Charlotte is ten years old and has recently started experiencing frequent, distressing nightmares. At first it only happened once in a while, but over the last two months, Charlotte has experienced nightmares several times per week. When she awakens from them, she runs to her parents’ bedroom, breathing heavily and crying, insisting on sleeping with them. The nightmares are typically similar, involving a large, frightening man trying to break into the house and hurt Charlotte and her parents. In the nightmares, Charlotte tries to run away from the man, but she can’t move and can’t warn her parents about him. Just as he gets to her, she awakens.

Charlotte’s mother, Janice, is at a loss as to what is causing the problem. Charlotte isn’t a particularly anxious child in general and, as far as Janice knows, she hadn’t experienced any type of trauma.

Three months earlier, Charlotte’s family moved from Michigan to Florida. Charlotte seemed to adjust well, having to switch schools and find new friends. But of course such an experience would be stressful for any child. Perhaps, her mother thinks, it’s the anxiety surrounding all of these changes that’s causing the nightmares. Her mother also notices that Charlotte has been paying more attention to the news, tuning in whenever there is a story about violent crime. Janice remembers discussing her concerns about the new town where the family was moving to her friends, as the crime rate is significantly higher here than it was in Michigan. She wonders if Charlotte overheard her talking about this and took it to heart. Janice notices that when Charlotte’s father is out of town on business trips, leaving Charlotte and Janice alone, Charlotte becomes far more irritable, teary, and anxious. During these periods, she is almost guaranteed to wake up at least three times per week with a nightmare.

While this problem isn’t causing extreme distress at this point, Charlotte’s overall sleep quality is deteriorating. This, in turn, has made her more sleepy and irritable when she is awake and is affecting her friendships and school performance. Janice has decided to bring Charlotte to counseling, to see what can be done to help her daughter sleep more peacefully.

Facts about Nightmares

So what causes our unconscious brains to drag us away from the glowing, peaceful pathways of dreamland towards down the dark, thorny caverns of nightmares?

Often, when we’re experiencing stress or anxiety and are not keeping healthy sleep habits, we are at higher risk of experiencing sleep problems, including nightmares (“Nightmare disorder: Symptoms & causes,” n.d.). Some who have suffered from trauma experience nightmares related to the frightening memory of what happened to them. Other common causes of nightmares include substance use and adjusting to medications, such as antianxiety medication (ironic, I know). In some cases, other psychiatric problems, such as Major Depressive Disorder, Panic Disorder, Generalized Anxiety Disorder, and Schizophrenia, increase the person’s likelihood of experiencing nightmares (“Nightmare disorder: Symptoms & causes,” n.d.). To clarify, people with mental health disorders may be at heightened risk of experiencing nightmares, but not every person who has nightmares suffers from these disorders.

Nightmare Disorder is listed in the DMS-V under Sleep-Wake Disorders, under the subcategory of Parasomnias. To receive a diagnosis of Nightmare Disorder, the individual must repeatedly experience sleep disturbances commonly known as nightmares, which the DSM defines as “occurrences of extended, extremely dysphoric [unpleasant], and well-remembered dreams that usually involve efforts to avoid threats to survival, security, or physical integrity and that generally occur during the second half of the major sleep episode” (American Psychiatric Association, 2013). These sleep disturbances cause the person significant distress or problems in life (American Psychiatric Association, 2013). The symptoms of the disorder are not the result of other medical conditions or of substance use (American Psychiatric Association, 2013).

In diagnosing a client with Nightmare Disorder, the mental health professional must determine that the nightmare problem does not directly result from a different diagnosis (American Psychiatric Association, 2013). For example, if a client with PTSD experiences nightmares, the nightmares may be a symptom of the trauma diagnosis. However, if the individual experienced nightmares before the traumatic event took place, or if the nightmares sometimes have no relation to the traumatic event, a separate diagnosis of Nightmare Disorder would be appropriate.

Additionally, mental health professionals must determine at what point the nightmares take place during the sleep cycle, as well as the frequency and severity of nightmares. They must specify whether the problem is acute (the period of nightmares occurring over the course of one month or less), subacute (between one month and six months), or persistent (six months or greater) (American Psychiatric Association, 2013). Clinicians also must determine how often nightmares occur during these periods of nightmares, noting whether the severity is mild (less than one nightmare per week during the period), moderate (one or more nightmares per week, but less than nightly), or severe (nightmares happening nightly during the period) (American Psychiatric Association, 2013).

Children With Nightmares

Nightmares often begin in childhood between the ages of 3 and 6 years, peaking around age 10 (“Nightmare disorder: Symptoms & causes,” n.d.). According to the APA (2013), between 1.3% and 3.9% of parents report that their preschool children have nightmares “often” or “always”. The prevalence increases between ages 10 to 13 for both genders. At this point, males tend to have fewer nightmares, whereas females tend to have increased episodes throughout their 20s (American Psychiatric Association, 2013). After this period, nightmare episodes steadily decrease for both genders. Approximately 6% of adults report experiencing nightmares on a monthly basis, while 1-2% report frequent nightmares (American Psychiatric Association, 2013).

