Nightmares

Nightmares are vivid and coherent dreams that can be threatening, upsetting, bizarre, and become increasingly disturbing as they progress and result in waking from sleep. They commonly involve impending danger or distressing themes. Thus causing us to feel fear, embarrassment, or anxiety upon waking.

Night terrors on the other hand are episodes of screaming and agitated movement such as flailing or thrashing, accompanied by intense fear.

Whilst nightmares occur during REM (dream) sleep, which occurs in later part of the night like after 2 to 3 a.m, night terrors occur during NREM sleep (usually stage 3/earlier in the night). As a result, they differ in several ways. In night terrors, a person usually feels confused, agitated, and fearful, has no recollection of the dream, and they occur early during the night. Nightmares, on the other hand, have less intense fear, but a person remembers them and is quickly able to orient themselves after the dream. If nightmares arise from trauma, such as in people with posttraumatic stress disorder (PTSD), they can occur in earlier stages of sleep. (https://sleepeducation.org/sleep-disorders/nightmares/)

How common are Nightmares?

An average person has at least 1 to 2 nightmares in a week. An estimated 50% to 85% of adults report having the occasional nightmare. Nightmares tend to become less frequent and intense as you age. Women tend to report nightmares more often than men but are also more open to discussing their dreams and nightmares.

Nightmares are very common in children aged 3-6 years. Up to 50% of young children have severe nightmares that cause them to wake up their parents. They peak by ten years of age. After that, they usually decrease but some children can continue to have them as teens and adults. They can also have a genetic component to them.

What causes Nightmares:

There can be many causes of nightmares. Thankfully so there are things we can control on our own or with the help of a medical professional, we can decrease both the intensity and the frequency of these nightmares. Here are some common causes;

-Stress and anxiety.

-Depression.

-PTSD.

-Lack of sleep.

-Parasomnias or disorders of sleep like night terrors disorder, nightmare disorder, restless leg syndrome, and sleep apnoea. Etc.

-Certain medications.

-Drug/alcohol abuse.

-Watching scary movies or reading scary books before bedtime.

When should we seek help for Nightmares?

Having a nightmare is unpleasant no matter what. But if they bother you, either by interrupting your sleep to where you don’t feel rested, or by emotionally disturbing you so much that you continue thinking about them the next day and beyond, seek help. If they affect your concentration, your focus, affect your mood and your energy, you must seek help.

What are some self-help strategies to decrease the intensity and duration of nightmares:

1: Manage your Stress and anxiety:

If Stress and anxiety are the cause of our nightmares, then taking active steps to manage our stress, will lead to relaxation, thus decreasing the intensity and frequency of nightmares. Here are some easy to decrease that everyday stress.

-exercise.

-walking.

-practice Deep breathing.

- meditate.

-take a Yoga Class.

- develop a hobby.

- keep a journal.

- keep the screen time minimal.

2: Lifestyle change.

Healthy sleep routine.

avoid eating spicy offs and late dinner.

Cut down on drinking and smoking.

Keep your room temperature below 65 degrees.

Use a soft comfortable or heavy weighted blanket.

Read before bedtime. ( avoid scary novels)

Use a night light.

3: Keep a dream Journal:

If it's your child having a nightmare, after they wake from a nightmare, respond quickly and soothe your child at the bedside. The next day asks them what they saw, and how it made them feel. This may prevent future nightmares. Adults can keep a dream journal, meaning write down their nightmares, describe what they saw, how they felt, how often do you see these dreams, Is there any associations between the events of the day and this recurring nightmare. Discuss all this with your therapist if you have one.

4: Various forms of Medical treatment.

If nightmares are associated with an underlying sleep disorder or parasomnias like night terror disorder, nightmare disorder, restless leg syndrome, or sleep apnea, then your doctor will refer you to a sleep specialist. They will do a sleep study and treat the underlying condition if you have sleep apnea, a CPAP may cure the problem.

Medications. If nightmares are due to trauma, or PTSD, the use of Prazosin, is considered. SSRI/Benzodiazepines, are also considered in some cases, especially if they are associated with anxiety or depression. But there are some antidepressants or hypnotics e.g. Zolpidem, which actually can cause nightmares. So consult your doctor, before you try any over-the-counter or other medications.

Therapy. A form of cognitive-behavioral therapy (CBT) called imagery rehearsal therapy (IRT) is used specifically to help improve your sleep by addressing nightmares. In fact, it's the most frequently recommended therapy technique for severe nightmares.

In IRT your therapist will help you recall your most recent nightmare. After discussing what were the stressors that precede this nightmare, or any past traumas that may feed such dreams, they will help you imagine an alternate ending to this nightmare. You then will be asked to keep practicing to imagine this ending for at least 10 to 20 minutes each day, while you are awake. By a couple of weeks, these nightmares then become less scary. Sometimes more sessions are needed.

Each session can last anywhere from 60 to 90 min.

If nightmares are due to PTSD, they tend to be more severe, so they may take longer to treat.

We all love to get a good night’s rest and it is incredibly essential for our health and wellbeing. Anything that interferes with that process can make us feel disturbed and sad. If you feel you or your loved one, or your child has been struggling for a while with scary dreams or nightmares, and you are afraid that it will happen again, then the best thing to do, is to talk to your doctor and seek the right help in a timely manner.

Reference:

https://facty.com/ailments/sleep/what-are-night-terrors/

https://www.self.com/story/when-to-see-doctor-nightmares.

https://www.news-medical.net/health/Difference-Between-Nightmares-and-Night-Terrors.aspx

https://www.healthline.com/health/sleep/imagery-rehearsal-therapy#how-it-works

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