Nightmare disorder

Nightmare Disorder 818
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Nightmare disorder, which is also called dream anxiety disorder, is characterized by the occurrence of repeated dreams during which the sleeper feels threatened and frightened. The sense of fear causes the person to awake.


Nightmares are dreams that cause intense fear. These dreams are often complex and fairly long. During the dream, the sleeper usually encounters or experiences a threat to their life or safety. Nightmares are also reported that do not involve physical danger.

As the dream progresses, the threat to the person usually increases, as does their sense of fear. Waking usually occurs just as the threat or danger reaches its climax. It is often difficult for a person to return to sleep after waking from a nightmare. Nightmares usually occur during the second half of the night's sleep.

Causes and symptoms

During the course of a nightmare the sleeper may moan, talk, or move slightly, although these signs do not always appear. The person wakes from the nightmare with a profound sense of fear. Waking is complete, and usually accompanied by increased heart rate, sweating, and other symptoms of anxiety or fear. Once fully awake, the person usually has a good recall of the dream and what was so frightening about it. Because of the physical symptoms of anxiety and because clarity is achieved immediately upon waking, returning to sleep after a nightmare is often difficult. The vividness of the recall and the prominence of the dream images in the person's mind can also make it difficult to calm down and return to sleep.

Sometimes people may avoid going to sleep after a particularly intense nightmare because of the fear of having another bad dream. In addition, people may have problems falling asleep if they are experiencing anxiety caused by the fear of having nightmares. As a result, these people may have the signs and symptoms associated with mild sleep deprivation, such as decreased mental clarity, problems paying attention, excessive daytime sleepiness, irritability, or mild depression.

The causes of nightmares are not known for certain. Adults who have nightmares on a regular basis are a small minority of the American population. About half of these people are thought to suffer from psychiatric disorders that cause the nightmares. Nightmares may also be triggered by major psychological traumas, such as those experienced by patients with post-traumatic stress disorder . For most patients who do not have an underlying mental disorder, the nightmares are attributed to stress. Nightmares that occur on an irregular and occasional basis are usually attributed to life stressors and associated anxiety.

Some researchers think that artistic or creative people are at greater risk for nightmares, as are people who are generally sensitive. These people are considered to have well-developed imaginations and are very sensitive to environmental and social factors.

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. Withdrawal from alcohol and other medications can also sometimes cause nightmares.


The actual percentage of people that suffer from nightmare disorder is not known, as many people do not seek treatment for it. There are, however, estimates of the proportion of the population that experience occasional nightmares. Many children suffer from nightmares that concern their parents. Estimates on the number of children who have recurrent nightmares range from 10–50%. In children, however, nightmares are not usually associated with psychiatric illness.

The number of children experiencing nightmares decreases as they get older. More than 3% of young adults have frequent nightmares, but only about 1% of mature adults experience nightmares once or twice a week. Half of the adults in the United States who experience regular nightmares have diagnosable psychiatric illnesses. Women are estimated to have nightmares two to four times more frequently than men. There is some uncertainty as to whether this figure reflects an actual difference between the sexes in the frequency of nightmares, or whether women are simply more likely than men to report nightmares. Nightmares typically decrease in frequency as people grow older.


A diagnosis of nightmare disorder is usually made because the person reports the problem to their family physician or a psychiatrist . There are no laboratory tests for nightmare disorder, although the doctor may give the patient a physical examination to rule out any medical conditions that may be causing anxiety or stress.

Nightmares are characterized by awakening with a sense of fear, a clear recollection of the dream, and physical symptoms of anxiety. Nightmares can occur during nighttime sleep or daytime naps. A patient experiencing nightmares must meet the criteria listed in the Diagnostic and Statistical Manual of Mental Disorders to be diagnosed with nightmare disorder. The manual, which provides guidelines used by the American Psychiatric Association for diagnosing psychiatric disturbances, gives four distinct criteria:

  • • The patient must experience repeated awakenings from frightening dreams.
  • • When the patient awakes, he or she must wake fully and be aware of his or her surroundings.
  • • The nightmares must cause the patient distress in important areas of his or her life.
  • • The nightmares cannot be directly attributed to another disorder, or be the direct effects of medications, substance abuse, or a medical condition.

Nightmare disorder can be confused with sleep terror disorder . Both disorders are characterized by an arousal during sleep when the patient shows symptoms of anxiety or fear. Sleep terror, however, is characterized by a partial arousal from sleep during which the patient is generally nonresponsive. After a nightmare, the patient becomes fully awake and is aware of his or her surroundings. During an episode of sleep terror, a patient often gets out of bed and is active, and often screams or cries. During a nightmare, the patient may move slightly or moan but does not display such dramatic or active symptoms. Patients do not remember either the sleep terror episode or what caused the fear, but patients who have nightmares remember them with great clarity and often in considerable detail. Such symptoms of fear or anxiety as increased heart rate, dilated pupils, and sweating are not as dramatic in patients with nightmare disorder as they are in patients experiencing sleep terrors.


Nightmares that are associated with a psychiatric disorder are managed by treating the underlying disorder. For patients without psychiatric disorders, psychological counseling to deal with any recurring themes in the nightmares may be helpful. Children may not require treatment for nightmares unless the dreams are causing significant distress, as nightmares generally resolve as children mature.

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. Psychotherapy can be an effective way to identify major stressors in the person's life, and to explore ways in which they may be reduced or eliminated.


Nightmare disorder can be a lifelong disorder. A general improvement in symptoms often takes place, however, as the patient gets older. Treatment for any underlying psychological disorders can be very successful.



