Nightmare

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Nightmare
Specialty Sleep Medicine, Psychology, Psychiatry
Causes Stress, anxiety, fever

A nightmare, also known as a bad dream, [1] is an unpleasant dream that can cause a strong emotional response from the mind, typically fear but also despair, anxiety, disgust or sadness. The dream may contain situations of discomfort, psychological or physical terror, or panic. After a nightmare, a person will often awaken in a state of distress and may be unable to return to sleep for a short period of time. [2] Recurrent nightmares may require medical help, as they can interfere with sleeping patterns and cause insomnia.

Contents

Nightmares can have physical causes such as sleeping in an uncomfortable position or having a fever, or psychological causes such as stress or anxiety. Eating before going to sleep, which triggers an increase in the body's metabolism and brain activity, can be a potential stimulus for nightmares. [3]

The prevalence of nightmares in children (5–12 years old) is between 20 and 30%, and for adults between 8 and 30%. [4] In common language, the meaning of nightmare has extended as a metaphor to many bad things, such as a bad situation or a scary monster or person.

Etymology

The word nightmare is derived from the Old English mare , a mythological demon or goblin who torments others with frightening dreams. The term has no connection with the Modern English word for a female horse. [5] The word nightmare is cognate with the Dutch term nachtmerrie and German Nachtmahr (dated).

History and folklore

The sorcerous demons of Iranian mythology known as Divs are likewise associated with the ability to afflict their victims with nightmares. [6] The mare of Germanic and Slavic folklore were thought to ride on people's chests while they sleep, causing nightmares. [7]

Signs and symptoms

Those with nightmares experience abnormal sleep architecture. The impact of having a nightmare during the night has been found to be very similar to that of insomnia. This is thought to be caused by frequent nocturnal awakenings and fear of falling asleep. [8] When awoken from REM sleep by a nightmare, the dreamer can usually recall the nightmare in detail. They may also awaken in a heightened state of distress, with an elevated heart rate or increased perspiration. [9] Nightmare disorder symptoms include repeated awakenings from the major sleep period or naps with detailed recall of extended and extremely frightening dreams, usually involving threats to survival, security, or self-esteem. The awakenings generally occur during the second half of the sleep period. [10]

Classification

According to the International Classification of Sleep Disorders-Third Edition (ICSD-3), the nightmare disorder, together with REM sleep behaviour disorder (RBD) and recurrent isolated sleep paralysis, form the REM-related parasomnias subcategory of the Parasomnias cluster. [11] Nightmares may be idiopathic without any signs of psychopathology or associated with disorders like stress, anxiety, substance abuse, psychiatric illness or PTSD (>80% of PTSD patients report nightmares). [12] As regarding the dream content of the dreams they are usually imprinting negative emotions like sadness, fear or rage. [4] According to the clinical studies the content can include being chased, injury or death of others, falling, natural disasters or accidents. Typical dreams or recurrent dreams may also have some of these topics. [13]

Cause

The Nightmare (Henry Fuseli, 1781) Detroit Institute of Arts Henry Fuseli (1741-1825), The Nightmare, 1781.jpg
The Nightmare (Henry Fuseli, 1781) Detroit Institute of Arts

Scientific research shows that nightmares may have many causes. In a study focusing on children, researchers were able to conclude that nightmares directly correlate with the stress in children's lives. Children who experienced the death of a family member or a close friend or know someone with a chronic illness have more frequent nightmares than those who are only faced with stress from school or stress from social aspects of daily life. [14] A study researching the causes of nightmares focuses on patients who have sleep apnea. The study was conducted to determine whether or not nightmares may be caused by sleep apnea, or being unable to breathe. In the nineteenth century, authors believed that nightmares were caused by not having enough oxygen, therefore it was believed that those with sleep apnea had more frequent nightmares than those without it. The results actually showed that healthy people have more nightmares than sleep apnea patients. [15] Another study supports the hypothesis. In this study, 48 patients (aged 20–85 yrs) with obstructive airways disease (OAD), including 21 with and 27 without asthma, were compared with 149 sex- and age-matched controls without respiratory disease. OAD subjects with asthma reported approximately 3 times as many nightmares as controls or OAD subjects without asthma. [16] The evolutionary purpose of nightmares then could be a mechanism to awaken a person who is in danger.

