Nightmares

Definition

A nightmare is a bad dream that brings out strong feelings of fear, terror, distress, or anxiety.

Alternative Names

Considerations

Common Causes

Nightmares usually begin before age 10 and are most often considered a normal part of childhood. They tend to be more common in girls than boys. Nightmares may be triggered by seemingly routine events, such as starting at a new school, taking a trip, or a mild illness in a parent.

Nightmares may continue into adulthood. They can be just one way our brain has of dealing with the stresses and fears of everyday life. One or more nightmares over a short period of time may be caused by:

• A major life event, such as the loss of a loved one or a traumatic event
• Increased stress at home or work

Nightmares may also be triggered by:

• A new drug prescribed by your health care provider
• Abrupt alcohol withdrawal
• Drinking too much alcohol
• Eating just before going to bed
• Illegal street drugs
• Illness with a fever
• Over-the-counter sleep aids and medicines
• Stopping certain drugs, such as sleeping pills or narcotic pain pills

Repeated nightmares may also be a sign of:

• Breathing disorder in sleep (sleep apnea)
• Post-traumatic stress disorder (PTSD), which can occur after you've seen or experienced a traumatic event that involved the threat of injury or death
• More severe anxiety disorders or depression
• Sleep disorder (for example, narcolepsy or sleep terror disorder)

Home Care

Stress is a normal part of life. In small amounts, stress is good. It can motivate you and help you get more done. But too much stress can be harmful.

If you are under stress, ask for support from friends and relatives. Talking about what is on your mind can help.

Other tips include:

• Follow a regular fitness routine, with aerobic exercise if possible. You will find that you will be able to fall asleep faster, sleep more deeply, and wake up feeling more refreshed.
• Limit caffeine and alcohol.
• Make more time for your personal interests and hobbies.

Try using relaxation techniques, such as guided imagery, listening to music, doing yoga, or meditating. With some practice, these techniques could help you reduce stress.

Listen to your body when it tells you to slow down or take a break.

Practice good sleep hygiene. Go to bed at the same time each night, and wake up at the same time each morning. Avoid long-term use of tranquilizers, as well as caffeine and other stimulants.

Call your health care provider if

If your nightmares started shortly after you began taking a new medication, contact your health care provider. He or she will let you know whether to stop taking that medication.

For nightmares caused by the effects of "street drugs" or regular alcohol use, ask for advice from your doctor on the safest and most effective way to quit.

Contact your health care provider if:

• You have nightmares more than once a week
• Nightmares stop you from getting a good night's rest, or from keeping up with your daily activities for a long period of time

What to expect at your health care provider's office

Your health care provider will examine you and ask you questions. Next steps may include:

• Certain tests
• Changes in your medicines
• New medicines to help with some of your symptoms
• Referral to a mental health provider

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References

Moore DP, Jefferson JW. Nightmare disorder. In: Moore DP, Jefferson JW, eds. Handbook of Medical Psychiatry. 2nd ed. Philadelphia, Pa: Mosby Elsevier; 2004:chap 123.

Moser SE, Bober JF. Behavioral problems in children and adolescents. In: Rakel RE, ed. Textbook of Family Medicine. 7th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 33.