Home HealthTopics Health Centers Reference Library Research
Join us on Facebook Join us on Facebook Share on Facebook

Sleep Disorders

Bad Nightmares

12/10/2008

Question:

I have been having really bad nightmares since i was about 12 (I am now 26). They don`t happen every night, and they can be quite random when they happen. I`m tired a lot and find it very hard to sleep at night. 90% of the time, when I have nightmares I will wake up and the dream is still happing. Many times I`ve turned my light on to see something `under my covers`. Only minutes later I do realise its nothing and it was nothing. Often my girlfriend wakes me, and only last week we had an argument "minutes after waking me" that there really WAS something in the bed. I`ve also woken up to screaming my lungs out hard enough so the people next door could hear.

Its really becoming a problem....

Answer:

Thank you for using NetWellness. It seems that you have a very distressing problem. Occasional nightmares are normal in an adult and 10-15% of children report recurrent nightmares. The age of onset is usually 3-6 years of age, and the peak prevalence is at 6-10 years of age. Both sexes are affected equally in children. Nightmares are less common in adulthood, and occur more frequently in women. Recurrent nightmares can give rise to insomnia, sleep avoidance related to a fear of falling asleep, and excessive daytime sleepiness related to sleep disruption.

There are known sleep disorders that are associated with severe and recurrent nightmares, primarily REM (rapid eye movement) behavior disorder and nightmare disorder. Both of these disorders occur during REM sleep (also known as dream sleep) and are typically seen in the 2nd half of the night. While both of these conditions are associated with nightmares, they are different in that patients with REM behavior disorder will tend to “act out” their dreams, often in a violent manner, while those with nightmare disorder do not.

There can be other causes of nightmares that also need to be considered, including other sleep disorders (such as obstructive sleep apnea), psychiatric problems, stress and side effects from medications or illicit substances.

A comprehensive history and physical examination is required in order to provide you with a correct diagnosis. You should start by seeing your primary care physician who can provide you with a referral to a Sleep Specialist. It’s possible you may require at least one polysomnogram (sleep study) to investigate whether or not you have a sleep disorder. Sometimes, one night of study may not be enough to capture an "event" and thus additional nights of testing are needed.

The specific treatment for nightmares often depends on the underlying cause or diagnosis as to why you are having these. However, in general terms, there are a number of things that can be done to help. First, one should adopt good sleep hygiene. By this I mean avoiding sleep deprivation, having a regular bed time and avoiding possible precipitators of the nightmares, such as alcohol and illicit drugs. Secondly, there is psycho-behavioral therapy which can be very beneficial for some individuals. And lastly, there are a number of pharmacologic therapies that are available for sleep related disorders.

Once again, thank you for visiting NetWellness. I hope this answers some of your questions and provides you with guidance so you can address your problem.

For more information:

Go to the Sleep Disorders health topic, where you can:

Response by:

Steven  Kadiev, MBBCh Steven Kadiev, MBBCh
Formerly:
Assistant Professor
College of Medicine
The Ohio State University