Among these sleep disorders, insomnia and nightmares are very common in clinical practice associated with psychiatric disorders [1]. Nightmares are associated with increased psychological distress [1], worse physical health outcomes [2], and increased risk of self-harm and suicide [3,4].
An estimated 2% to 8% of adults can't get rest because terrifying dreams wreak havoc on their sleeping patterns. In particular, nightmares can be an indicator of mental health problems, such as anxiety, post-traumatic stress disorder and depression.
Causes – In adults, the most common conditions associated with recurrent nightmares are acute stress disorder, posttraumatic stress disorder (PTSD), depression, and anxiety. Certain medications and substances can induce or exacerbate nightmares, during either treatment or withdrawal (table 1).
Although some continue to believe nightmares reduce psychological tensions by letting the brain act out its fears, recent research suggests that nocturnal torments are more likely to increase anxiety in waking life.
Indeed, studies suggest that nightmares are often linked to unmet psychological needs and/or frustration with life experiences. Yet those links aren't always easy to make—except in cases of trauma (discussed below), our nightmares tend to reflect our troubles through metaphor rather than literal representation.
There can be a number of psychological triggers that cause nightmares in adults. For example, anxiety and depression can cause adult nightmares. Post-traumatic stress disorder (PTSD) also commonly causes people to experience chronic, recurrent nightmares. Nightmares in adults can be caused by certain sleep disorders.
1. Being chased. Being chased is one of the most common nightmares. If you dream that you're being chased by something, whether it's an 8-foot-tall rabbit or a shrouded figure, then it's an indicator that you're running away from something or someone in real life.
Impact of nightmares
Trauma-related nightmares generally occur during REM sleep, which is when we tend to have vivid dreams. When you wake up from these nightmares, you may experience fear, anxiety, panic, distress, frustration, or sadness. You can also wake up soaked in sweat and with your heart pounding.
Can Nightmares Cause Trauma? Vivid dreams or waking up with clear memories of nightmares can be an unsettling experience. While the hypothesis that nightmares can cause trauma may not be the subject of a significant amount of research, the answer to this question may depend on the way trauma is defined.
"If you wake from a nightmare and have difficulty falling back asleep, get out of bed, do something soothing like a few yoga poses or find a place to sit, close your eyes, and try a breathing technique or relaxation exercise."
Nightmares in particular have been associated with psychotic decompensation. Among the parasomnias, it is the frequency of nightmares in childhood that best predict psychosis in adolescence [46]. Nightmares have also been reported to predict schizophrenia relapse.
Nightmares occur more frequently in patients with schizophrenia than they do in the general population. Nightmares are profoundly distressing and may exacerbate daytime psychotic symptoms and undermine day-to-day function.
It's true. Nightmares occur frequently in people with Bipolar Disorder. In The Reinterpretation of Dreams, the authors write: Bipolar patients report bizarre dreams with death and injury themes before their shift to mania (Beauchemin and Hays, 1995).
Depression & Nightmares
One study found that 28.4% of participants with severe depression reported frequent nightmares and that depression was one of the strongest indicators of frequent nightmares.
Behavioral intervention with imagery-rehearsal therapy is currently the only treatment strategy recommended for all patients with recurrent nightmares. Prazosin may be used to treat both PTSD-associated and idiopathic nightmare disorder.
Sleep terrors differ from nightmares. The dreamer of a nightmare wakes up from the dream and may remember details, but a person who has a sleep terror episode remains asleep. Children usually don't remember anything about their sleep terrors in the morning.
However, the presence of nightmares not only influences the development of PTSD but also accelerates the progression of PTSD following trauma exposure. 9,10 Subjects who reported nightmares prior to trauma exhibited more severe PTSD symptoms after being exposed to a traumatic event than those who did not.
Impact on PTSD
Nightmares are a feature of PTSD. Even general nightmares can feel life-threatening, but with PTSD, they are actually tied to an existing trauma that happened in the near or far past. Replaying traumatic events over and over can cause a struggle for someone to cope.
Some experts believe nightmares in PTSD are the sleeping version of “re-experiencing,” or reliving a traumatic event. When you're awake, reexperiencing may occur in the form of a flashback. These intrusive symptoms have to do with how PTSD changes brain regions involved in fear response and memory recall.
Nightmare disorder, also known as dream anxiety disorder, is a sleep disorder characterized by frequent nightmares. The nightmares, which often portray the individual in a situation that jeopardizes their life or personal safety, usually occur during the REM stages of sleep.
Intrusive memories
Recurrent, unwanted distressing memories of the traumatic event. Reliving the traumatic event as if it were happening again (flashbacks) Upsetting dreams or nightmares about the traumatic event. Severe emotional distress or physical reactions to something that reminds you of the traumatic event.
It's common for people experiencing nightmares to show bodily symptoms of panic, including higher perspiration and a racing heart. The area of the brain responsible for these symptoms is the amygdala, the brain's "fear center," which shows a lot of activity during nightmares.
In a way, chronic nightmares can be a warning about your physical or mental health. If chronic nightmares are disturbing your sleep, it's worth bringing it up to a doctor or therapist. They'll be able to help you create a plan for more peaceful sleep.
Nightmares about falling were followed closely by dreams about being chased (more than 63 percent). Other distressing nightmares included death (roughly 55 percent), feeling lost (almost 54 percent), feeling trapped (52 percent), and being attacked (nearly 50 percent).