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Nightmare Disorder

Kathryn Patricelli, MA

What is Nightmare Disorder?

Symptoms of this disorder include:

  • repeated and long dreams that leave a person feeling unwell or unhappy. The dreams usually involve trying to avoid threats to survival or physical safety/security. This most often happens during the second half of the night's sleep.
  • when the person wakes up, they rapidly become alert and aware
  • these issues cause stress in the person's life or trouble at work, in relationships with others, or other daily activities.
  • the issues are not caused by a substance (medication or drug of abuse).
  • there isn't another medical or mental health condition that explains the dreams that leave the person feeling unwell or unhappy

How common is Nightmare Disorder?

About 1 to 4% of parents' report that their preschool children (3-5 years old) have nightmares often or every night. This often increases between ages 10 and 13 for both males and females and then continues to increase for females between ages 20-29. It typically decreases with age, but remains more likely in females. Only a small number of people continue to have the issue as adults.

What are the risk factors for Nightmare Disorder?

Those who report past negative events in their life can be more likely to have this condition, as do those who have sleep deprivation or irregular times for sleeping and being awake. There also may be genetic/brain factors that are involved. Parents who have routines for comforting children after a nightmare may reduce the chance that the child will have this condition.

What other disorders or conditions often occur with Nightmare Disorder?

Nightmares can commonly occur with other medical conditions including heart disease, cancer, pain, and withdrawal from drug use. They also can occur with mental health issues including post-traumatic stress disorder (PTSD), schizophrenia, depression, anxiety disorders, personality disorders, grief after a death, REM sleep behavior disorder, and acute stress disorder.

How is Nightmare Disorder treated?

If the nightmares are happening because of another medical or mental health issue, then treatment usually focuses on that condition.

Medication is not generally used. However, it might be given if the doctor thinks that it would be helpful to reduce the amount of times the person is awake during the night or the type of sleep that happens.

Stress management techniques can also be used, including relaxation strategies or counseling to talk about how the nightmares are affecting the person's life and making them feel.

Treatment may also involve imagery rehearsal therapy. If the person is having dreams because of PTSD, they may find help in talking through the nightmare and working out a new, more positive ending to the situation while awake, so that it is no longer bothering them as much and may reduce the likelihood of it occurring again while they are sleeping.