Nightmare

Alternative Names: Dreams – bad; Bad dreams

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Definition:
A nightmare is a dream occurring during rapid eye movement (REM) sleep that arouses feelings of intense, inescapable fear, terror, distress, or extreme anxiety that usually awakens the sleeper.It is a bad dream which causes a strong unpleasant emotional response from the sleeper,it is typically fear or horror (scary stuff), being in situations of extreme danger, or the sensations of pain, falling, drowning or death or sometimes getting caused by giant animals. Such dreams can be related to physical causes such as a high fever, turned faced down on a pillow during sleep (most often in the case of drowning nightmares), or psychological ones such as psychological trauma or stress in the sleeper’s life, or can have no apparent cause. If a person has experienced a psychologically traumatic situation in life—for example, a person who may have been captured and tortured—the experience may come back to haunt them in their nightmares. Sleepers may waken in a state of distress and be unable to get back to sleep for some time. increased stress in daiy routines may also trigger nightmares and Eating before bed, which triggers an increase in the body’s metabolism and brain activity, is another potential stimulus for nightmares.

Occasional nightmares are commonplace, but recurrent nightmares can interfere with sleep and may cause people to seek medical help. A recently proposed treatment consists of imagery rehearsal. This approach appears to reduce the effects of nightmares and other symptoms in acute stress disorder and post-traumatic stress disorder.

Practitioners of lucid dreaming claim that it can help conquer nightmares of this type, rather than of the traditional type.

Nightmares, unlike night terrors, can be recalled afterward and are accompanied by much less anxiety and movement. These frightening dream experiences, which tend to occur at times of insecurity, emotional turmoil, depression, or guilt, can occur in all age groups.

Nightmares occur exclusively during REM sleep. REM sleep phases grow longer in the latter part of the sleep cycle, and the majority of nightmares occur from the middle of the night onward.

Night terrors, by contrast, take place in non-REM (nondream) sleep. During night terrors people wake up sweating heavily, their hearts pounding, and screaming in fear. They are unaware of their surroundings and unresponsive to attempts to comfort them. They may not calm down for 10 or 15 minutes, although they return to sleep quickly once the episode ends. Generally they do not remember what scared them, but rarely a person will retain a vague image of something terrifying. A few children and adults who experience night terrors will sleepwalk during the episode.

Considerations:-
Nightmares tend to be more common among children and become less frequent toward adulthood. About 50% of adults have occasional nightmares, women more often than men.

Eating just before going to bed, which raises the body’s metabolism and brain activity, may cause nightmares to occur more often. Adults who have repeated nightmares that become a significant problem should seek help.

Historic use of term
Nightmare was the original term for the state later known as (cf. Mary Shelley and Frankenstein‘s Genesis), and more currently as sleep paralysis, associated with rapid eye movement (REM) sleep. The original definition was codified by Dr Johnson in his A Dictionary of the English Language and was thus understood, among others by Erasmus Darwin and Henry Fuseli, to include a “morbid oppression during sleep, resembling the pressure of weight upon the breast.”

Such nightmares were widely considered to be the work of demons and more specifically incubi, which were thought to sit on the chests of sleepers. In Old English the name for these beings was mare or mære (from a proto-Germanic *mar?n, related to Old High German, -in modern german it would become “Nachtmar”-, and Old Norse mara), hence comes the mare part in nightmare. Etymologically cognate with Anglo-Saxon /mara/ (‘incubus’) may be Hellenic /Mar?n/ (in the Odusseid) and Samsk?ta /M?ra/ (supernatural antagonist of the Buddha).

Folk belief in Newfoundland, South Carolina and Georgia describe the negative figure of the Hag who leaves her physical body at night, and sits on the chest of her victim. The victim usually wakes with a feeling of terror, has difficulty breathing because of a perceived heavy invisible weight on his or her chest, and is unable to move i.e., experiences sleep paralysis. This nightmare experience is described as being “hag-ridden” in the Gullah lore. The “Old Hag” was a nightmare spirit in British and also Anglophone North American folklore.

Various forms of magic and spiritual possession were also advanced as causes. In nineteenth century Europe, the vagaries of diet were thought to be responsible. For example, in Charles Dickens‘s A Christmas Carol, Ebenezer Scrooge attributes the ghost he sees to “… an undigested bit of beef, a blot of mustard, a crumb of cheese, a fragment of an underdone potato…” In a similar vein, the Household Cyclopedia (1881) offers the following advice about nightmares:

“Great attention is to be paid to regularity and choice of diet. Intemperance of every kind is hurtful, but nothing is more productive of this disease than drinking bad wine. Of eatables those which are most prejudicial are all fat and greasy meats and pastry… Moderate exercise contributes in a superior degree to promote the digestion of food and prevent flatulence; those, however, who are necessarily confined to a sedentary occupation, should particularly avoid applying themselves to study or bodily labor immediately after eating… Going to bed before the usual hour is a frequent cause of night-mare, as it either occasions the patient to sleep too long or to lie long awake in the night. Passing a whole night or part of a night without rest likewise gives birth to the disease, as it occasions the patient, on the succeeding night, to sleep too soundly. Indulging in sleep too late in the morning, is an almost certain method to bring on the paroxysm, and the more frequently it returns, the greater strength it acquires; the propensity to sleep at this time is almost irresistible.

