Nightmares: a dream occurring out of rapid eye movement (REM) sleep that elicits disturbing emotions both during the dream and upon awakening. Everyone has them once in awhile, from the young to the elderly. For some people, nightmares happen frequently.


     Nightmares are so common as to be considered a normal part of our dream experience--once in awhile. Nightmare Disorder develops when particularly disturbing nightmares become frequent. Even garden variety, normal nightmares can leave us feeling distraught. Dream sequences seem very real. They often involve some form of danger or oppression. The theme tends to repeat itself in subsequent nightmares. Some common scenarios include:

> being chased by a predator or demon
> the loss of a family member or loved one
> a disaster that destroys our property
> an intruder who breaks into our home
> being tortured by someone who once harmed us

      Nightmares leave us feeling overwhelmed with negative emotions such as anxiety, anger, sadness, embarassment, or grief. As vivid as nightmares can be, their content cannot cause us any physical harm. However, anxiety following a nightmare can deprive us of sleep, which may induce more nightmares. Most people can cleary recall the details of a nightmare, from the plot to the scenery.

Bad Dream vs. Nightmare. Both involve disturbing dreams, but a bad dream is less powerful than a nightmare. Nightmares awaken us from sleep. Bad dreams do not.
Nightmare vs. Night Terror. These are entirely different experiences. Nightmares are a form of dreaming, which arise during REM sleep. Night terrors, which arise out of NREM sleep, do not involve dreaming but a partial arousal from sleep. Parts of the brain that control emotion arise while the rest of the brain sleeps.


      An occasional nightmare poses no cause for concern, even if we lose a little sleep over it. A sleep evaluation may be of help if nightmares frequently disrupt sleep or cause great fear or stress about them. Keeping a sleep log will aid the diagnostic process. The log should reflect the freqency of nightmares, the time of night they occur, and a description of their content. Tests are not usually performed unless another sleep disorder is suspected. If necessary, a sleep study or overnight polysomnogram will record brainwaves, muscular activity and breathing during sleep.


  Good sleep habits minimize sleep deprivation, which can aggravate nightmares. Psychotherapy may be used to address the underlying conflicts that precipitate nightmares. This can be an extensive but important process, if nightmares are due to a severe life trauma or emotional disorder. A form of psychotherapy called systematic desensitization gradually addresses dream content related to particularly disturbing trauma. Additional therapies include: relaxation therapy, hypnosis, and stress management. Parents can take specific measures to respond to a child following a nightmare:

> Respond in a calm, reassuring manner to avoid frightening your child.
> Offer a stuffed animal or security blanket at night.
> Put a dim nightlight in your child's room.
> Reassure your child that nightmares are normal and will not harm them.

Nightmare Mechanics

     Like other parasomnias, nightmares involve unpleasant events during sleep. They are also specific to a certain portion or stage of sleep called REM sleep. REM sleep is when dreams occur. Dreaming happens during sleep but is connected to our waking lives. The brain contains files everything we do while we are awake. Some of those memories contribute to dreams. This is perfectly normal. If we have experienced a traumatic event, severe life stress, or an emotional illness, the kind of memories that contribute to dreaming may be very powerful. If the dream is powerful enough to awaken us, we have a nightmare. 

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