Sleep is such a big part of day-to-day life that it's not surprising that a nightmare disorder can take such a huge emotional toll on someone.
The dreams can be disturbing and detailed and feel like a threat to the self or others. It may seem like you're constantly living a horror-like scenario you can't seem to get out of.
Nightmare disorder in adults tends to be quite common – 4% of Americans are severely affected by it. The percentage increases when it comes to psychiatric patients with other diagnoses.
It seems that only about 1% of children suffer from nightmare disorder, although they do frequently report having nightmares.
For someone suffering from this disorder, bedtime preparations can look very different from what we know.
A person who suffers from a nightmare disorder has co-occurring nightmares that affect their day-to-day lives, quality of sleep, and general mood.
Apart from frequently co-occurring with PTSD, it can be a traumatic experience on its own and can significantly increase negative emotions like anxiety, depression, or even anger.
What Is a Nightmare Disorder?
Nightmare disorder is a rapid eye movement (REM) sleep-related parasomnia, which means that it usually occurs in the REM stage of sleep, which is the stage in which dreams occur. You may have nightmare disorder if your nightmares:
- Cause you significant distress
- Interfere with the quantity and quality of your sleep
- Happen frequently (at least once a week)
- Affect you for an extended period of time
- Cause anxiety about going to sleep
- Significantly interfere with daytime functioning (impairment in work, school, or relationships)
- Are vivid, and you remember them very well
- Have a long-lasting effect on you
- Leave you feeling restless and fatigued
But what causes nightmares to be so frequent and disturbing? Well, the answer is more nuanced.
Nightmare disorder can be present both in adults and children, and the content and manifestation vary by age and personal experience. Nightmares in adults tend to be more complex or abstract and more of a long-term deal.
Nightmare disorder can cause insomnia because of fear of sleeping. Thought suppression and avoidance make it even worse and increase the symptoms' frequency.
Re-experiencing the nightmare, intrusive thoughts, and high arousal are common side-effects. To make matters worse, physical symptoms like sweating or rapid heartbeat often accompany these nightmares.
While many people don't actively seek treatment for nightmare disorder, considering it just a passing phase or something to scoff at, there is hope!
There are many treatment options out there; you just have to find the right one for you.
What Causes Nightmare Disorder?
As with any mental disorder, the cause can be explained by a combination of genetic and environmental factors:
- Heredity: A genetic predisposition to sleep disorders may be partly at fault, with frequent nightmares or sleep disorders sometimes running in the family.
- Affective load: Regular day-to-day stress and anxiety can make someone more likely to suffer from a nightmare disorder.
- Trauma: Deeply negative experiences can predispose an individual to frequent nightmares, especially related to the traumatic event.
- Other sleep disorders: Poor sleep hygiene, irregular sleep, insomnia, or sleep deprivation are associated with the risk of developing a nightmare disorder.
- Other mental disorders: Depression, anxiety, and BPD are often associated with this disorder.
- Major life events or significant life changes: The death of a loved one, moving, or separation can negatively affect sleep quality.
- Drug or substance abuse
Nightmare disorder is often a package deal, as it's commonly associated with other diagnoses.
66.7% of people with nightmare disorders suffer from PTSD, 37% from mood disorders, and 31.1% from anxiety disorders. Substance abuse disorder, anxiety, schizophrenia, and borderline personality disorder (BPD) are common occurrences as well.
It is also more frequent in adults than children and more frequent in young women.
Treating a Nightmare Disorder With Therapy
Treating nightmares in adults is sometimes difficult, but you have many options to choose from.
When picking a nightmare disorder treatment, you have to consider other co-occurring disorders, as they may require a different approach.
So how can you stop nightmares in adults?
Psychotherapy is considered the gold standard in nightmare disorder treatment, and it can sometimes be used in combination with medication.
Psychotherapy
Therapeutic approaches generally focus on restructuring thoughts and emotions about the content of the nightmares and behavioral changes that target dysfunctional sleeping habits.
Talk therapy is highly effective in treating nightmare disorders and has proven to be superior to pharmacological approaches alone.
Lifestyle changes are usually targeted – avoiding certain triggers, like substance abuse or caffeine intake (that can exacerbate nightmares) and creating a comforting sleep environment.
- Cognitive behavioral therapy emphasizes changing dysfunctional thought patterns, emotions, and behaviors to feel better.
