One night you wake up scared, anxious, and sweating with your heart pounding. You recall certain disturbing events and realize it was just a bad dream. These vivid, frightening dreams that feel threatening or bothersome that cause you to wake up startled are commonly known as nightmares.

According to Sleep Education, 50% to 85% of adults report undergoing occasional nightmares. They are more common in children ages 3 to 6 and lessen after age 10. Occasional nightmares in adults are normal, but for some people, nightmares happen frequently, disrupting their daily life and mental health. Although the etiology of this remains unclear, researchers have found an association between nightmares and many mental health concerns. Stress in school, work, or at home can trigger nightmares. Anxiety creates a higher possibility of nightmares. Sleep deprivation and insomnia can lead to nightmares due to irregular sleep and lack of sleep. A traumatic event usually after an accident, injury, or sexual abuse is often linked to disturbing dreams. A common disorder associated with nightmares is Post-Traumatic Stress Disorder (PTSD). Harvard University found 80% of people experiencing PTSD have frequent nightmares. Half of those people, after a traumatic event, are more likely to replay the same trauma in their minds. Medications can have a result on the severity of nightmares. Pharmaceuticals affecting norepinephrine, serotonin, dopamine, acetylcholine, or gamma-aminobutyric acid (GABA) signaling can stimulate nightmares. Knowing the probable cause for a person’s frequent nightmares is crucial to know to prevent worsening the problem.

Nightmares in the Brain

Nightmares usually transpire during rapid eye movement (REM) sleep, which consists of intense vivid dreaming, rapid eye movement, irregular heartbeat, and increased breathing rate. REM sleep originates in the pons, an area in the brain that shuts down neurons in the spinal cord to eliminate movement. Meanwhile, signals are sent to the thalamus and the cerebral cortex (the area in the brain that learns and organizes information). Most dreams occur in the last third of the night with the exception of nightmares and PTSD. They occur both early and late in the sleep period. Due to the intensity of the dream, people will wake up aware of what happened and feel anxious or scared.

Nightmare Disorder

Nightmares can happen every now and then, but people with a nightmare disorder will have them consistently throughout the week. This condition disrupts a person’s sleep and daily functioning. Mayo Clinic refers to nightmare disorders as parasomnia, a type of sleep disorder that creates an abnormal and undesirable experience when falling asleep, during sleep, and waking up. They occur frequently and range from mild to chronic. According to the Anxiety and Depression Association of America, 4 to 6 percent of Americans have nightmare disorder. 

Some of the symptoms of nightmare disorder are:

• The frequency of nightmares overtime
• Disruption of sleep can cause major distress, such as constant fear or anxiety of having another nightmare during sleep
• Being sleepy during the day, tired, or low energy
• Impairment functioning in social situations, school, and your work life
• Behavioral issues during sleep and fear of the dark 

Better quality of sleep

It is essential for a person to have a good night’s rest for healthy function and mental well-being. Nightmares can cause feelings of dread, panic, sadness, or guilt. If left untreated, it can worsen pre-existing mental health conditions. People must find the underlying cause to reduce the frequency of nightmares. People can have high-quality sleep every night by building better sleeping habits. Below are some of the ways people can improve their sleep hygiene.

• Following a consistent sleep schedule will help maintain stability, and prevent sleep avoidance and nightmares
• Relaxation methods such as deep breathing can help reduce stress and worry that spur nightmares
• Reduce screen time before bed to relax brain activity and prevent seeing worrying images that can make nightmares more likely
• Promote a soothing sleep environment such as setting a comfortable temperature, blocking excess light, and setting up your bed to be relaxing and inviting

Methods that can help a person reduce recurring nightmares. 

• Identify stressors and ask yourself: What are your biggest worries? What can you do to solve them at the moment? Will you take the necessary steps to solve the problem?
• Evaluate your lifestyle for a better quality of sleep. Reduce the consumption of drinking, caffeine, smoking, and eating large meals during the day.
• Apply image rehearsal therapy (IRT). This therapy asks people to write out the recurring nightmare, give it a positive ending, and rehearse it prior to going to sleep.

References

Edwards, S. (2015). Nightmares and the brain. Harvard Medical School. Retrieved from https://hms.harvard.edu/news-events/publications-archive/brain/nightmares-brain

Manjarrez, A. (2022, August 9). Which neurons go to sleep first in humans? fmri can tell. The Scientist Magazine®. Retrieved April 19, 2023, from https://www.the-scientist.com/news-opinion/which-neurons-go-to-sleep-first-in-humans-fmri-can-tell-70340

  Nardoff, M. R. (2023, January 12). When disturbing dreams affect quality of life: Mental health nightmare disorder and treatment. Anxiety and Depression Association of America, ADAA. Retrieved from https://adaa.org/learn-from-us/from-the-experts/blog-posts/consumer/when-disturbing-dreams-affect-quality-life 

Nightmare disorder: What it is, symptoms & treatment. Cleveland Clinic. (n.d.). Retrieved April 12, 2023, from https://my.clevelandclinic.org/health/diseases/24464-nightmare-disorder 

Pruthi, S. (2021, June 5). Nightmare disorder. Mayo Clinic. Retrieved April 13, 2023, from https://www.mayoclinic.org/diseases-conditions/nightmare-disorder/symptoms-causes/syc-20353515 

Why am I having nightmares? Hope Mental Health: Psychiatric Mental Health Specialists. (n.d.). Retrieved April 15, 2023, from https://www.hopementalhealth.com/blog/why-am-i-having-nightmares