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Nightmares (cont.)

IN THIS ARTICLE

When do nightmares occur?

Dreams and nightmares occur during REM (rapid eye movement) sleep. Sleep is categorized into REM and non-REM stages, with most people experiencing four to five sleep cycles each night. Each cycle lasts for 90 to 100 minutes. REM sleep occurs more frequently during the second half of the night. Nightmares occur most commonly at this time.

What is the treatment for nightmares?

Research suggests that dreams can be impacted by conscious thought before bed. Remembering fun events or funny stories can sometimes help derail a nightmare before it begins.

  • No specific medical treatment is indicated for nightmares.
  • If a nightmare occurs, reassurance and comfort are appropriate.
  • If nightmares occur frequently, an evaluation of daytime routines is needed. This includes assessing exposure to daytime stressors, television, or video games and bedtime practices.
  • Lucid dreaming, or being aware during a dream, can help redirect a nightmare into a pleasant dream.

Nightmare prevention

Practicing good sleep hygiene is important for everyone who has experienced nightmares. This includes:

  • establishing a bedtime routine that starts at the same time every evening and
  • making bedtime a safe and comfortable time.

For children:

  • using a nightlight can decrease fear or anxiety;
  • discussing “monsters” -- either under the bed or in the closet -- and showing the child that nothing harmful is present can be reassuring; and
  • imagining alternate endings to nightmares can provide a child with a sense of empowerment prior to going to sleep.

For adults, improvement in sleep/wake cycles can be seen with:

  • eliminating television or computer exposure an hour or more before bedtime;
  • maintaining consistent sleep and wake times;
  • eliminating working in bed;
  • cutting back on caffeine after 1PM (for those who work daytime hours); and
  • practicing lucid dreaming.

If nightmares occur frequently (more than two nights per week over many months), then psychological evaluation is suggested. Different types of psychotherapy, including cognitive-behavioral therapy and hypnosis, can be of benefit in decreasing the frequency of nightmares.

What is the prognosis for nightmares?

Most people who have experienced a nightmare find that this is an isolated event. The long-term outcome is generally good. If nightmares occur frequently over several months or follow a traumatic event, evaluation by a psychologist or psychotherapist is indicated.

Nightmares are not associated with sleepwalking or other parasomnias (disruptive sleep disorders).

Medically reviewed by Jon Glass, MD; American Board of Psychiatry and Neurology

REFERENCES:

Stores, G. "Aspects of parasomnias in childhood and adolescence." Archives of Disease in Childhood 94.1 (2009): 63-69.

Thompson, D. F. and D. R. Pierce. "Drug-induced nightmares." The Annals of Pharmacotherapy 33.1 (1999): 93-98.

Previous contributing author and editors: Author: Kevin P. Connelly, DO. Editors: Anthony M Murro, MD, Laboratory Director, Professor, Department of Neurology, Medical College of Georgia; Mary L Windle, Pharm D, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Pharmacy Editor, eMedicine.com, Inc; Carmel Armon, MD, MHS, MSc, Professor of Neurology, Tufts University School of Medicine, Chief, Division of Neurology, Baystate Medical Center, Springfield, Massachusetts.


Medically Reviewed by a Doctor on 6/27/2016
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