Many people suffer from nightmares and other types of bad dreams. They are so prevalent that some people may be wondering if bad dreams serve us in some way.
Here are some statistics:
- About 4 people out of a hundred experience a nightmare at least once a week.
- 85 people out of a hundred experience a nightmare at least once a year.
- Bad dreams/anxiety dreams, which are less emotionally intense than nightmares and do not result in an awakening, are 4 times more frequent than nightmares.
- 7-20% of children suffer from nightmares.
Clearly, nightmares and bad dreams are natural and quite common. The problem starts when your nightmares become more and more frequent and start interfering with your life.
What is a nightmare?
We define a nightmare as a dream in which the dreamer experiences an intense negative emotion, such as a sense of threat, anxiety, fear, anger or even sadness. Nightmares occur during late-night REM sleep and are clearly remembered upon awakening.
Having a bad dream every now and then doesn’t mean you have a Nightmare Disorder.
Nightmares should not be confused with anxiety dreams, which are scary dreams recalled only upon waking up in the morning. Real nightmares lead to an awakening.
To be diagnosed as suffering from a Nightmare Disorder, there are several criteria that have to be met:
- Nature of dream – repeated dreams involving negative emotions, which are well-remembered and usually involving threat and occurring in the second half of sleep.
- Nature of awakening – if the dreamer awakens from the dream, he immediately becomes alert and oriented.
- Nature of distress – significant distress or impairment is experienced.
- Not caused by taking a drug or a substance.
- Not related to other mental or medical disorders. An exception would be suffering from REM sleep behavior disorder (RBD), PTSD (Post-Traumatic Stress Disorder) or acute stress disorder as long as the nightmares started before the condition.
Types of Nightmare Disorders by Severity
How many nightmares do you experience per week?
If you have less than 1 nightmares per week, then you are said to have a Mild Nightmare Disorder.
If 1-6 nightmares occur per week, then your condition is classified as a Moderate Nightmare Disorder.
Finally, experiencing more than 6 nightmares per week is known as a Severe Nightmare Disorder
Types of Nightmare Disorders by Duration
Acute Nightmare Disorder diagnosis is given to those suffering from nightmares for one month or less.
If your nightmares occur for more than one month, you will be diagnosed with a Subacute Nightmare Disorder.
Persistent Nightmare Disorder sufferers experience bad dreams longer than 6 months.
Children are often only diagnosed with Nightmare Disorder in cases of persistent distress.
Types of Nightmares by When They Occur
There is a subtype of nightmares which are experienced before falling asleep. It’s called sleep-onset nightmares and involves experiencing terrifying hypnagogic hallucinations while trying to fall asleep.
Nightmares can also occur during NREM (non-REM) sleep.
Why do nightmares occur? What is their function/purpose?
While some theories claim that mild, infrequent and non-recurring nightmares may have a purpose (specifically for emotional regulation), many other sleep researchers agree that nightmares occur as a symptom of an underlying disorder and not as a separate condition with a specific function.
Therefore, we should probably rephrase the title of this subsection as:
What causes nightmares?
And the answer is…we don’t know.
There is evidence that nightmares are more prevalent among people who also suffer from impaired sleep quality, sleep disorders, PTSD (Post-Traumatic Stress Disorder), depression, a suicidal tendency and anxiety as well as other psychiatric conditions and neurologic diseases.
Also, people who are “night owls” seem to be suffering more from nightmares than “early birds.”
Some drugs and medications, such as hypnotics, antidepressants and antihypertensives, may cause nightmares.
Nightmares and Other Sleep Disorders
In REM sleep behavior aggressive dreams may occur and are enacted, usually with the dreamer counterattacking from their beds.
In narcolepsy nightmares are experienced during long REM periods which occur immediately upon falling asleep.
PTSD and Nightmares
PTSD, or Post-Traumatic Stress Disorder, is a condition that some people develop after being exposed to a severely threatening traumatic experiences.
One of the diagnostic criteria of PTSD is presence of intrusive symptoms, such as reexperiencing the trauma in nightmares.
Indeed, the main way to distinguish PTSD-related nightmares from Nightmare Disorder is in the reliving of the actual traumatic memories which triggered the PTSD within nightmares.
Regular nightmares are usually not episodic and are rarely corresponds to actual events in the dreamer’s waking life.
Also, while regular nightmares occur mostly during the second half of the night when REM sleep predominates, PTSD nightmares can also occur during sleep stages 1 and 2.
Treatment of PTSD-Related Nightmares (PTN)
The medical approach to treating PTSD-related nightmares up until recently was to use drugs such as Prazosin HCl (Minipress, Vasoflex, Lentopres, Hypovase, etc.).
