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You wake up with your heart pounding, and maybe even with a shout. Isolated nightmares are normal, but when dreams resulting in extreme terror or anxiety recur often they can become a debilitating sleep disorder.

Sleep disorders, or parasomnias, occur in 35-45% of children aged 2-18 years. Common sleep disorders in children include sleepwalking, sleep talking, night terrors, and nightmares.
Childhood parasomnias are believed to be a benign disorder caused by immaturity of neural circuits, and most resolve during adolescence.
Nightmares are defined as “recurrent episodes of awakening from sleep with recall of intensely disturbing dream mentation, usually involving fear or anxiety, but also anger, sadness, disgust, and other dysphoric emotions.”

Nightmare disorder is defined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) as repeated awakenings with recollection of terrifying dreams, usually involving threats to survival, safety or physical integrity

Most nightmares may be a normal reaction to stress, and some clinicians believe they aid people in working through traumatic events. Frequent occurrence of nightmares becomes a disorder when it impairs social, occupational and other important areas of functioning. At this point, it may be referred to as Nightmare Disorder (formerly Dream Anxiety Disorder) or “repeated nightmares.”

Causes

  • Anxiety or stress is the most common: In 60 percent of cases, a major life event precedes the onset of nightmares
  • Illness with a fever
  • Death of a loved one (bereavement)
  • Adverse reaction to or side effect of a drug
  • Recent withdrawal from a drug such as sleeping pills
  • Excessive alcohol consumption
  • Abrupt alcohol withdrawal
  • Breathing disorder in sleep (sleep apnea)
  • Sleep disorders (narcolepsy, sleep terror disorder)
  • Eating just before going to bed, which raises the body’s metabolism and brain activity, may cause nightmares to occur more often.

Nightmares Treatment
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.