Written by Sara Bozyel
Our dreams have a flow of connecting our imagination with our experiences. They recreate some of our memories, add some spice, and then visualize them in the REM stage of sleep. Nightmares are just like our dreams, however, they create an intense emotional sequence of –mostly– fear and anxiety enough to wake us up. It is well-known that nightmares are frightening, but what exactly are nightmares? How do they occur? Are they a disorder or just a bad dream?
To begin with, to avoid misunderstandings, nightmares are assumed and confused with bad dreams, since they both cause unpleasant and disturbing visions. However, there is a major point that distinguishes them. Unlike nightmares, regardless of their disturbing contact, bad dreams cannot cause strong and intense feelings enough to wake us up and leave the stage of sleep (2). We can say that they are more of an overspiced dream.
Defining nightmares as disorders, in general, would be wrong. Nightmares are only defined as a disorder if you are struggling with inconvenient issues such as; major distress or impairment during the day –such as anxiety or persistent fear– bedtime anxiety about having another nightmare, problems with concentration or memory, not being able to stop thinking about visions from your dreams, daytime sleepiness, fatigue or low energy, problems in daily life, or behavior problems related to bedtime or fear of the dark (1). While most people have these nightmares on occasion, people who struggle with nightmare disorder have frequent nightmares that interfere with their sleep, temper, and daytime functioning. It is a sleep disorder known as parasomnia (5). Parasomnia disorder has many varieties. They happen during the latter part of the night (4). If awakened during the event, you'd likely be able to recall part or all of the dream. Parasomnias that happen during REM sleep include Nightmare disorder which is, in a nutshell, vivid dreams that cause feelings of fear, terror, and/or anxiety (4).
Bad dreams are not the only thing that nightmares get confused with. Nightmares are often confused with night terrors, a phenomenon more dramatic than a nightmare (3). Night terrors are not technically dreams but are instead sudden fearful reactions that occur during transitions from one sleep phase to another (3). They typically occur two to three hours after sleep begins, when deep non-REM sleep transitions to REM sleep (3). Night terrors often cause children to kick, scream, and thrash about, but, because night terrors do not occur during REM sleep, most children do not remember them (3). They are often forgotten the next day because they arise during what is known as short-wave sleep, a time when neurons in the neocortex, the brain’s center for higher mental functions, are less active (3).
People who are deeply affected by nightmares can be treated in a variety of ways. First, the cause of the stress, if there is one, must be determined. If a stressor is identified, effective ways to manage it should be found. For medication-induced nightmares, dosages might need to be altered or different drugs administered. People with post-traumatic or chronic nightmares can be treated with psychological therapy or with medication.
References:
Nightmare disorder - Symptoms and causes. (2021, June 5). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/nightmare-disorder/symptoms-causes/syc-20353515.
Nightmares and bad dreams among individuals with musculoskeletal pain: A link to vitamin D and calcium. (12, August). PubMed Central (PMC). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8451217/.
Nightmares and the brain. (n.d.). Harvard Medical School. https://hms.harvard.edu/news-events/publications-archive/brain/nightmares-brain.
Parasomnias: Causes, symptoms, types & management. (n.d.). Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/12133-parasomnias--disruptive-sleep-disorders.
Suni, E. (2022, November 3). Nightmares. Sleep Foundation. https://www.sleepfoundation.org/nightmares.
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