Causes  and Risk Factors :-
Anxiety and stress are the most common causes of nightmares. A major life event occurs before the nightmare in most cases.

Other causes of nightmares include:
*Illness with a fever
*Death of a loved one (bereavement)
*Reaction to or side effect of a drug
*Recent withdrawal from a drug, such as sleeping pills
*Excessive alcohol consumption
*Abrupt alcohol withdrawal
*Breathing disorder in sleep (sleep apnea)
*Sleep disorder (narcolepsy, sleep terror disorder)

Particularly among adults, prescription drugs such as levedopa, reserpine, beta blockers, and antidepressants, as well as withdrawal from addictive drugs, all can provoke nightmares. Heavy drinking also is strongly associated with nightmares.

Other drugs suspected of causing nightmares include heart drugs, antibiotics such as ciprofloxacin, antihistamines, appetite suppressers such as fenfluramine, antidepressants, Parkinson’s drugs such as levodopa, and ulcer drugs (cimetidine). However, many drugs cannot be stopped abruptly without side effects, so it is necessary to consult your physician before altering the use of medications.

In both adults and children, nightmares and night terrors can be caused by unresolved psychological conflicts or traumatic events. They are a frequent feature of post-traumatic stress disorder. Emotional traumas that disturb the sleep of children can be overlooked easily by adults – such as the loss of a favorite toy or overhearing a loud argument between parents.

Although nightmares and night terrors are considered normal developmental events in children, disappearing by adolescence, frequent episodes at any age warrant professional evaluation. Crisis intervention techniques can be very effective in dealing with the trauma.

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Diagnosis:
Diagnosis will be based upon history and the absence of any underlying organic problems.

Tests that may be done include:
*Blood tests (such as CBC or blood differential)
*Liver function tests
*Thyroid function tests
*EEG

If therapies for stress and anxiety, medication side effects, and substance use do not treat the problem, your health care provider may want to send you to a sleep medicine specialist for a sleep study (polysomnography). In very rare cases, patients need to take special medications that suppress or reduce REM sleep to prevent nightmares.

Treatment :-
Some people have significant psychological problems that are causing bad dreams. It is important to consider psychotherapy to pinpoint major life stressors, past traumatic events and depression that might be causing bad dreams.

If one is taking medications, it is advisable to ask the prescribing physician if the pills might be the culprit.

Chronic nightmares have also been treated by a desensitization method that uses instruction about rehearsal of the nightmare and the imagining of a different ending.

In one study, patients were instructed to select a recent nightmare and write it down, change the nightmare in any way they wished, write down the changed version and rehearse the changed nightmare in an imagery relaxed state. Patients were instructed to rehearse the changed version once a day for three consecutive days after each nightmare or until the nightmare went away.

It was concluded that the use of desensitization or rehearsal techniques can reduce the frequency of nightmares and decrease distress.

Home Care
If you are under severe stress, you should ask for support from friends and relatives. Talking about what is on your mind can really help. Also, follow a regular fitness routine, with aerobic exercise if possible. You will find that you will be able to fall asleep faster, sleep more deeply, and wake up feeling more refreshed. Learn techniques to reduce muscle tension (relaxation therapy), which also will help reduce your anxiety.

Practice good sleep hygiene. Go to bed at the same time each night, and wake up at the same time each morning. Avoid long-term use of tranquilizers, as well as caffeine and other stimulants.

If you noticed that your nightmares started shortly after you began taking a new medication, contact your health care provider. He or she will let you know how to stop taking that medication if necessary, and recommend an alternative.

For nightmares caused by the effects of “street drugs” or regular alcohol use, ask for advice on the best ways to quit. An Alcoholics Anonymous group, for example, might suggest a safe way for you to stop drinking without putting your health at risk. You can also attend their regularly scheduled meetings. See also: Alcoholism – support group.

Also, look at your lifestyle — friends, work, family — to find and change factors that encourage substance abuse.

Questions To Ask Your Doctor About Nightmares:-
*Are these nightmares or night terror?
*Is there a psychological cause such as depression, emotional trauma, or stress?
*Is it related to any medications that are currently being taken?
*Should any changes be made in the medications currently being taken?
*Would psychotherapy help?
*What can be expected from psychotherapy?

Medical investigation:
Studies of dreams have found that about three quarters of dream content or emotions are negative.

One definition of “nightmare” is a dream which causes one to wake up in the middle of the sleep cycle and experience a negative emotion, such as fear. This type of event occurs on average once per month. They are not common in children under 5, more common in young children (25% experiencing a nightmare at least once per week), most common in adolescents, and less common in adults (dropping in frequency about one-third from age 25 to 55).

Fearfulness in waking life is correlated with the incidence of nightmares.

Scientists speculate that negative dreams are evolutionarily adapting, purging the brain of memories or associations which trigger fear.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://en.wikipedia.org/wiki/Nightmare
http://www.healthscout.com/ency/68/612/main.html#cont
http://www.nlm.nih.gov/medlineplus/ency/article/003209.htm

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