Lucid-dreaming advocate Stephen LaBerge has outlined a possible reason for how dreams are formulated and why nightmares occur. To LaBerge, a dream starts with an individual thought or scene, such as walking down a dimly lit street. Since dreams are not predetermined, the brain responds to the situation by either thinking a good thought or a bad thought, and the dream framework follows from there. If bad thoughts in a dream are more prominent than good thoughts, the dream may proceed to be a nightmare. [17]

A panel from the early 20th century comic Dream of the Rarebit Fiend, whose protagonist regularly suffers nightmares after eating cheese Dream of the Rarebit Fiend 1905-02-25 (cropped).jpg
A panel from the early 20th century comic Dream of the Rarebit Fiend , whose protagonist regularly suffers nightmares after eating cheese

There is a view, possibly featured in the story A Christmas Carol , that eating cheese before sleep can cause nightmares, but there is little scientific evidence for this. [18] A single, biased study conducted by the British Cheese Board in 2005 argued that consuming cheese could trigger more vivid dreams, but this study was not backed up with sufficient research, and contradicts existing studies which found that consuming dairy products is associated with better overall sleep quality. [19]

Severe nightmares are also likely to occur when a person has a fever; these nightmares are often referred to as fever dreams.

Recent research has shown that frequent nightmares may precede the development of neurodegenerative diseases, such as Parkinson's disease and dementia. [20] [21] [22]

Treatment

Sigmund Freud and Carl Jung seemed to have shared a belief that people frequently distressed by nightmares could be re-experiencing some stressful event from the past. [23] Both perspectives on dreams suggest that therapy can provide relief from the dilemma of the nightmarish experience.

Halliday (1987) grouped treatment techniques into four classes. Direct nightmare interventions that combine compatible techniques from one or more of these classes may enhance overall treatment effectiveness: [24]

Post-traumatic stress disorder

Recurring post-traumatic stress disorder (PTSD) nightmares in which traumas are re-experienced respond well to a technique called imagery rehearsal. This involves dreamers coming up with alternative, mastery outcomes to the nightmares, mentally rehearsing those outcomes while awake and then reminding themselves at bedtime that they wish these alternative outcomes should the nightmares recur. Research has found that this technique not only reduces the occurrence of nightmares and insomnia [25] but also improves other daytime PTSD symptoms. [26] The most common variations of imagery rehearsal therapy (IRT) "relate to the number of sessions, duration of treatment, and the degree to which exposure therapy is included in the protocol". [27]

Medication

Trials have included hydrocortisone, gabapentin, paroxetine, tetrahydrocannabinol, eszopiclone, Sodium oxybate, and carvedilol. [29]

See also

Related Research Articles

Post-traumatic stress disorder (PTSD) is a mental and behavioral disorder that develops from experiencing a traumatic event, such as sexual assault, warfare, traffic collisions, child abuse, domestic violence, or other threats on a person's life or well-being. Symptoms may include disturbing thoughts, feelings, or dreams related to the events, mental or physical distress to trauma-related cues, attempts to avoid trauma-related cues, alterations in the way a person thinks and feels, and an increase in the fight-or-flight response. These symptoms last for more than a month after the event and can include triggers such as misophonia. Young children are less likely to show distress, but instead may express their memories through play. A person with PTSD is at a higher risk of suicide and intentional self-harm.

<span class="mw-page-title-main">Dialectical behavior therapy</span> Psychotherapy for emotional dysregulation

Dialectical behavior therapy (DBT) is an evidence-based psychotherapy that began with efforts to treat personality disorders and interpersonal conflicts. Evidence suggests that DBT can be useful in treating mood disorders and suicidal ideation as well as for changing behavioral patterns such as self-harm and substance use. DBT evolved into a process in which the therapist and client work with acceptance and change-oriented strategies and ultimately balance and synthesize them—comparable to the philosophical dialectical process of thesis and antithesis, followed by synthesis.

<span class="mw-page-title-main">Nightmare disorder</span> Medical condition

Nightmare disorder is a sleep disorder characterized by repeated intense nightmares that most often center on threats to physical safety and security. The nightmares usually occur during the REM stage of sleep, and the person who experiences the nightmares typically remembers them well upon waking. More specifically, nightmare disorder is a type of parasomnia, a subset of sleep disorders categorized by abnormal movement or behavior or verbal actions during sleep or shortly before or after. Other parasomnias include sleepwalking, sleep terrors, bedwetting, and sleep paralysis.

Psychological trauma is an emotional response caused by severe distressing events that are outside the normal range of human experiences. It must be understood by the affected person as directly threatening the affected person or their loved ones generally with death, severe bodily injury, or sexual violence; indirect exposure, such as from watching television news, may be extremely distressing and can produce an involuntary and possibly overwhelming physiological stress response, but does not produce trauma per se. Examples of distressing events include violence, rape, or a terrorist attack.

