Nightmare Disorder – Causes, Diagnosis and How to Deal With It

Nightmare disorder can cause severe problems in a person’s daily routine. It can be hard to get proper rest when your brain starts associating bedtime with fear and stress, and this issue can then affect your work performance, libido, overall health, and other aspects of life.

Everyone gets nightmares from time to time. While they can be unsettling in the short-term, most people have no issues in life that stem from nightmares during sleeping hours. It’s treated as just a part of life, often equated to the inconvenience of getting woken up by outside noise or bathroom urgency (except nightmares are scarier than those things). If the nightmares are uncommon or not too inconvenient, it’s not necessary to perform a medical investigation of potential causes and such. However, for around 4% of people in the United States, nightmares are a severe problem.

Nightmare disorder (otherwise known as dream anxiety disorder) can cause severe problems in a person’s daily routine, usually stemming from their tendency to avoid sleep after experiencing nightmares as often as they do with this condition. It can be hard to get proper rest when your brain starts associating bedtime and your bed itself with fear and stress, and this issue can then affect your work performance, libido, overall health, and other aspects of life. In order to deal with nightmare disorder, one must first understand it, and that’s where we come in. This article contains all the information you need to recognize nightmare disorder and take the right steps towards making your life easier with this condition. Let’s get into it.

What is Nightmare Disorder and How Do You Recognize It?

As its name may imply, nightmare disorder is a condition characterized by frequent and intense nightmares. It belongs to the parasomnia category, and the nightmares only occur during REM sleep. These nightmares can often cause severe anxiety and dysphoria, if not full-blown depression. This condition ruins your sleep in two major ways, which have a huge number of negative consequences when it comes to your health and personal safety. The first way nightmare disorder destroys your sleep is straightforward – you wake up often during the night because of nightmares, causing fragmented sleep which ruins your circadian rhythm. In case you don’t know what a circadian rhythm is, it’s a rhythm that dictates processes in your body, and things like appetite, libido, daily energy levels, etc. You have a clock in your brain that uses photoreceptors to tell the time of day, and then decides how your body operates depending on whether it’s day or night.

By disrupting your circadian rhythm, you throw your entire body off-balance in terms of hormone production and general functioning. Your immune system takes a hit, which can lead to seemingly unrelated illnesses that are hard to trace back to nightmare disorder or any other sleep disorder. The second thing that happens is that your brain starts to harbor very negative associations with the bed. Without your direct knowledge, you begin to imagine your bed as a source of fear, stress, and anxiety, which can convince a lot of people to indirectly or directly avoid sleeping. Eventually, fatigue builds up to a point where the person is unable to function properly in any environment, including work, traffic, social situations, etc. This means that it’s much easier for nightmare disorder to throw you off-balance than most other sleep disorders, at least when it comes to the effective amount of rest you get (it’s one thing to sleep for 7 hours total, and another to do so uninterrupted).

There are several ways to notice nightmare disorder, and ways it differs from other parasomnias that make it unique. The most obvious way to spot nightmare disorder is the resulting nightmares. Whether it’s you or your loved ones, nightmares often wake the person up and put them in a very alert state where they’re aware of their surroundings. Other parasomnias like sleepwalking make the sleeper almost completely unresponsive to their environment. These nightmares are frequent, often intense and they appear on their own, without a trigger like substance abuse or medication side-effects.

Additionally, nightmares are much easier to remember than the episodes of any other sleep disorder. People feel fear and anxiety, which tend to stick for a while after the person wakes up, making them much more capable of remembering nightmares, even if only partially. One benefit of this is that nightmares are easy to document in a sleep journal, which helps you determine whether you have this disorder in the first place, and it helps doctors when they try to diagnose you properly.

A lot of parasomnias involve motor activity, usually leg jerking or arm flailing (if not walking around and doing other things). Nightmare disorder doesn’t come with any of these symptoms, at least usually. The most intense movement you can expect to see is a sudden stir as you wake up from the nightmare. Waking up from a nightmare leaves you in a state where you’re almost perfectly aware of what’s going on, whereas a lot of similar disorders come with a dose of confusion and disorientation.

