Do I Have A Nightmare Disorder?
A nightmare is a dream with disturbing content that can cause you to wake up with feelings of fear, sadness, guilt, or anxiety. You might wake up sweating or with a pounding heart as well. Nightmares differ from bad dreams in that nightmares tend to cause you to wake up alert rather than confused or groggy, although both can affect sleep quality and sleep patterns. You also may be better able to remember specific details of what happened in a nightmare. Nightmares occur most often during the second half of the night, during rapid eye movement (REM) sleep, and they could be a sign of certain sleep disorders or mental health conditions if persistent and frequent.
More about nightmares or bad dreams
Below is additional information about nightmares or bad dreams.
Other signs of a nightmare or bad dreams may include:
Dreams that seem extremely real and vivid
Dreams that become more disturbing as they continue
A storyline involving threats to survival or safety
Dreams that cause enough distress that it's difficult to fall back to sleep
Although different types of nightmares and night terrors can be scary, occasional nightmares don’t tend to be a sign of any negative health issues. In fact, they can be quite normal and common. They are most often experienced by young children between ages three and 12, according to the American Academy of Pediatrics, but they can also happen to older children, teenagers, and adults.
If you are experiencing recurrent nightmares or a high nightmare frequency, do not hesitate to reach out to a professional through an online therapy service. In some cases, nightmares may be a sign of a mental health condition, such as post-traumatic stress disorder (PTSD), dream anxiety disorder, nightmare disorder, or other mental health disorders. Even if nightmares are not a sign of a larger problem, those that happen often enough to disrupt your patterns of REM sleep could have a negative impact on your health. National Center on Sleep Disorders Research suggests that not getting enough sleep can cause problems with physical health, attention, memory, and learning.
Common causes of nightmares
What causes nightmares? Scientists are not sure exactly why nightmares (or dreams in general) occur, but over time you could notice certain triggers. If you find yourself wondering, “Why am I experiencing chronic nightmares?” you might consider whether you have any of the following risk factors that could trigger nightmares:
High levels of stress and anxiety
A traumatic event(s) in your past
Any of various mental health and medical conditions, such as PTSD or bipolar disorder
Certain medications, including those used to treat heart disease
Medication or drug withdrawal
Sleep deprivation
A history of nightmares among biological family members
A personal history of nightmares
Recently engaging with scary movies, books, or video games
Snacking before bedtime
Fever or illness
Sleep apnea
Narcolepsy
Nightmare disorder
At times, you may experience nightmares even if none of these triggers nor any type of disorders are present. If you’re concerned, you might consider seeing a counselor or healthcare provider.
What is nightmare disorder?
Nightmare disorder tends to be much less common than having the occasional nightmare: The American Academy of Sleep Medicine reports that it affects around 4% of adults. You may want to contact a healthcare provider if these types of dreams persist over time, routinely disrupt your sleep, or cause severe distress. If you frequently experience some of the following complications, nightmare disorder might be at play:
Persistent nightmares
Major distress or impairment of daytime functioning the day after a nightmare
Fear of going to bed or falling asleep
Anxiety over having another nightmare
Problems with memory or concentration
Persistent mental images from nightmares during your daily life
Lucid dreams
Excessive daytime sleepiness
Poor sleep quality
Violent eye and leg movements
Problems functioning at school, at work, or in social situations
Behavioral problems that are related to a fear of the dark
If your nightmares cause you to experience any of the above problems, you may be experiencing nightmare disorder. It can be difficult to diagnose nightmare disorder as there are generally no specific tests typically administered. Instead, your healthcare provider will likely talk to you about your symptoms and give you a physical exam. If they believe your nightmares might be related to a sleep disorder, they may have you do an overnight sleep study. Depending on the results, they may prescribe sleep medicine, review the effects, and consider further treatment.
The process of treating nightmare disorders varies. If the nightmares are related to a different sleep disorder, then your healthcare provider will likely treat the underlying disorder and your nightmares may subside. In other cases, they may recommend stress and anxiety management or prescribe blood pressure medication. For those living with post-traumatic stress disorder (PTSD), doctors sometimes prescribe medication to prevent PTSD-related nightmares. Also, counseling or therapy, including lucid dream therapy, could be helpful for those with nightmare disorder.
How to stop nightmares
If you’re wondering how to stop having nightmares, you’re not alone. It may help to get to the root of the issue. If you think stress or anxiety could be causing your nightmares, it may be time to find some healthy coping strategies. If PTSD or trauma is the source of your nightmares, you may wish to speak with a mental health professional. If a sleep disorder is one of your nightmare causes, it may be a good idea to talk to your doctor about various treatment options.