Eye movement desensitization and reprocessing (EMDR) is a form of psychotherapy that is a recommended treatment for post-traumatic stress disorder (PTSD), but remains controversial within the psychological community. It was devised by Francine Shapiro in 1987 and originally designed to alleviate the distress associated with traumatic memories such as PTSD.

Acute stress reaction (ASR), also known as psychological shock, mental shock, or simply shock, and acute stress disorder (ASD), is a psychological response to a terrifying, traumatic, or surprising experience. Combat stress reaction (CSR) is a similar response to the trauma of war. The reactions may include but are not limited to intrusive or dissociative symptoms, and reactivity symptoms such as avoidance or arousal. It may be exhibited for days or weeks after the traumatic event. If the condition is not correctly addressed, it may develop into post-traumatic stress disorder (PTSD).

<span class="mw-page-title-main">Complex post-traumatic stress disorder</span> Psychological disorder

Complex post-traumatic stress disorder is a stress-related mental disorder generally occurring in response to complex traumas, i.e., commonly prolonged or repetitive exposures to a series of traumatic events, within which individuals perceive little or no chance to escape.

A sympatholytic (sympathoplegic) drug is a medication that opposes the downstream effects of postganglionic nerve firing in effector organs innervated by the sympathetic nervous system (SNS). They are indicated for various functions; for example, they may be used as antihypertensives. They are also used to treat anxiety, such as generalized anxiety disorder, panic disorder and PTSD. In some cases, such as with guanfacine, they have also shown to be beneficial in the treatment of ADHD.

Prolonged exposure therapy (PE) is a form of behavior therapy and cognitive behavioral therapy designed to treat post-traumatic stress disorder. It is characterized by two main treatment procedures – imaginal and in vivo exposures. Imaginal exposure is repeated 'on-purpose' retelling of the trauma memory. In vivo exposure is gradually confronting situations, places, and things that are reminders of the trauma or feel dangerous. Additional procedures include processing of the trauma memory and breathing retraining.

Memory and trauma is the deleterious effects that physical or psychological trauma has on memory.

Cognitive behavioral therapy for insomnia (CBT-I) is a technique for treating insomnia without medications. Insomnia is a common problem involving trouble falling asleep, staying asleep, or getting quality sleep. CBT-I aims to improve sleep habits and behaviors by identifying and changing the thoughts and the behaviors that affect the ability of a person to sleep or sleep well.

Cognitive processing therapy (CPT) is a manualized therapy used by clinicians to help people recover from posttraumatic stress disorder (PTSD) and related conditions. It includes elements of cognitive behavioral therapy (CBT) treatments, one of the most widely used evidence-based therapies. A typical 12-session run of CPT has proven effective in treating PTSD across a variety of populations, including combat veterans, sexual assault victims, and refugees. CPT can be provided in individual and group treatment formats and is considered one of the most effective treatments for PTSD.

PTSD or post-traumatic stress disorder, is a psychiatric disorder characterised by intrusive thoughts and memories, dreams or flashbacks of the event; avoidance of people, places and activities that remind the individual of the event; ongoing negative beliefs about oneself or the world, mood changes and persistent feelings of anger, guilt or fear; alterations in arousal such as increased irritability, angry outbursts, being hypervigilant, or having difficulty with concentration and sleep.

Childbirth-related post-traumatic stress disorder is a psychological disorder that can develop in women who have recently given birth. This disorder can also affect men or partners who have observed a difficult birth. Its symptoms are not distinct from post-traumatic stress disorder (PTSD). It may also be called post-traumatic stress disorder following childbirth (PTSD-FC).

<span class="mw-page-title-main">Post-traumatic stress disorder and substance use disorders</span> Association of PTSD and substance dependencies

Post-traumatic stress disorder (PTSD) can affect about 3.6% of the U.S. population each year, and 6.8% of the U.S. population over a lifetime. 8.4% of people in the U.S. are diagnosed with substance use disorders (SUD). Of those with a diagnosis of PTSD, a co-occurring, or comorbid diagnosis of a SUD is present in 20–35% of that clinical population.

MDMA-assisted psychotherapy is the use of prescribed doses of MDMA as an adjunct to psychotherapy sessions. Research suggests that MDMA-assisted psychotherapy for post-traumatic stress disorder (PTSD), including Complex PTSD, might improve treatment effectiveness. In 2017, a Phase II clinical trial led to "breakthrough therapy" designation by the US Food and Drug Administration (FDA) for potential use as a treatment for PTSD.

<span class="mw-page-title-main">Post-traumatic stress disorder after World War II</span>

WWII lasted from September 1st, 1939 until September 2nd, 1945. The death toll during WWII has been estimated to be between 35,000,000 and 60,000,000. However, the exact number is unknown. With all those fatalities, it should not be surprising that it left so many lasting effects on the survivors. There have been many terms for these lasting effects over the decades. These terms include, but are not limited to, shell shock and combat fatigue. In 1980, the diagnosis of PTSD was added to the newly published DSM 3.