However, the use of this drug entails some side effects, including dizziness, headache, drowsiness, lack of energy, weakness, palpitations, nausea, vomiting, diarrhea, constipation, edema, orthostatic hypotension, dyspnea, syncope, vertigo, depression, nervousness and rash.
Fortunately, according to a review recently published in Current Psychiatry Reports of the medical literature about the management of post-traumatic nightmares using drugs and non-drug treatments, “Prazosin is no longer considered a first-line pharmacological intervention for PTN.”
So what are the alternatives, you may be wondering?
A synthetic cannabinoid known as Nabilone shows promise, although long-term effects are not yet fully understood.
Psychological treatments are available in which the patient is exposed to nightmares and/or goes through a restructuring of their nightmares.
In Imagery Rehearsal Therapy (IRT), for instance, patients learn how to deal with the unpleasant imagery while they’re awake. They write down their nightmare, then rescript it with a better outcome. Finally, they rehearse the images of the altered dream story.
Combining this method with relaxation techniques or lucid dreaming techniques, wherein patients can change their dream while its happening, can make this a highly beneficial approach.
This psychological intervention can significantly reduce the severity and frequency of nightmares as well as improve insomnia (especially when combined with Cognitive-Behavioral Therapy, or CBT) and other symptoms of PTSD.
How to Stop Having Nightmares
As I mentioned above, there is no consensus among sleep researchers as to whether nightmares have a function or are just a symptom of a different condition.
Why is this question so important?
We really need to know if nightmares have a positive function, or purpose, because if they do, perhaps treating them is not such a good idea as it might disrupt an important emotional process.
For this reason, only nightmares that are frequent, severe and disruptive of daily functioning should be treated.
Do you experience recurrent dreams that involve feelings of extreme threat, anxiety, fear, terror, anger, rage, embarrassment or disgust?
Do these dreams most often occur during the second half of the night and do they result in a rapid awakening and with clear memory of the nightmare you just experienced?
If you answered yes to both these questions, you may be suffering from a Nightmare Disorder.
It’s important to treat a Nightmare Disorder since it can lead to avoiding sleep, which in turn can lead to sleep deprivation, more intense nightmares and insomnia.
The best treatments options for Nightmare Disorder include:
- Image rehearsal therapy (IRT; explained above.)
- Systematic desensitization
- Progressive deep muscle relaxation
- Lucid dreaming therapy – learning how to change your nightmare while you’re experiencing it.
- Self-exposure therapy
Sleepwalking and Sleep Terrors
While regular nightmares occur during REM sleep, there is a subtype of nightmares that occur during NREM sleep. These nightmares are often associated with sleepwalking and night terrors.
If you find yourself having bad dreams that make you do things, such as sleepwalk or scream in terror, then this is “your” subtype of nightmares.
Treating your sleepwalking or night terror will often improve the dreams as well.
Here are some suggestions:
- Avoid sleep deprivation and daytime stress
- Don’t drink alcohol or eat heavy meals before bed
- Avoid hyperthermia (overheating)
- Instruct your sleeping partner to guide you back to bed if they “catch” you sleepwalking
- Obviously, you should close (and lock) all doors and windows if you sleepwalk
- Learn how to “practice” relaxation
- Eat melatonin-rich foods 1 hour before going to bed (e.g., 2 pistachio nuts)
- Hypnosis and some drugs may help if everything else fails
REM Sleep Behavior Disorder (RBD)
If you enact violent dreams, then you may be suffering from RBD, a disorder common in patients with some neurodegenerative diseases, such as Parkinson disease.
Apart from the enactment of dreams, RBD nightmares (as well as Parkinson dreams) contain aggression and animals.
3-12 mg melatonin before sleep can alleviate this type of nightmares.
A narcoleptic’s dream life is quite fascinating. They recall more dreams and experience more false awakenings, stronger emotions, recurrent dreams and lucid dreams. Unfortunately, nightmares are also common.
Luckily, most narcoleptics can easily learn how to lucid dream and therefore lucid dreaming therapy by which the patient learns how to turn recurrent nightmares into good dreams, would be an ideal treatment approach.
Some narcoleptics also experience frightening visual, verbal and non-verbal auditory, tactile and kinetic hallucinations, including the sensation of having out-of-body experiences. Full-fledged visions and sleep paralysis can also occur. These experiences are not nightmares and can be reduced with drugs.