Some use the terms “nightmares” and “sleep terrors” interchangeably, but they are actually different problems. One difference has to do with the experiences themselves. Nightmares produce a vivid, story-like quality that many can recall in detail upon awakening(American Psychiatric Association, 2013). Sleep terrors, in contrast, produce either no dream recall or involve images with no story-like quality to them (American Psychiatric Association, 2013). Another difference is the person’s degree of orientation upon awakening. When one awakens from a nightmare, he rapidly becomes alert and aware of where he is, understanding that the negative experience was just a dream (American Psychiatric Association, 2013). In contrast, people experiencing sleep terrors often only partially awaken and are highly aroused and disoriented during these episodes. Signs of arousal include dilated pupils (mydriasis), rapid heart rate (tachycardia), rapid breathing, and sweating (American Psychiatric Association, 2013). Sleep terrors often begin with a panicky scream, the person disorientated and inconsolable, unresponsive to attempts to comfort him (American Psychiatric Association, 2013). The next day, many no not remember the sleep terror episode at all. Another difference between nightmares and sleep terrors is the period of time when the episodes usually take place. Nightmares usually happen late in the night, during REM sleep, while sleep terrors usually happen during the first third of the night during stage 3 or 4 NREM sleep (American Psychiatric Association, 2013).

Natural Remedies to Help Nightmares and Bad Dreams

Now that we understand what nightmares are, how might we reduce their occurrences? There are many ways to prevent nightmares and improve one’s overall sleep quality. (For a more detailed look at developing good sleep habits, check out this article about sleep and mental health.)

How to Help a Child With Nightmares and Bad Dreams

As the statistics show, many who suffer from nightmares are children. If you are a parent trying to find out how to help a child with bad dreams, keep in mind how important it is to offer calm, patient reassurance to the child (“Nightmare disorder: Diagnosis & treatment,” n.d.). When your child has a nightmare, respond quickly and soothingly, making him feel safe as he awakens. This act of comforting may go far in preventing future nightmares. It is also important to talk to the child about the dream, letting him describe it in detail (“Nightmare disorder: Diagnosis & treatment,” n.d.). While it is crucial to acknowledge and validate the negative emotions surrounding the dream, be sure to remind him that nightmares are not real and cannot cause him harm (“Nightmare disorder: Diagnosis & treatment,” n.d.).

Parents might also encourage creative activities to help the child better interpret the nightmare. For example, try having the child draw a picture of the nightmare, to “talk” to the characters in the dream, or to write about it in a journal (“Nightmare disorder: Diagnosis & treatment,” n.d.). Encourage your child to rewrite the ending of the nightmare in a way that makes the child feel safe and vindicated. In the illustration of Charlotte, her mother might have Charlotte describe a good ending to the story. For example, in Charlotte’s recurring dream, maybe right as the man enters the house, the police arrive and arrest the man. Or maybe Charlotte’s father sneaks up behind the man and knocks him out, tying him up until help arrives. Getting to visualize a situation in which the child feels safe and protected can help the child to overcome the fear that the nightmare inspires, thus reducing the likelihood of the same dream reoccurring.

Lastly, try to help your child with nightmares find sources of comfort that make him feel safe as he prepares for sleep, such as having him sleep with a favorite toy or blanket (“Nightmare disorder: Diagnosis & treatment,” n.d.). He might also benefit from sleeping with a nightlight. Keep both your child’s door and yours open, to show your child that you are accessible, no matter what bad dream comes along. Instilling a feeling of safety before sleep may be all that is needed to lessen the occurrence of nightmares (“Nightmare disorder: Diagnosis & treatment,” n.d.).

Help for Nightmares: Stress Management

For both children and adults suffering from nightmares, stress management is key. Try mindfulness exercises to shut down racing thoughts and unmanageable anxiety contributing to poor sleep. Engage in frequent stress-releasing activities, such as yoga and deep-breathing (“Nightmare disorder: Diagnosis & treatment,” n.d.). Lastly, invest in good sleep hygiene habits, such as turning off all electronics thirty minutes before sleep, performing relaxation exercises before bedtime, keeping the bedroom at a comfortable temperature, and going to bed/awakening at about the same time each day (including weekends). Investing in your sleep health will make sleep a more pleasurable, beneficial experience. The healthier your sleep habits, the less likely it is that you will experience nightmares.

In Conclusion …

There is nothing inherently wrong or pathological about experiencing occasional nightmares. In fact, most (if not all) humans will experience them, regardless of whether they suffer from mental illnesses or are experiencing high anxiety levels. Like any other dreams, nightmares represent our brains processing thoughts and emotions while we sleep. The occurrence of nightmares doesn’t reach the level of a disorder unless it causes the person significant distress. This, in turn, may lead to fatigue, difficulty concentrating, depression, and irritability, all of which can create long-term psychiatric difficulties.

If you suffer from nightmares, there are many ways to improve your mental health and thus reduce their occurrences. We at Jax Therapy Network encourage you to try the tips listed in the section above. If the problem persists, consider seeking help from sleep specialists or mental health professionals. In the long run, taking action to improve sleep patterns is one of many ways to protect one’s psychological health and overall well-being.

Courtesy: Gwendolyn Brown, M.S..

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