What is nightmare disorder, Causes and Symptoms

Nightmare is any disturbing dream that causes negative feelings. Nightmares are very common in childhood and tend to become less frequent as the individual grows. When they occur sporadically, they are perfectly normal and do not indicate any type of problem.

In general, stress or anxiety situations during the day tend to increase the chance of you having nightmares at night. It is estimated that 30 to 50% of the pediatric population and up to 8% of the adult population have frequent disruptive dreams, sometimes even weekly.

What distinguishes episodes of occasional nightmares from so-called nightmare disorder is how much these distressing dreams negatively affect the patient’s quality of life.

In order for the diagnosis of nightmare disorder to be made, the patient must meet the 4 criteria described below:

A. Recurring, prolonged, very vivid and distressing nightmares that involve threats to survival, safety or physical integrity, and which the patient is able to remember in detail upon waking.

B. When the patient awakens from the nightmare, he quickly regains alertness and guidance (the patient does not become confused, disoriented or lethargic upon waking).

C. Recurrent nightmares cause significant stress, behavioral changes and negatively influence the personal, social and professional life of the patient.

D. To be a nightmare disorder, the condition cannot be the result of adverse drug effects or be directly triggered by other diseases.


Nightmares usually arise in REM sleep, which is when the brain activity is elevated, the body musculature is totally relaxed and the eyes make rapid involuntary movements.

An adult goes into REM sleep 4 to 5 times a night, with cycles lasting from 15 to 25 minutes, which corresponds to a total of about 90 to 120 minutes of REM sleep per sleeping night.

Children have more REM sleep time than adults, which is why nightmares are more common in this age group.

We do not know exactly why nightmares arise, but some triggering factors are well known, such as:

  • Stress.
  • Anxiety .
  • Traumas.
  • Post-traumatic stress disorder .
  • Acute stress disorder.
  • Sleep deprivation.
  • Insomnia .
  • Medicines*
  • Substance abuse, such as alcohol or drugs.
  • Abstinence from substances such as alcohol or drugs.
  • Depression.
  • Panic syndrome.
  • Neurological diseases.
  • Sleep apnea.
  • Restless legs syndrome.
  • Hypoglycemia .


Patients with nightmare disorder have very vivid and terrifying dreams very often and can remember with dream details. The nightmare is so real that the patient wakes up scared, all sweaty, breathless and heart racing. It is very common for the individual to be scared and have difficulty getting back to sleep.

In milder cases, these nightmares appear at most once a week; in moderate cases, they occur more than once a week; and in severe cases, the patient has nightmares every night.

Nightmare disorder can also be classified according to its duration:

  • Acute: when the duration is less than 1 month.
  • Subacute: when the frame lasts from 1 to 6 months.
  • Chronic: when the patient has recurring nightmares for more than 6 consecutive months.

Patients who have terrifying dreams with high frequency are prevented from having restorative sleeps and end up suffering negative impacts in their daily lives.

Some signs and symptoms of patients suffering from nightmare disorder are:

  • Mood changes.
  • Anxiety attacks.
  • Fear of sleeping.
  • Fear of the dark.
  • Memory or reasoning problems.
  • Drowsiness during the day.
  • Chronic fatigue.
  • Discouragement.
  • Lack of concentration.
  • Low academic or professional performance.
  • Low sociability.



Episodes of nightmares that do not negatively impact the lives of patients do not require specific treatment. Often, simple measures can be enough, such as suspending or exchanging suspect medications.

If nightmares are caused by other illnesses, such as sleep apnea or restless leg syndrome, treatment aimed at these problems is often enough. The same reasoning applies to other psychiatric disorders, such as depression, anxiety, and posttraumatic stress.

Some measures that aim to improve sleep hygiene also tend to be effective, for example:

  • Take a warm bath before bed.
  • Avoid full bladder sleep.
  • Exercise regularly during the day.
  • Avoid physical exertion at night.
  • Avoid large, greasy meals at night.
  • Do not eat right before bed.
  • Do not sleep while being fasted for a long time.
  • Avoid caffeine at night.
  • Avoid cigarettes and alcoholic beverages.
  • Always sleep at about the same time every day.
  • Avoid making the room too bright, noisy, cold or hot.
  • Have a comfortable bed.
  • Avoid television, cell phones or computer for at least 1 hour before bed.
  • Look for activities that help you relax, such as yoga or meditation.

If the measures cited above are not effective, the patient may receive treatment with psychotherapy. The so-called exposure therapy usually brings good results.


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