Other Causes of Nightmares
The following disorders which are associated with nightmares (hallucinations and enacted dreams with open eyes, to be more precise) are beyond the scope of this article, but still deserve a mention:
- Parkinson Disease, especially when treated with levodopa
- Guillain-Barré Syndrome
- Dementia with Lewy bodies
- Alcohol withdrawal syndrome (delirium tremens)
- Fatal familial insomnia
- Morvan chorea
Since there are many disorders and conditions which may be causing a persistent nightmare problem, it’s important to make a full assessment when trying to come up with a treatment plan.
Uninformed doctors and physicians will most likely prescribe medications when there may be better alternatives, such as imagery rehearsal therapy and lucid dreaming therapy. For this reason, I suggest getting in touch with a sleep specialist or a sleep coach who will be able to guide you through the process of diagnosing your issue and setting up the best treatment plan possible.
Are you taking drugs? Some drugs may cause nightmares so it’s important to go over the list of side effects of every drug you’re taking to make sure it’s not the cause of your bad dreams.
Is the frightening aspect of the dream an episodic memory? Something you experienced in the past?
Do you have PTSD?
Do you have any sleep disorders, such as sleepwalking, narcolepsy, night terror or REM sleep behavior disorder (RBD)? If unsure, tests, such as video polysomnography (PSG) and Multiple Sleep Latency Tests, should be conducted to rule out any sleep disorders.
It’s important to answer these questions because as you saw above, every nightmare type is treated differently.
…or read on if you still have any questions about nightmares and bad dreams.
If you have a question which is not addressed below, feel free to post them as replies to this article or contact me.
We all have bad dreams/nightmares every now and then, but for some people, these manifestations of the subconscious mind can become serious disruptors of everyday existence.
Do these dreams carry any hidden meanings? What causes them and what can be done to get rid of them? These are the questions I shall attempt to answer for you below.
What is the meaning of bad dreams?
There are two types of nightmares defined by science and these are the garden-variety type (that are randomly occurring nightmares, the frequency of which can vary from a handful per year to daily – especially in the case of children), and post-traumatic.
The trigger behind the latter variety is obvious: having gone through a real-life trauma, the sufferer has his/her subconscious mind overloaded with the negative sensations generated by this trauma. These sensations then surface in the form of nightmares, with varying frequency. Such nightmares are expected to subside over time, as the trauma itself fades in the memory of the sufferer.
As far as garden-variety nightmares are concerned, their main trigger can be usually traced back to anxiety. People experiencing such nightmares frequently are thought to be more weary of the real world that surrounds them, and more afraid of certain real-life situations too.
Even infrequent nightmares can be traced back to certain anxieties, which take hold of the dreamer’s subconscious and bubble to the surface when the sufferer loses the ability to consciously suppress them.
Bad dreams are always followed by a flood of relief upon waking up, when the sufferer finds solace in the real world, where sanity and normalcy rule.
Despite the bothersome and even irritating nature of these dreams, they should generally not be suppressed, as they offer a potentially useful peek into one’s fears and stresses, and can yield a trove of information for therapists working on the elimination/management of these fears.
What can cause nightmares?
Besides the nightmare triggers already addressed above, science has identified a trove of other issues which can promote and trigger bad dreams.
Nightmares are surprisingly frequent among the 5-12 year-olds, though baby nightmares are apparently rather frequent as well. Children are thought to grow out of nightmares, and indeed, while in the above said age-group, the prevalence of the issue can be as high as 50%, in adults it drops to 2-8%.
With children, triggers can indeed be diverse. Scary stories, movies and TV shows can results in bad dreams, as can school-related stress (whether it originates in bullying or in certain obligations students are required to fulfill).
Adults will experience bad dreams due to a diverse range of issues too, some of them trivial, others less so.
Late-night eating can and will induce nightmares in those who indulge in this type of activity. Carbohydrate-rich foods, when ingested late at night, will up the metabolic rate of the body, and they will increase brain activity.
Unresolved conflicts can also surface at night, in the shape of nightmares, and apparently one’s momentary hormonal state has an impact on dreaming and thus on nightmares, as well.
Sleep disorders such as sleep apnea can induce bad dreams in adults too.
What medication can cause bad dreams?
If the multitude of potential nightmare triggers listed above feels overwhelming to you, you may not want to read on, because the list is indeed still longer.
Some prescription medications, such as Remeron, have been known to trigger bad dreams as well. Physicians actually have a list of drugs which can elicit such side effects, and this list is indeed rather formidable, given that it’s not about a handful of pills used for the treatment of some rare and obscure conditions.
In fact, some antibiotics have made the above said list, together with anti depressants (which should theoretically have the opposite effect), blood pressure medications, cholesterol management drugs and antihistamines.
The list does not stop there though.
If you are taking dietary supplements for whatever reason (and yes that includes bodybuilding supplements and various over the counter supplements people use to treat a range of real or imagined “health issues”), you may want to double-check the label for ingredients which may be pushing you down Freddy Krueger’s hallways of terror.