Sleep hygiene
It may also help to practice what is known as good sleep hygiene. One example of practicing sleep hygiene is to reconsider the type of content you consume; you might try avoiding engaging with scary movies, books, and video games, which could cause an increased risk of nightmares, especially around the evening hours. Additional sleep hygiene practices include several simple lifestyle changes you can employ to try to get better sleep.
Six tips for better sleep without anxiety, terror, and fear
Sleep hygiene involves practices you use to improve your ability to fall asleep and sleep soundly through the night. Below are six sleep hygiene practices to try.
Here are some tips for getting better sleep without anxiety or fear.
1. Establish a consistent sleep schedule to avoid insomnia and nightmares
Going to bed and waking up at the same time every day may help keep your sleep stable. You might try to avoid sleep schedule disruptions.
2. Create (and stick to) a relaxing and consistent bedtime routine
Your usual bedtime routine might include taking a warm shower, following your skincare routine, brushing your teeth, or reading a chapter of a book. Many people enjoy drinking a cup of herbal tea before bedtime. Others incorporate meditation, gentle yoga, or breathing exercises to relax their body and mind before drifting off to sleep.
3. Avoid using screens for an hour before bed
The blue light from your phone or computer may suppress your body’s release of melatonin, which is a hormone that helps you sleep. Melatonin is typically released in response to darkness, so using screens before bed could make it more difficult for you to fall asleep or get restful sleep.
4. Avoid or limit caffeine and alcohol to prevent sleep disorders
Both of these can disrupt sleep and may even contribute to nightmares. You might try not to drink any caffeine or alcohol in the evening. As a study in the American Academy of Sleep’s journal suggests, caffeine can result in sleep disturbances even if consumed as many as six hours before bed.
5. Optimize your sleep environment
You also might make sure the room where you sleep is sufficiently dark and at a comfortable temperature. Decorating the room with familiar, comforting objects may also be a good idea. You might consider whether your bed, pillows, and blankets are comfortable.
6. Exercise during the day
Regular daily exercise (but not right before bed) may improve the quality of your sleep in addition to potentially providing overall health benefits. Exercise can be as simple as taking a walk or dancing to your favorite music.
Talk to a counselor for any sleep or nightmare disorder
Counseling is an option that may help you address your nightmares or sleep problems. Whether you prefer to speak to a counselor in person or online, they may be able to help you understand why you’re having nightmares. A mental health professional can also suggest various methods to stop your nightmares and improve your sleep overall. The American Academy of Sleep Medicine has found that engaging in cognitive-behavioral therapy can be an effective treatment for nightmare disorder, per the Academy of Sleep’s website.
If you’re interested in online therapy, BetterHelp is one option if you’re 18 or older, and TeenCounseling offers the same services specifically for teens. BetterHelp and TeenCounseling are online counseling platforms. They can match you with a certified counselor who can suggest stress reduction techniques and help you with your nightmares and other mental health concerns (such as post-traumatic stress disorder, for example).
You can talk to a licensed therapist virtually from the comfort of your own home. Also, you can contact your therapist in between sessions via in-app messaging, and they’ll get back to you as soon as they are able. Research suggests that online therapy can be as effective as in-person sessions in many cases. See below for client reviews of BetterHelp counselors.
Takeaway
Frequently asked questions about nightmare disorders and insomnia
What are the symptoms of a nightmare disorder, like anxiety, fear, or terror?
While symptoms of nightmare disorder (sometimes called dream anxiety disorder) may vary between individuals, the condition is most characterized by frequent nightmares that cause significant distress and impair functioning in daily life. Here are some common symptoms of nightmare disorder:
Recurring, distressing nightmares with themes of threat, danger, or harm
Intense fear, anxiety, or terror during the nightmares
Trouble falling back to sleep after waking from a nightmare
Frequent sleep disruptions caused by nightmares
Waking up with feelings of panic, sweating, or heart palpitations
Difficulty concentrating, fatigue, irritability, or emotional distress during waking hours
Avoidance of activities, places, people, or other potential sources that may lead to nightmares
Is it okay to have nightmares every night?
While occasional nightmares and distressing dreams are common, frequent and persistent nightmares may be a sign of a more serious issue like mental health conditions such as nightmare disorders, anxiety, depression, and post-traumatic stress disorder (PTSD). Nightmares may also be a symptom of certain physical conditions like lupus. If you're having nightmares every night, consult with a healthcare professional who can assess your symptoms and identify (or rule out) potential causes.
Is there a cure for nightmare disorder?
