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What is Nightmare Disorder? Symptoms. Diagnosis and Treatment

At some point in life, everyone can have a nightmare: being attacked by an animal, being in a catastrophe, or having our teeth fall out suddenly. However, when this is a frequent situation that’s repeated several times a week and disturbs our daily lives, we’re talking about a nightmare disorder.

It’s very common to find ourselves with these dreams that we remember with discomfort when we wake up. So far, there’s nothing to worry about if it happens once in a while. However, their repetition deserves our attention.

What is Nightmare Disorder?

Not every nightmare is a disorder, but a disorder does become a nightmare. It sounds like a play on words, however, it is important to understand the difference.

Nightmares are experienced as dreams that trigger unpleasant emotions (fear, anxiety, sadness, distress). They seem very real and vivid; therefore, upon awakening, we have clear memories of the discomfort and may experience difficulty falling back to sleep.

Nightmares arise in the REM sleep phase, during what is usually the second half of the night.

So, why do we speak of a nightmare disorder? When do nightmares become a disorder? This happens because their presence is continuous and affects our daily functioning and well-being. That is, it’s not limited to a specific moment, but is prolonged over time.

The symptoms of a nightmare disorder

Some of the symptoms of a nightmare disorder are the following:

  • Frequent and continuous nightmares.
  • During the day we remember the nightmare. We find it difficult to disconnect from it and, when evoking it, it causes us discomfort again. We may also have difficulty concentrating and continuing our tasks.
  • We experience exhaustion and tiredness and like our rest was not restorative.
  • We have mood changes, such as irritability, listlessness, or anguish.

Different classifications

There are different classifications for this disorder. First, it can be classified according to its duration:

  • Acute: The nightmares last less than 1 month.
  • Subacute: The occurrence is from 1 to 6 months.
  • Persistent: This occurs for more than 6 months.

Also, it can be classified regarding severity:

  • Mild: The nightmares occur less than once a week.
  • Moderate: They occur several times a week, but not every night.
  • Severe: This occurs almost every night of the week.

The diagnosis

Now, nightmares can function as an indicator or warning sign of something else that is happening to us, such as anxiety, stress, trauma, or depression. For example, nightmares are thought to be one of the ways in which the brain attempts to process post-traumatic stress.

The intensity of the experience is so strong that during wakefulness it is difficult to “process” or “transform” it. However, the “unsaid” seeks to be resolved in some way.

On the other hand, to identify the origin of the nightmare disorder, it’s a good idea to recognize if there were changes in the diet, in the daily routine and habits, if there was a particular event, etc. Having insomnia is also a factor that predisposes to nightmares.

In this sense, to talk about this disorder a differential diagnosis is required. For example, it can’t be diagnosed if it occurs concomitantly with substance use or if there’s an underlying mental disorder.

How to Overcome a Nightmare Disorder

There are different recommendations to take into account to overcome nightmare disorder. Some of them are the following.

1. Make a doctor’s appointment

In this way, you will be able to determine if there is any organic cause that may be influencing your rest. For example, nightmares may occur along with coronary heart disease.

2. Take care of your nighttime diet

The quality of sleep also depends on the food at the end of the day, if you have consumed alcohol or any other substance. To promote rest, it’s recommended to have a light dinner at least two hours or more before resting.

3. Perform an adequate sleep hygiene

One of the ways to contribute to a restful sleep has to do with previous preparation. For example, try to maintain a routine of going to bed and getting up at the same time. It’s also possible to practice some breathing and relaxation exercises.

4. Imagine positive things

Practicing imagination with endings that modify the content of the nightmare is possible. During the day, anxiety about dreams can cause us to try to avoid remembering them.

However, such attempts often fail and generate more frustration. Instead, we can become aware of the emotions, identify what is troubling us about the dream, and think of a more pleasant ending. For example, if we dream of an animal attacking us, we can plan a different version in which someone warns that we are being attacked and comes to our aid.

5. Ask for professional help

You can start psychological therapy to develop stress-coping and problem-solving skills, heal wounds from the past, and to build resilience from a traumatic situation. It’s a way to become active around our discomfort and not let the dream (or rather, the nightmare) solve it by itself

Quality of sleep is quality of life

When we sleep, the brain recovers from the activity and demands of the day. It allows us to clarify our ideas to make better decisions, but other processes also take place, such as the consolidation of learning.

Addressing nightmare disorder is essential since lack of rest is a limiting factor in having a good quality of life. When it’s prolonged over time, it can even generate anxiety or a phobia.

Sometimes, it leads to compensatory behaviors, such as leaving the lights on or not being able to sleep alone. Over time, if this disorder is not addressed, it leads to difficulties.

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