<span class="mw-page-title-main">Narrative exposure therapy</span> Short-term therapy for trauma-related disorders

Narrative Exposure Therapy (NET) is a short-term psychotherapy used for the treatment of post-traumatic stress disorder and other trauma-related mental disorders. It creates a written account of the traumatic experiences of a patient or group of patients, with the aim of recapturing self-respect and acknowledging the patient's value. NET is an individual treatment, NETfacts is a format for communities. Narrative Exposure Therapy is a subtype of Written Exposure Therapy.

Psychedelic treatments for trauma-related disorders are the use of psychedelic substances, either alone or used in conjunction with psychotherapy, to treat trauma-related disorders. Trauma-related disorders, such as post-traumatic stress disorder (PTSD), have a lifetime prevalence of around 8% in the US population. However, even though trauma-related disorders can hinder the everyday life of individuals with them, less than 50% of patients who meet criteria for PTSD diagnosis receive proper treatment. Psychotherapy is an effective treatment for trauma-related disorders. A meta-analysis of treatment outcomes has shown that 67% of patients who completed treatment for PTSD no longer met diagnostic criteria for PTSD. For those seeking evidence-based psychotherapy treatment, it is estimated that 22-24% will drop out of their treatment. In addition to psychotherapy, pharmacotherapy (medication) is an option for treating PTSD; however, research has found that pharmacotherapy is only effective for about 59% of patients. Although both forms of treatment are effective for many patients, high dropout rates of psychotherapy and treatment-resistant forms of PTSD have led to increased research in other possible forms of treatment. One such form is the use of psychedelics.

Imagery Rescripting is an experiential therapeutic technique that uses imagery and imagination to intervene in traumatic memories. The process is guided by a therapist who works with the client to define ways to work with particular traumatic memories, images, or nightmares.

