Lately, I have been talking a lot about difficulty sleeping, particularly insomnia. We have covered that topic fairly exhaustively, so I wanted to deal with a common occurrence, which when its chronic is considered a sleep disorder. It is something that we have all had at some time or another - nightmares.
"Because I said to myself that my bed would comfort me, my couch would carry me in suffering. You have terrified me with dreams, and you make me tremble with nightmares." (Job 7:13-14).
The word nightmare is derived from the old English expression, niht (night) and mare (demon). This referred to a demon that was believed to sit on the chest of the sufferer making it difficult for them to breathe and move when they awoke from a frightening dream. (This may also have had to do with the fact that most dreams occur during REM sleep, during which our body is essentially paralyzed. REM sleep is nature's way of ensuring our dreams are not acted out- see my blog on Sleep Paralysis).
Nightmares are alarming episodes that cause us to wake up abruptly from REM sleep. The dreamer is alert almost immediately and can describe a detailed, often fantastic dream plot. It is unusual for the dreamer to thrash about or perform other activities during the dream. The lack of activity during the dream actually supports the diagnosis of nightmares, as opposed to other sleep disorders, such as sleep terrors, REM behavior disorder, or sleep walking, where moving about is common. Upon awakening the sufferer may have difficulty falling asleep again.
Nightmares occur commonly, particularly in children (20-30%, decreasing with age). It also occurs in adults (about 5-8% report problems with nightmares), more commonly in women. Nightmare sufferers complain of an increased number of nighttime awakenings, difficulty falling asleep, and problems with daytime memory and anxiety following a poor night's sleep.
Nightmares are associated with medications used to treat both medical and psychiatric illnesses. Some of the more common types of medicines that cause nightmares are antidepressants, pain killers, sleep aids, blood pressure pills, and drugs to help smokers quit tobacco use.
Nightmares are frequently experienced in those with psychiatric disorders. They are actually a defining part of the illness in those with post-traumatic stress disorder (more about this later), but occur in those with both depression and schizophrenia. In patients with depression, nightmares have themes reflecting their poor self-image. In schizophrenia, intense dreams can occur during relapses. Panic attacks also may occur during sleep in patients with panic disorder, anxiety, or depression and are experienced as nightmares.
In my next post, I will finish up the discussion on nightmares, and I'll touch on a novel therapy called imagery rehearsal. Imagery rehearsal has been used successfully for the treatment of chronic nightmares and more recently for sleep issues such as insomnia, acute nightmares, and post-traumatic stress disorder.
Published On: September 06, 2007