Sunday, November 23, 2014

Definition

A nightmare is a dream occurring during rapid eye movement (REM) sleep that arouses feelings of intense, inescapable fear, terror, distress, or extreme anxiety that usually awakens the sleeper.

Description

A nightmare is a vivid, frightening dream that usually results in the dreamer waking up with full or partial recall of the dream itself. A night terror is an episode of extreme fright during sleep without any recollection of a dream. Both nightmares and night terrors strike children much more often than adults.

Nightmares, unlike night terrors, can be recalled afterward and are accompanied by much less anxiety and movement. These frightening dream experiences, which tend to occur at times of insecurity, emotional turmoil, depression, or guilt, can occur in all age groups.

Nightmares occur exclusively during REM sleep. REM sleep phases grow longer in the latter part of the sleep cycle, and the majority of nightmares occur from the middle of the night onward.

Night terrors, by contrast, take place in non-REM (nondream) sleep. During night terrors people wake up sweating heavily, their hearts pounding, and screaming in fear. They are unaware of their surroundings and unresponsive to attempts to comfort them. They may not calm down for 10 or 15 minutes, although they return to sleep quickly once the episode ends. Generally they do not remember what scared them, but rarely a person will retain a vague image of something terrifying. A few children and adults who experience night terrors will sleepwalk during the episode.

Causes

Particularly among adults, prescription drugs such as levedopa, reserpine, beta blockers, and antidepressants, as well as withdrawal from addictive drugs, all can provoke nightmares. Heavy drinking also is strongly associated with nightmares.

Other drugs suspected of causing nightmares include heart drugs, antibiotics such as ciprofloxacin, antihistamines, appetite suppressers such as fenfluramine, antidepressants, Parkinson's drugs such as levodopa, and ulcer drugs (cimetidine). However, many drugs cannot be stopped abruptly without side effects, so it is necessary to consult your physician before altering the use of medications.

In both adults and children, nightmares and night terrors can be caused by unresolved psychological conflicts or traumatic events. They are a frequent feature of post-traumatic stress disorder. Emotional traumas that disturb the sleep of children can be overlooked easily by adults - such as the loss of a favorite toy or overhearing a loud argument between parents.

Although nightmares and night terrors are considered normal developmental events in children, disappearing by adolescence, frequent episodes at any age warrant professional evaluation. Crisis intervention techniques can be very effective in dealing with the trauma.

Diagnosis

Diagnosis will be based upon history and the absence of any underlying organic problems.

Treatment

Some people have significant psychological problems that are causing bad dreams. It is important to consider psychotherapy to pinpoint major life stressors, past traumatic events and depression that might be causing bad dreams.

If one is taking medications, it is advisable to ask the prescribing physician if the pills might be the culprit.

Chronic nightmares have also been treated by a desensitization method that uses instruction about rehearsal of the nightmare and the imagining of a different ending.

In one study, patients were instructed to select a recent nightmare and write it down, change the nightmare in any way they wished, write down the changed version and rehearse the changed nightmare in an imagery relaxed state. Patients were instructed to rehearse the changed version once a day for three consecutive days after each nightmare or until the nightmare went away.

It was concluded that the use of desensitization or rehearsal techniques can reduce the frequency of nightmares and decrease distress.

Questions

Are these nightmares or night terror?

Is there a psychological cause such as depression, emotional trauma, or stress?

Is it related to any medications that are currently being taken?

Should any changes be made in the medications currently being taken?

Would psychotherapy help?

What can be expected from psychotherapy?