What Is A Nightmare?
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, is a potential stimulus for nightmares.
Recurrent nightmares may require medical help, as they can interfere with sleeping patterns and cause insomnia.
Signs and symptoms
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. 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 patient report nightmares). As regarding the dream content of the dreams they are usually imprinting negative emotions like sadness, fear or rage. According to the clinical studies the content can range from being chased, injury or death of others, falling, natural disasters or accidents. Typical dreams or recurrent dreams may also have some of these topics.
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. 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. The results actually showed that healthy people have more nightmares than the sleep apnea patients. 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 Ss with asthma reported approximately 3 times as many nightmares as controls or OAD Ss without asthma. 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 with a high frequency. 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. Since the prominence of bad thoughts in dreams is higher than good, the dream will proceed to be a nightmare.
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 phenomenon.
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.  Both perspectives on dreams suggest that therapy can provide relief from the dilemma of the nightmare 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:
- Analytic and cathartic techniques
- Story-line alteration procedures
- Face-and-conquer approaches
- Desensitization and related behavioral techniques.
Post-traumatic stress disorder
Reccurring post-traumatic stress disorder 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 awake, and then reminding themselves at bedtime that they wish these alternate outcomes should the nightmares reoccur. Research has found that this technique not only reduces the occurrence of nightmares and insomnia, but also improves other daytime PTSD symptoms. 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”. The medication prazosin appears useful in decreasing the number of nightmares and the distress caused by them in people with PTSD.
Fearfulness in waking life is correlated with nightmares. Studies of dreams have estimated that about 75% of the time, the emotions evoked by dreams are negative. However, it is worth noting that people are more likely to remember unpleasant dreams.
One definition of “nightmare” is a dream which causes one to wake up in the middle of the sleep cycle and experience a negative emotion, such as fear. This type of event occurs on average once per month. They are not common in children under five, but they are more common in young children (25% experiencing a nightmare at least once per week), most common in teenagers, and common in adults (dropping in frequency about one third from age 25 to 55). The prevalence in children (5-12 years old) is between 20-30% and in adults 8-30%.
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