While there isn't a specific cure, there are several treatments for nightmare disorder that can help reduce or eliminate symptoms. Some of the most common treatment approaches for nightmare disorder in adults include:
Imagery rehearsal therapy (IRT)
Cognitive behavioral therapy (CBT)
Exposure, relaxation, and rescripting therapy (ERRT)
Lucid dreaming therapy
Hypnosis
Self-exposure therapy
Systematic desensitization
Sleep dynamic therapy (SDT)
Testimony method
People with nightmares caused by post-traumatic stress disorder (PTSD) may benefit from eye movement desensitization and reprocessing (EMDR) therapy
Medication
Recent research suggests a supplemental technique to other treatments of nightmare disorder called target memory activation can help individuals for whom standard therapies like IRT aren't effective alone. While awake, the patient repeatedly pairs a sound with an imagined positive outcome in their nightmare, and then that sound is played during the rapid eye movement (REM) stage of sleep. With the introduction of the sound, study participants experienced a significant reduction in nightmares over therapy alone.
Are nightmares linked to mental illness?
Aside from nightmare disorder, nightmares may be a symptom of several types of mental health disorders, including PTSD, schizophrenia, anxiety disorders, and depression.
How rare is nightmare disorder?
According to the American Academy of Sleep Medicine (AASM), "Nightmare disorder affects approximately 4% of adults, occurring in isolation or as part of other disorders such as PTSD."
What age does nightmare disorder start?
Nightmare disorder can arise at any age; however, studies suggest nightmares are most common in younger children between three and five years old (between 10% and 50% have bad dreams severe enough to disturb their parents).
What does the Bible say about nightmares?
While the Bible doesn't specifically address nightmares as a concept, it does address themes related to fear, anxiety, and troubled dreams. For example, there are instances in the Old Testament in which dreams are used to deliver messages or warnings, such as in the case of Joseph's prophetic dreams in the Book of Genesis. While warnings may be delivered through dreams in some stories in the Bible, nightmares aren't explicitly discussed throughout the narratives.
How long can nightmare disorder last?
For some people, nightmare disorder resolves on its own within weeks, but for others, it can persist for months or years. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), nightmare disorder duration-related specifiers include:
Acute: Nightmares occurring for one month or less
Subacute: Nightmares occurring for more than one but less than six months
Persistent: Nightmares occurring for six months or longer
Why do I have such horrible dreams of terror; is it insomnia?
There are many potential reasons why you might be having disturbing dreams. While insomnia can be a part of the reason, there may be others. Some common factors that can contribute to the occurrence of nightmares include:
Chronic stress: High levels of stress or anxiety can manifest in dreams and lead to nightmares. Traumatic events, significant life changes, ongoing stressors, or unresolved emotional issues can cause disturbing dreams
Trauma or PTSD: People who have experienced trauma or have PTSD might be more prone to nightmares related to their past traumatic experiences
Sleep disorders: Conditions like sleep apnea, restless legs syndrome, or insomnia can disrupt sleep patterns and increase the likelihood of nightmares
Medications: Certain medication side-effects include vivid or disturbing dreams
Substance use: Withdrawal from or chronic use of substances like alcohol or opiates can also cause nightmares
Eating certain foods before bed: Consuming heavy or spicy foods close to bedtime can trigger indigestion or heartburn, which might disrupt sleep and lead to nightmares
Sleep environment: Factors like noise, light, temperature, or an uncomfortable sleep environment can affect the quality of sleep, which might contribute to nightmares
Mental health conditions: Disorders like anxiety, depression, and some personality disorders sometimes feature nightmares as a symptom.
What are nightmares trying to tell you?
Dream interpretation isn't an exact science, and researchers are still learning about how and why humans dream the way they do. Nightmares can be unsettling, but it is commonly believed that they can carry critical psychological messages. While not everyone interprets nightmares the same way, there are some common themes and explanations:
Unresolved stress or anxiety: Nightmares can reflect unresolved stress, anxiety, or fears in waking life. They might arise from situations you're worried about, personal conflicts, or pressures you're facing.
Emotional processing: Your brain uses dreams, including nightmares, to process emotions. If you're having intense emotions like grief, anger, or trauma, nightmares can be a way for your mind to confront and process these feelings.
Repressed memories or trauma: Nightmares may sometimes surface as a result of past trauma or repressed memories. This can be a way for the subconscious mind to bring unresolved issues to the forefront.
Fear of the unknown or change: Changes in life, even positive ones, can cause stress. Nightmares might symbolize fears related to uncertainty or transitions, such as moving to a new place, starting a new job, or going through a relationship change.
Physical causes: Sometimes, nightmares can be caused by physical factors, such as illness, medications, or even sleeping in an uncomfortable position. In this case, they might not be directly related to emotional or psychological issues but can still reflect discomfort in some way.
Existential or philosophical concerns: Occasionally, nightmares are thought to tap into deeper, existential fears—such as the fear of death, the unknown, or loss of control. These can be harder to pinpoint but may reflect a search for meaning or a confrontation with life's bigger questions.
Metaphorical messages: Nightmares often use symbolism. For example, being chased might represent running away from a problem, or falling could symbolize a fear of failure. The specific content of your nightmares can offer clues to what your subconscious is trying to communicate.
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