There are three levels of nightmare disorder severity that sleep experts agree on, and they’re separated based on how frequent the nightmares are. Mild nightmare disorder comes with one or fewer nightmares per week on average, making it a nuisance, but nothing to obsessively worry over. Moderate nightmare disorder is considered a condition where you experience more than one nightmare per week, but not every night. Severe nightmare disorder is defined by nightly or almost nightly episodes and is a huge problem for the person in question.

What Causes Nightmare Disorder?

Unfortunately, much like many other sleeping disorders, nightmare disorder doesn’t have a single cause we can point to. A lot of other parasomnias are at least partially caused by genetics, but this isn’t the case for nightmare disorder. The main similarity this condition shares with others in its category is that it occurs primarily in children. Children are also the most vulnerable when it comes to the amount of fear caused by nightmares and sleep avoidance. Around 30% of all children experience frequent nightmares, whereas another 40% experience them occasionally. Once adulthood kicks in, nightmare disorder becomes much less common, with only around 2% of adults having to face this condition.

Nightmares, in general, are linked to mental health issues and psychiatric disorders, such as schizophrenia and BPD (borderline personality disorder). Nightmare disorder can also come out of these problems, but it’s not guaranteed. Because it occurs only during REM sleep, older adults are much less likely to experience this disorder, as their time spent in REM sleep is drastically reduced. The contributing factors should sound familiar by now, as they’re shared among most sleeping disorders. Bad sleep hygiene, stress, anxiety, trauma, substance abuse – these are only some of the potential contributing factors for nightmare disorder and should be paid attention to during daily life. Nightmares can cause stress and anxiety, which can, in turn, generate more nightmares, meaning it’s very hard to get proper rest once the vicious cycle kicks in. If you are forced to take prescription or over-the-counter medication for other conditions (even if they’re completely unrelated), make sure the side-effects don’t include an increased chance or severity of nightmares. Any medication that messes with your REM sleep can contribute to nightmares in one way or another, but the most common offenders are hypnotics, beta blockers and SSRIs (selective serotonin reuptake inhibitors).

Doctors rarely have trouble diagnosing nightmare disorders, because the symptoms are either unique or very easy to notice, especially if you bring them a sleep journal. They will examine your medical history, perform a selection of basic examinations, and possibly get you to fill out a questionnaire or two. These questionnaires are often specialized diagnostic tests developed specifically to test for sleep disorders and fatigue levels, and filling them out can not only help diagnose nightmare disorder but any other sleep-related problem as well. When checking for medicine side-effects, no one does it better than a doctor, so consult them if you’re unsure about anything.

How to Live With Nightmare Disorder

As is the case with many other sleeping disorders, nightmare disorder doesn’t have a perfect cure. Instead, sleep experts and doctors recommend several steps you can take to change your lifestyle and avoid things that increase the chances or severity of a nightmare episode. Following these tips can also improve your general health, and that’s a good reason to do it even if nightmares temporarily subside. Don’t think you’re in the clear if you go for one whole week without nightmares or something like that. Here’s what you can do to make your life easier despite having to deal with this annoying condition:

  • Try to avoid and relieve stress whenever possible. Relaxation exercises are a wonderful habit to pick up for people who experience frequent nightmares because they can alleviate anxiety and stress – two common contributing factors for nightmare disorder. Alternatively, regular visits to a local sauna can do the trick, especially because saunas relieve your body of many toxins that cause discomfort.
  • Exercising regularly has a similar effect as performing relaxation exercises and visiting saunas, almost acting as a mixture of the two. When combined with these other positive habits, exercise can really help you air out frustrations, achieve better health overall and avoid nightmares in some cases.
  • Medications like prazosin can alleviate symptoms and reduce nightmare frequency, but they should never be consumed without consulting your primary care physician. Don’t experiment with medicine. If you are taking medication for other conditions, and the side-effects cause nightmares, you may want to discontinue that treatment plan and request alternatives from your doctor.


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