| Nightmare | |
|---|---|
 | |
| The Sleep of Reason Produces Monsters (Francisco de Goya, c. 1797) | |
| Specialty | Psychology Psychiatry |
| Causes | Stress or Anxiety |
A nightmare, also called a bad dream, is an unpleasant dream that can cause a strong emotional response from the mind, typically fear but also despair, anxiety and great sadness. However, psychological nomenclature differentiates between nightmares and bad dreams, specifically, people remain asleep during bad dreams whereas nightmares awaken individuals. Further, the process of psychological homeostasis employs bad dreams to protect an individual's Homeostatically Protected Mood (HPMood) from the impact of elevated anxiety levels. During sleep, nightmares indicate the failure of the homeostatic system employing bad dreams to extinguish anxiety accumulated throughout the day. 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.
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
Those
with nightmares experience abnormal sleep architecture and that the
results of having a nightmare during the night were very similar to
those of people who have insomnia. This is thought to be caused by
frequent nocturnal awakenings and fear of falling asleep.
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.
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). 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.
Cause
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 it. 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 subjects with asthma reported
approximately 3 times as many nightmares as controls or OAD subjects
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.
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. 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:
- Analytic and cathartic techniques
- Storyline alteration procedures
- Face-and-conquer approaches
- Desensitization and related behavioral techniques.
Posttraumatic stress disorder
Recurring posttraumatic 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 while 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.
Epidemiology
The prevalence in children (5–12 years old) is between 20 and 30%, and in adults 8 to 30%.
Etymology
The Nightmare (Henry Fuseli, 1781)
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 word for "female horse." Subsequently, the prefix "night-" was added to stress the dream aspect. The word "nightmare" is cognate with the Dutch term nachtmerrie and German Nachtmahr (dated).
