Nightmares in Adults

A nightmare is a disturbing dream that evokes fear, anxiety, and distress. While such dreams are common in children, only 2% to 8% of the adult population may have such frightening dreams.

Nightmares are placed under the category of parasomnias. Parasomnias are sleep-related disorders that are characterized by unusual or abnormal behavior during different stages of sleep.

Nightmares should not be confused with night terrors or panic attacks that occur at night. Night terrors are unusual sleep disturbances in which the affected individual may gasp, scream, cry, or moan. These usually involve violent body movements or profuse sweating. They occur during the deep non-rapid eye movement (NREM) sleep.

The affected individuals have no memory of such sleep disturbances. On the other hand, nightmares are dreams that occur in the REM phase of sleep. Dreams are usually experienced during this phase of sleep.

The characteristic sign of such elaborate dream sequences is that the dreamer perceives an impending threat. The intense fear that the dreamer feels forces him/her to awaken.

➤ The person having such a dream wakes up at the extreme point of terror. The dreamer may feel intense inescapable fear for some time after waking. There may be rapid beating of the heart and sweating.

➤ The dreamer is able to recall the contents or details of the dream. Sometimes the dream is so upsetting that the dreamer may find it difficult to return to sleep.

➤ The dreamer is fully alert after he/she awakens from the terrifying dream.

Victims of sexual abuse or people who have recently suffered from a traumatic experience such as a natural disaster or an accident are more likely to suffer from recurrent nightmares. What they visualize in their dreams could be somewhat similar to what they have experienced during the traumatic event.

The incidence of such dreams is quite high in people suffering from PTSD. Post-traumatic Stress Disorder (PTSD) is a disorder in which people relive the traumatic experience for months or years following the event. They feel scared even when they are not in danger. Such dreams may occur on a daily basis or after an interval of certain days.

Psychiatric illnesses such as schizophrenia and dissociative disorders could also be the reason behind such frightening dreams. Depression that is associated with anxiety could also be a contributory factor.

When such dreams are not triggered by a mental illness, stress or anxiety is often the contributory factor. Prolonged stress could be the reason behind frightening dreams, especially the recurring ones. Stress could arise due to problems at workplace, death of a loved one, monetary problems or relationship issues.

Use of certain drugs can also cause nightmares. Certain drugs that are used for treating Parkinson's disease, Alzheimer's disease, or hypertension could cause such dreams. Amphetamines, antidepressants, narcotics, and drugs that act on the neurotransmitters could also cause disturbing dreams.

Alcohol abuse and substance abuse could also be contributory factors. Withdrawal from certain drugs, especially the ones that suppress REM sleep, could cause rebound nightmares.

The course of action that needs to be adopted would largely depend upon the cause of such dreams. If any medical condition is the cause, then medical help must be sought to treat that condition.

➤ If the underlying cause is the use of certain drugs, it would be best to discontinue taking such drugs.

➤ For those who suffer from PTSD, coping with the traumatic event is extremely essential. Therapy, counseling and reassurance from family members can be of great help in helping such people cope better.

➤ If dreams are induced by stress, steps must be taken to eliminate stress. Listen to soothing music before going to bed. Practicing relaxation techniques like yoga, meditation, and deep breathing exercises can prove beneficial. Don't watch horror movies at night.

Occasional nightmares are not really a cause of serious concern and it would be best if you don't keep thinking about them, but if you have such dreams frequently, it would be best to consult a psychologist and a dream analyst. A proper clinical evaluation is necessary to manage this disorder. In some cases, an overnight sleep lab study may be required.

If the dream contents are very disturbing, medical experts may opt for desensitization, hypnosis, imagery rehearsal therapy, lucid dreaming, and nightmare-focused cognitive behavioral therapy. These techniques have been found to be quite effective in lowering the incidence of such dreams.

Disclaimer: The given particulars are solely for educating the reader. It is not intended to be a substitute for the advice of a medical expert.