References

  1. ↑ Harper, Douglas. "nightmare". Online Etymology Dictionary . Retrieved 11 July 2016.
  2. ↑ American Psychiatric Association (2000), Diagnostic and Statistical Manual of Mental Disorders, 4th ed, TR, p. 631
  3. ↑ Stephen, Laura (2006). "Nightmares". Psychologytoday.com. Archived from the original on 31 August 2007.{{cite journal}}: Cite journal requires |journal= (help)
  4. 1 2 Peter, Helga; Penzel, Thomas; Jörg, Hermann Peter (2007). Enzyklopädie der Schlafmedizin. Heidelberg: Springer Medizin Verlag. ISBN   978-3-540-28839-8.
  5. ↑ Liberman, Anatoly (2005). Word Origins And How We Know Them. Oxford: Oxford University Press. p. 87. ISBN   978-0-19-538707-0 . Retrieved 29 March 2012.
  6. ↑ "DĪV, Volume VII, Fasc. 4". Encyclopædia Iranica . 28 November 2011 [15 December 1995]. pp. 428–431. Retrieved 3 July 2021.
  7. ↑ Bjorvand and Lindeman (2007), pp. 719–720.
  8. ↑ Simor, Pé, et al. "Disturbed Dreaming and Sleep Quality: Altered Sleep Architecture in Subjects with Frequent Nightmares."European Archives of Psychiatry and Clinical Neuroscience 262.8 (2012): 687–96. ProQuest. Web. 24 April 2014.
  9. ↑ "Nightmares". stanfordhealthcare.org. Retrieved 17 March 2024.
  10. ↑ Grohol, John M.; read, Psy D. Last updated: 8 Jul 2020 ~ Less than a minute (17 May 2016). "Nightmare Disorder Symptoms". psychcentral.com. Retrieved 29 September 2020.{{cite web}}: CS1 maint: numeric names: authors list (link)[ permanent dead link ]
  11. ↑ Sateia, Michael J (2014). "International Classification of Sleep Disorders-Third Edition". Chest. 146 (5): 1387–1394. doi:10.1378/chest.14-0970. ISSN   0012-3692. PMID   25367475.
  12. ↑ Morgenthaler, Timothy I.; Auerbach, Sanford; et, al. (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 (6): 1041–1055. doi:10.5664/jcsm.7178. ISSN   1550-9389. PMC   5991964 . PMID   29852917.
  13. ↑ Schredl, Michael; Göritz, Anja S. (2018). "Nightmare Themes: An Online Study of Most Recent Nightmares and Childhood Nightmares". Journal of Clinical Sleep Medicine. 14 (3): 465–471. doi:10.5664/jcsm.7002. PMC   5837849 . PMID   29458691.
  14. ↑ Schredl, Michael, et al. "Nightmares and Stress in Children." Sleep and Hypnosis 10.1 (2008): 19–25. ProQuest. Web. 29 April 2014.
  15. ↑ Schredl, Michael, et al. "Nightmares and Oxygen Desaturations: Is Sleep Apnea Related to Heightened Nightmare Frequency?" Sleep and Breathing 10.4 (2006): 203–209. ProQuest. Web. 24 April 2014.
  16. ↑ Wood, James M.; Bootzin, Richard R.; Quan, Stuart F.; Klink, Mary E. (December 1993). "Prevalence of nightmares among patients with asthma and chronic obstructive airways disease". Dreaming. 3 (4): 231–241. doi:10.1037/h0094382. ProQuest   1023291364 EBSCOhost   1994-18130-001.
  17. ↑ Stephen, LaBerge (1990). Exploring the World of Lucid Dreaming. New York: Ballantine Books. pp. 65–66.
  18. ↑ Hammond, Claudia (17 April 2012). "Does cheese give you nightmares?". BBC. Retrieved 7 October 2018.
  19. ↑ "Does cheese really give you vivid dreams?". www.bbc.com. Retrieved 17 March 2024.
  20. ↑ Otaiku, Abidemi (2022). "Distressing dreams and risk of Parkinson's disease: A population-based cohort study". eClinicalMedicine. 8 (48). doi:10.1016/j.eclinm.2022.101474. PMC   9249554 . PMID   35783487.
  21. ↑ Otaiku, Abidemi (2022). "Distressing dreams, cognitive decline, and risk of dementia: A prospective study of three population-based cohorts". eClinicalMedicine. 21 (52). doi:10.1016/j.eclinm.2022.101640. PMC   9596309 . PMID   36313147.
  22. ↑ Otaiku, Abidemi (2023). "Distressing dreams in childhood and risk of cognitive impairment or Parkinson's disease in adulthood: a national birth cohort study". eClinicalMedicine. 8 (48). doi:10.1016/j.eclinm.2023.101872. PMC   10102896 . PMID   37064510.
  23. ↑ Coalson, Bob (1995). "Nightmare help: Treatment of trauma survivors with PTSD". Psychotherapy: Theory, Research, Practice, Training. 32 (3): 381–388. doi:10.1037/0033-3204.32.3.381.
  24. ↑ Cushway, Delia; Sewell, Robyn (2012). Therapy with Dreams and Nightmares: Theory, Research & Practice (2 ed.). SAGE Publications Ltd. p. 73. ISBN   978-1-4462-4710-5.
  25. ↑ Davis, J. L.; Wright, D. C. (2005). "Case Series Utilizing Exposure, Relaxation, and Rescripting Therapy: Impact on Nightmares, Sleep Quality, and Psychological Distress". Behavioral Sleep Medicine. 3 (3): 151–157. doi:10.1207/s15402010bsm0303_3. PMID   15984916. S2CID   5558629.
  26. ↑ Krakow, B.; Hollifield, M.; Johnston, L.; Koss, M.; Schrader, R.; Warner, T. D.; Tandberg, D.; Lauriello, J.; McBride, L. (2001). "Imagery Rehearsal Therapy for Chronic Nightmares in Sexual Assault Survivors with Posttraumatic Stress Disorder: A Randomized Controlled Trial". JAMA: The Journal of the American Medical Association. 286 (5): 537–45. doi:10.1001/jama.286.5.537. PMID   11476655.
  27. ↑ Lu, M.; Wagner, A.; Van Male, L.; Whitehead, A.; Boehnlein, J. (2009). "Imagery rehearsal therapy for posttraumatic nightmares in U.S. Veterans". Journal of Traumatic Stress. 22 (3): 236–239. doi:10.1002/jts.20407. PMID   19444882., p. 234
  28. ↑ El-Solh, AA (2018). "Management of nightmares in patients with posttraumatic stress disorder: current perspectives". Nature and Science of Sleep. 10: 409–420. doi: 10.2147/NSS.S166089 . PMC   6263296 . PMID   30538593.
  29. 1 2 3 4 Waltman, Scott H.; Shearer, David; Moore, Bret A. (11 October 2018). "Management of Post-Traumatic Nightmares: a Review of Pharmacologic and Nonpharmacologic Treatments Since 2013". Current Psychiatry Reports. 20 (12). Springer Science and Business Media LLC: 108. doi:10.1007/s11920-018-0971-2. ISSN   1523-3812. PMID   30306339. S2CID   52958432.

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