Aldrich, Michael S. Sleep Medicine. New York: Oxford University Press, 1999.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th edition, text revised. Washington DC: American Psychiatric Association, 2000.

Chokroverty, Susan, ed. Sleep Disorders Medicine: Basic Science, Technical Considerations, and Clinical Aspects. 2nd ed. Boston: Butterworth-Heinemann, 1999.

Sadock, Benjamin J., and Virginia A. Sadock, eds. Comprehensive Textbook of Psychiatry. 7th ed. Vol. 2. Philadelphia: Lippincott Williams and Wilkins, 2000.


Krakow, Barry, and others. "Imagery Rehearsal Therapy for Chronic Nightmares in Sexual Assault Survivors with Posttraumatic Stress Disorder." Journal of the American Medical Association 286, no. 5 (August 1 2001).


American Academy of Sleep Medicine. 6301 Bandel Road NW, Suite 101, Rochester, MN 55901. (507) 287-6006. <> .

Tish Davidson, A.M.

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User Contributions:

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Feb 19, 2007 @ 8:20 pm
Thanks for the info. It really helps. Very helpful indeed. kudos to you.
Jason Zitterkopf
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Mar 6, 2007 @ 4:16 pm
You should also add caffine to the causes! I recently took caffine pills to stay awake in school, when i got done with school i came home to eat and while i ate i drank a highly caffinated soda and started studying. I grew tired and went to take a nap I fell asleep about 10 consecutive times, each time having a different nightmare/dream that woke me back up.
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Feb 19, 2008 @ 7:07 am
Thank you for this information. I have had nightmares and sleep terrors all my life. The descriptions you provided match my experiences exactly, right down to the muscle movements and sounds involved. I guess there is nothing I can do about them, but now, at least, I know that I am not so unusual compared to others. Yes, I have yelled to myself to WAKE UP, also, to no avail. I am 65, and have been on Paxil the last few years for depression, but that made no difference to my dreaming, although it made my depression go away completely. Is there any way to interpret what the dreams mean, what the fear means? Thanks, Lawrence.
Beth Leopard
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Jun 22, 2008 @ 6:18 pm
I have the exact symptoms you describe. Sometimes my dreams are terrifying and I feel my heart racing. I sometimes see things and I think it's real but it is the dream. I wish I could never dream again, because they are never pleasant. I am very tired of it. If you find out any more about our condition, please let me know.
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Mar 15, 2009 @ 10:22 pm
Thank you for having this. it really gives me more insight on my journalism story.
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Aug 24, 2009 @ 6:18 pm
Thank you for all those information, It's really important for me!
De Wet
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Jan 1, 2010 @ 5:05 am
Try Lucid Dreaming. It took me about 2 weeks of practice to get to Lucid Dreaming. Once you have Lucid Dreaming down you can escape your nightmares, because you have a greater sense of control of your dreams and what happens in them. I've turned many nightmares to be into pleasant ones. Keeping a dream journal is one of the most important parts of Lucid Dreaming.

The basic premise of Lucid Dreaming is realizing when you are having a dream (nightmare or otherwise) and taking it for what it is - just a dream. Once you get that far you can do things to test just how lucid you are during your dreams, like attempting to walk through walls at first and then maybe even running through them. Everyone knows you can't just walk through a wall, you'll hit your head and it will hurt, but if you know *for sure* that you're dreaming you wont have any issues walking/running through one. Once you have practiced enough you should be able to start dispelling your nightmares. Imagine being eaten alive by wild dogs or something as a nightmare, when your lucid and know your dreaming, you simply dispell the dream by turning the dogs to stone, or mist or simply make them dissappear all together and dream about something else. I ussualy replace the nightmare and decide to dream about being able to fly.

There are many lucid dreaming techniques out there but here is what I've found is most effective:
1. Keep a dream diary, A small book and a pencil next to your bed.
2. Go to bed with the clear intention to dream pleasant dreams, but make it specific. What do you want to dream about, and then start thinking about it.
3. Whenever you dream anything and wake from it or are able to recall the dream the next day (even if its just bits and pieces in the beginning) write it down in your dream diary. Recalling what you have dream't will get better this way. Most people dream, EVERY night, you just don't remember it.
4. Test your lucidity, once you start lucid dreaming, by trying to do something in your dream that would otherwise not be possible, here can get creative, but progress slowly, don't start with jumping off buildings or such.
5. Lucid dreaming is best done without sleeping aids such as sleeping pills, alcohol and other narcotics

*WARNING TO SLEEP WALKERS: It is dangerous to test your lucidity if you are a sleepwalker you might really be doing it. If your a sleepwalker, ALWAYS do small test that are not life threatening, but do the ones that are hard in principle, such as levitating walking through a wall and conjuring something out of mid air or something equally non threatening*

6.Take control of your dreams. You are now the director. Take control and have fun.

Give it a whirl.

De Wet
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Aug 14, 2010 @ 6:06 am
I have nightmares in my sleep i experience it several times, i know i am awake but i can't open my eyes and i can't move myself...i know i am awake because i do pray after praying i'm back to normal.. how bout that??
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Aug 31, 2011 @ 6:18 pm
I have to do a special project on mental disorders and stuff about the human body and this helped me a whole lot!
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Aug 23, 2018 @ 1:13 pm
i have had nightmares all my life. i wake fully aware of my surrounding . lately during my cycles i get deju vu from partial dreams the better parts to be exact. i was out on to bc estrogen and my head is clearer then it has been but the deju vu still are occuring. i need help i will explain in more detail to who ever can help me

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