Nightmare Disorder: Symptoms, Causes, and Treatment

What Is Nightmare Disorder?

Nightmare disorder is a sleep disorder characterized by long, extremely upsetting, and vivid dreams that cause significant distress or disrupt a person's life.

Nightmare disorder often co-occurs with a diagnosis of post-traumatic stress disorder (PTSD) in adults. For this reason, combat veterans, survivors of abuse, and those who have experienced other forms of trauma are at high risk for developing nightmare disorder.

Other common co-occurring diagnoses are substance use disorders, schizophrenia, schizoaffective, and borderline personality disorders. Nightmare disorder can be extremely unsettling, but it is treatable. The first step to recovery is learning the symptoms.

Symptoms of Nightmare Disorder

Maybe you’ve had a nightmare or two in the past but are beginning to experience them more regularly. At this point, you might be wondering what the difference between a bad dream and a diagnosis of nightmare disorder is. Here's what you should know.

First, let's explore what a nightmare is. It isn’t necessarily a stressful or creepy dream. It is incredibly vivid and disturbing, often involving threats to survival or a lack of safety. Upon waking up, you may experience the following symptoms:

•Trouble falling back asleep

•Waking up with unsettling emotions regarding the dream

•Physical discomfort, including sweating or a racing heartbeat

•The ability to recall vivid images from the dream for days to come

Diagnosis of Nightmare Disorder

Now that you’re aware of what constitutes a nightmare let’s look at the difference between a bad dream and a diagnosis of nightmare disorder. According to the DSM-5, the current diagnostic criteria for nightmare disorder include the previously mentioned indicators of a nightmare.

In addition, to constitute a diagnosis of nightmare disorder, one must also experience a significant impact on their ability to function at work, in social settings, or their daily life due to the distress of the nightmares.

It is important to note that the nightmares cannot be attributed to the physiological effects of a substance (such as drugs, alcohol, or certain prescription medications) or the result of another diagnosed mental health disorder.

The last note regarding the nightmares not being attributed to another mental health disorder can be tricky because nightmare disorder is often co-occurring with post-traumatic stress disorder. This means that your medical provider will need to rule out any other diagnoses and assess any co-occurring conditions.

To receive the most accurate diagnosis and most effective treatment possible, track your daily symptoms for a few weeks and review them with your medical provider.

According to the DSM-5, a nightmare disorder can be further specified depending on the duration and severity of nightmares.

•An acute specifier means the nightmares have been occurring for less than one month.

•Subacute means the nightmares have been occurring anywhere between one to six months.

•A persistent specifier means the nightmares and subsequent distress has been present for over six months.

Severity can be mild, moderate, and severe:

•Mild means the nightmares occur less than once a week

•Moderate means you’re experiencing the nightmares one or more times a week, but not nightly

•Severe means the nightmares are a nightly occurrence

It is crucial to receive a proper diagnosis, as that opens up the possibilities for treatment and relief.

Causes of Nightmare Disorder

First, let’s explore what can trigger nightmares in the first place. Stressors like untreated trauma and upsetting life circumstances can lead to nightmares.

It is worth noting that even medications, like some antidepressants, can increase nightmares. Severity and duration may be dependent upon the initial trigger of the nightmare and the presence of positive resources like social support, mental health treatment, and regulated sleep patterns.

Treatment for Nightmare Disorder

Image rehearsal therapy (IRT) is one of the top treatments for nightmare disorder. It is a type of cognitive-behavioral therapy (CBT) that guides individuals in recalling the nightmare, writing it down, and changing the story—removing upsetting aspects of the nightmare.

A person then rehearses and practices the new version of the story to displace the unwanted dream content. This approach aims at re-scripting the nightmare to lessen the painful emotional content of the dream.

Independently or in conjunction with IRT, a doctor may prescribe psychiatric medications. Some of the most common medications include prazosin and gabapentin, particularly for PTSD-related nightmares.

Coping With Nightmare Disorder

Coping with nightmare disorder can be exhausting, frustrating, and unsettling. Aside from seeking support from a medical professional, it is essential to set up resources in your daily life to help you cope.

•First, establish a healthy sleep routine incorporating meditation, taking a bath, or sipping your favorite non-caffeinated herbal tea before bed.

•Second, find sources of comfort you can turn towards when you wake up in the middle of the night. Maybe it is keeping a hallway light on if darkness scares you, or perhaps it is a weighted blanket to snuggle up under.

•Finally, reach out to your support system by identifying a trusted individual available to chat on days when you’re feeling challenged by this disorder.

Also, finding a therapist who can help you address any underlying trauma or other psychopathology that might be contributing to your nightmares can be especially helpful. Most of all, remember that this disorder is treatable, and by educating yourself on it today, you’re one step closer to feeling better.

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