The same goes for alcohol, though in that case, there isn’t really a list of ingredients to check.
Why do such medications result in nightmares for some?
Science believes these chemicals interfere with various stages of the sleep process, interference which often results in the unnatural lengthening of the REM sleep cycle, the stage where most dreaming occurs.
How do you get rid of nightmares?
If you get what you suspect are nothing more than “normal” adult nightmares, there’s not much you should do. Just forget about it and move on with your life.
How do you know whether your bad dreams fall into this category or not?
Simple: ask yourself whether they have a significant negative impact on the overall quality of your life.
If the answer is yes, and only then, you should start exploring ways of stopping your nightmares.
In addition to that, you should also educate yourself on the nature of bad dreams, learning to differentiate between nightmares and night terrors. Nightmares are said to mostly occur during the REM stages of sleep – as stated above – which means they come about during the last few hours of sleep, in the morning. “Proper” nightmares are associated with vivid images, sometimes as clear as reality itself.
Night terrors, on the other hand, occur within the first few hours of sleep and they are comprised of intense bouts of irrational fear, unaccompanied by the images characteristic of nightmares.
Given how nightmares are merely the symptoms of an underlying psychological issue, the best way to do away with them is to treat this underlying cause.
Reducing stress in your life is the best way to go about that.
Avoiding late-night snacking is another move you can make on the nightmare front, as is the overall improvement of your sleep quality.
Talking about your nightmares to someone also helps sometimes.
There are some herbal remedies which may help, such as:
- Chamomile (Matricaria recutita)
- Valerian root (Valeriana officinalis)
- Lemon Balm (Melissa officinalis)
- Passion Flower (Passiflora incarnata)
- St. John’s Wort (Hypericum perforatum)
What are the symptoms of a night terror?
Night terrors are intense bouts of fear during sleep, which activate the sufferer’s fight-or-flight systems.
Like nightmares, they affect children as well as adults.
Unlike nightmares though, night terrors occur during the deepest stages of sleep.
Night terrors in children are also associated with sleepwalking. Indeed, the victim of a night terror may sit up screaming, while remaining largely unaware of his/her surroundings and partially asleep. This explains why such victims are often inconsolable and why they seldom remember they even had a night terror.
Fever, extreme exhaustion and substance abuse are just some of the factors which can trigger night terrors. This form of sleep disorder is much more frequent in children than it is in adults.
In adults, the presence of night terrors can also be indicative of bipolar disorder and PTSD.
Why do we have bad dreams as kids?
Children can start having nightmares from a very early age, though it is thought that they are most vulnerable to this issue between the ages of 3 and 6, when their brains go through an accelerated period of development, which goes hand-in-hand with the development of fear and imagination.
As it’s obvious, those are indeed all the right ingredients for nightmares to blow up. As many as 50% of the children falling into this age group are thought to have problems with bad dreams, and for some of these kids, the problem can be quite debilitating.
In many cases, children’s nightmare problems negatively impact the sleep quality of their parents too.
While the triggers are mostly the same as listed above (stress, anxiety, unresolved conflicts, trauma, etc), researchers have spotted a genetic factor in childhood nightmare problems too. Around 7% of children who have a family history of nightmares (older siblings who struggled with the same problems) go on to have problems associated with bad dreams themselves.
Children with depression and mental retardation have more nightmares, and fevers can be a major trigger for some too (though that holds true for adults as well).
How do I give myself nightmares?
Although nightmares are generally considered a nuisance by most people, some don’t seem to mind having them, and then there are those who actually enjoy them. To such people, nightmares are the sources of fear-triggered adrenaline rushes, not unlike those experienced during the viewing of a scary movie.
Can one really exert some kind of control over how his/her subconscious mind serves up these “delightfully” vivid episodes of “virtual” terror?
Apparently, there are indeed a few measures you can take to invite nightmares into your life.
Altering your sleeping position is possibly the simplest such exercise. People who sleep face-down are more prone to having nightmares about being smothered/unable to breathe. Those sleeping on their right sides seem to be less inclined to have nightmares than those who sleep on their left sides.
Watching a frightening horror movie right before bed is another way to mentally grab a bazaar of bad dreams and try to take it to bed with you. We do tend to dream about things that are on our minds for most of the day, so willingly filling our minds with visually shocking images of gore and terror just before bed, may indeed exert an effect on what we’ll dream about.
Taking Vitamin B6 is apparently another way to bring about nightmares, as is drinking alcohol and leading a generally stressful life.
Spicy foods – preferably eaten shortly before bedtime – will sometimes do the trick too.