; Kartje, Rebecca (15 June 2018). "Position Paper for the Treatment of Nightmare Disorder in Adults: An American Academy of Sleep Medicine Position Paper". Journal of Clinical Sleep Medicine. 14 (06): 1041–1055. doi:10.5664/jcsm.7178.
  2. 1 2 3 "Journal of Clinical Sleep Medicine - Research & Review Articles in Sleep Medicine". jcsm.aasm.org. Retrieved 2018-10-07.
  3. ↑ "Nightmare Disorder". The Gale Encyclopedia of Mental Health. January 1, 2008. Retrieved April 14, 2016. Nightmares can be a side effect of some medications or drugs of abuse, including drugs given for high blood pressure; levodopa and other drugs given to treat Parkinson’s disease; amphetamines, cocaine and other stimulants; and some antidepressants.  – via HighBeam (subscription required)
  4. ↑ "Nightmare Disorder". The Gale Encyclopedia of Mental Health. January 1, 2008. Retrieved April 14, 2016. Because stress is thought to be the most common cause of nightmares, stress reduction techniques may prove to be effective complementary treatments. Typical relaxation techniques such as yoga, meditation or exercise may be helpful.  – via HighBeam (subscription required)
  5. ↑ Murray A. Raskind, Elaine R. Peskind, Evan D. Kanter, (February 2003). Reduction of Nightmares and Other PTSD Symptoms in Combat Veterans by Prazosin: A Placebo-Controlled Study, American Journal of Psychiatry, (160) 371-373.
  6. ↑ "Drug Helps PTSD Nightmares" (Press release). Department of Veteran Affairs. March 30, 2008. Archived from the original on July 3, 2009. Retrieved 2012-06-23. (Archived page)
  7. 1 2 "Nightmare disorder". minddisorders.com.
  8. ↑ Spoormaker, Victor I.; Jan van den Bout, Jan (October 2006). "Lucid Dreaming Treatment for Nightmares: A Pilot Study" (PDF). Psychotherapy-and-Psychosomatics. 75 (6): 389–394. doi:10.1159/000095446. PMID 17053341. Conclusions: LDT seems effective in reducing nightmare frequency, although the primary therapeutic component (i.e. exposure, mastery, or lucidity) remains unclear.
  9. ↑ Colic, M. (2007). "Kanna's lucid dreams and the use of narrative practices to explore their meaning." The International Journal of Narrative Therapy and Community Work (4): 19–26.
  10. ↑ R. Nisha Aurora.; et al. (2010). "Best Practice Guide for the Treatment of Nightmare Disorder in Adults" (PDF). Journal of Clinical Sleep Medicine. 6 (4): 549–553.
  11. ↑ Agargun, MY; Kara, H; Ozer, OA; Selvi, Y; Kiran, U; Ozer, B (December 2003). "Clinical importance of nightmare disorder in patients with dissociative disorders". Psychiatry and clinical neurosciences. 57 (6): 575–9. doi:10.1046/j.1440-1819.2003.01169.x. PMID 14629705.
  12. ↑ Semiz, UB; Basoglu, C; Ebrinc, S; Cetin, M (February 2008). "Nightmare disorder, dream anxiety, and subjective sleep quality in patients with borderline personality disorder". Psychiatry and clinical neurosciences. 62 (1): 48–55. doi:10.1111/j.1440-1819.2007.01789.x. PMID 18289141.
  13. ↑ Kennedy, G. (2002, November). A review of hypnosis in the treatment of parasomnias: Nightmare, sleepwalking, and sleep terror disorders. Australian Journal of Clinical & Experimental Hypnosis, 30(2), 99-155.
  14. ↑ Agargun, MY; Gulec, M; Cilli, AS; Kara, H; Sekeroglu, R; Dulger, H; Besiroglu, L; Inci, R (May 2005). "Nightmares and serum cholesterol level: a preliminary report". Canadian journal of psychiatry. Revue canadienne de psychiatrie. 50 (6): 361–4. doi:10.1177/070674370505000613. PMID 15999954.
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