- Cognitive behavioral therapy for insomnia focuses on cognitive interventions (restructuring negative thoughts) and behavioral interventions like stimulus control, sleep restriction, and healthy sleeping habits.
- Image rehearsal therapy is a type of cognitive behavioral therapy that focuses on reliving the content of the nightmare and changing the storyline. More specifically, putting it on paper and turning it into a more positive overall experience by rewriting the whole narrative, thus gaining a sense of control. It can be highly effective, especially when nightmare disorder is paired with PTSD.
- Lucid dreaming therapy involves the same principles as image rehearsal therapy, the difference being that the restructuring happens while having the actual dream. However, it is more difficult to implement.
- Exposure, relaxation, and rescripting therapy (ERRT) aims to relieve anxiety by adopting several techniques, like psychoeducation, progressive muscle relaxation, sleep hygiene, and exposure to the feared nightmares. This approach focuses on confronting post-traumatic nightmares.
- Progressive deep muscle relaxation is a relaxation technique that focuses on tensing each muscle group and then relaxing them, alternating between these states. It's very efficient for people who have insomnia.
- Eye movement desensitization and reprocessing (EMDR) is a therapeutic approach focused on trauma, and it is often considered one of the main treatment options for PTSD. It combines many different therapeutic approaches that aim to change how you process trauma in the brain. It involves a slow recall of the traumatic event while guided through a set of bilateral eye movements, thus reducing the intense emotions associated with it.
- Mindfulness meditation is a lesser-used nightmare disorder treatment that helps with emotion regulation by noticing and being aware of negative thoughts and emotions in a non-judgemental, non-labeling way.
Medication
It’s important to emphasize that you should talk to a professional before following any medical treatments, as they should be catered to your individual needs. Most medication for nightmare disorder targets PTSD-associated symptoms. They generally reduce trauma-related nightmares, thus improving sleep or anxiety.
Some medications are centered on suppressing or altering rapid eye movements, lowering the occurrence of nightmares in adults. However, you shouldn’t expect a significant decrease in nightmares without following psychotherapy.
Triazolam and nitrazepam are popular choices when it comes to nightmare disorders. They’re benzodiazepines, which means that they mainly target anxiety related to nightmares. They have been shown to be effective, especially when coupled with psychotherapy.
Prazosin has long been the standard treatment of choice for nightmare disorder because of its capacity to reduce hyperarousal in PTSD-related nightmares (by blocking norepinephrine). It’s also been frequently used to treat high blood pressure.
Antipsychotic medications like Olanzapine, Aripiprazole, and Risperidone have shown efficacy in treatment-resistant PTSD patients.
You can significantly benefit from all of these therapeutic approaches through online therapy. With online counseling, you can get the same results at a more affordable price and from anywhere in the world.
And there's ample evidence that online therapy can be as efficient as face-to-face therapeutic approaches.
The Bottom Line
Let acceptance be your starting point.
Every disorder is about managing symptoms, and a big part of that is accepting that they’re there and incorporating them into your life.
A full life means having dreams as well as nightmares. Both are part of the human experience, and neither can be avoided. You can't have one without the other.
You might find it hard to go to sleep or even allow yourself to sleep. Don't blame yourself for that. Healing is a step-by-step process that needs patience and self-care.
When healing, you must consider improving your symptoms and not look for an ultimate treatment that will “cure” you entirely in one single, magical stroke of a wand.
Nightmare disorder can sometimes be misunderstood because people tend to minimize how big of an impact it can have on someone.
Psychoeducation can help you understand your symptoms better and explain them to others.
While people who don't suffer from this disorder can have vivid nightmares, it's essential to know that it's very different than having an actual sleep condition, where nightmares differ in severity and how often they occur and can affect your overall level of functioning.
Luckily, there is hope even for the most haunted. And you don't have to do it alone.
Therapy can help by teaching you techniques to manage and improve your distressing symptoms. Not to mention it's a safe place where you can talk about anything – because if there's anybody that’s heard it all, it's a therapist.
Finding the right therapist that can tailor their approach to your individual, unique needs is critical in your healing process.
If you need help, don't hesitate to access our online therapy platform, where you can get specialized treatment from certified professionals who combine evidence-based practice with a humane and warm approach.
