Nightmares are scary by nature, even when you only get them a few times a week, month, or year, but what happens when you have nightmares every night? This worrying disorder affects around 4% of Americans and can have far-reaching effects on one’s health.
What Is Nightmare Disorder?
This worrying disorder is defined in the Diagnostic and Statistical Manual (DSM-5) as “repeated awakenings with recollection of terrifying dreams, usually involving threats to survival, safety, or physical integrity.” These nightmares are vivid, well-remembered disturbances that are regular, lasting for anywhere from a month (acute) to 6 months or more (persistent).
People with this disorder often experience distress or difficulty returning to sleep after nightmares. This is a problem with far-reaching effects on everyday functioning. Tasks that used to be easy get harder and harder as you become more sleep deprived, concentration goes out the window, and tiredness can affect relationships.
Luckily, there are plenty of professionals like counselors with a Masters in Counseling online who understand the effects of a nightmare disorder and can help you to treat and manage symptoms to improve sleep and overall well-being.
Sleep and Dreams
The DSM-5 mentions that nightmares usually occur in the second half of a major sleep cycle, a time when we are more likely to be in Rapid Eye Movement or REM sleep. Most of us have about 4 to 6 REM cycles each night, lasting anywhere from 10 minutes to over an hour, but getting progressively longer throughout the night. During the REM part of sleep, the body moves a lot less than in other sleep stages, and brain activity spikes, looking similar to wakeful brain activity on a scan.
At the time of writing, there is no machine that can see what you are thinking and seeing during REM sleep. However, research has shown that much of the body operates in a similar way to when you are awake. Except, of course, that your eyes are closed and your body isn’t moving – likely a mechanism to protect you from acting out dreams (which doesn’t always work, in the case of sleepwalking). Your mind is also processing emotions, consolidating memories, developing (especially during infancy), and preparing for the next wakefulness stage.
It’s important to note that nightmares are different from night terrors, the latter referring to agitation, screaming, or sleepwalking that usually happens during non-REM stages of sleep.
Nightmares and What Causes Them
As you can imagine, nightmares are not always conducive to all of these aims; waking up in cold sweats from vividly disturbing dreams does not seem like ideal wakefulness preparation or emotional processing.
Stress, anxiety, irregular sleep, a whole host of medications, and many other causes have been linked to nightmares. However, there is one very well-researched cause: Post Traumatic Stress Disorder or PTSD. These nightmares are often connected to the original trauma, replaying distressing scenes or emotions. Research suggests that between 70–90% of people with PTSD report frequent nightmares, making them one of the disorder’s hallmark symptoms.
Risk Factors and Symptoms
For people whose nightmares are not driven by trauma, simple things like eating a late-night snack can increase brain activity during sleep and lead to unsettling dreams. Certain medications, especially those that affect brain chemicals like antidepressants and narcotics, are known to trigger nightmares. Even some blood pressure medications can have similar effects as well as withdrawal from alcohol, sedatives, or other substances.
Psychological factors like anxiety and depression are also common causes. Sleep disorders such as sleep apnea and restless legs syndrome can disrupt sleep and increase the chance of nightmares. In some cases, if no clear cause is found, frequent nightmares might be considered a sleep disorder on their own. There’s also evidence that family history plays a part, as people with relatives who experience nightmare disorder may be more likely to have it themselves.
Treating Nightmares
There are good treatments out there, like Cognitive Behavioral Therapy for nightmares (CBT-N), a technique that uses tools like exposure therapy, where individuals gradually confront distressing dream content, and systematic desensitisation, which pairs exposure to nightmare-related imagery with relaxation techniques to reduce fear responses.
Cognitive restructuring is another valuable tool, helping people identify, challenge, and reframe the distressing thoughts and interpretations linked to their nightmares, addressing the underlying problem.
Not a fan of talk therapy? No problem. Eye Movement Desensitization and Reprocessing, or EMDR, is a type of therapy that uses lights to move the eyes. EMDR is often used for people with trauma and can effectively help you overcome nightmares by changing how the brain stores and processes traumatic memories.
Living with Nightmares
Nightmares can have a serious impact on our lives. If you struggle with them frequently, consider seeking help from a psychologist, sleep specialist, or doctor. These professionals can help you find the cause, whether it’s medications, sleep patterns, substances, or trauma.
At the end of the day, it takes awareness of what causes nightmares and a desire to overcome this serious disorder, and a willingness to engage in consistent, evidence-based strategies to truly improve sleep and well-being.
The New Jersey Digest is a new jersey magazine that has chronicled daily life in the Garden State for over 10 years.