Nightmares

Anatomy or system affected:Psychic-emotional system

Definition:Anxiety-provoking, scary, unpleasant, and frightening dreams that disturb sleep. They can cause sufferers, especially children, to cry in their sleep or awake in an emotionally upset, typically anxious state.

Causes and Symptoms

Nightmares have intrigued people for centuries, inspiring a range of explanations about what causes them. It is now known that they begin to occur in children shortly after the developmental stage of the "terrible twos," which overlaps but is not the same as the chronological age of two.

Two concurrent developments mark this period of growth. The first is intellectual and cognitive. Children develop the ability to conceptualize, process, and recall information in ways that they could not before and begin reporting that they had dreams the previous night. These dreams usually involve things they wish for, playful fantasies, and daytime activities. The second development is emotional. At this stage, children are growing beyond the autonomy and individuation issues that characterize the infamous "terrible twos." They start involuntarily to experience strong aggressive feelings and desires to control, and they direct these emotions toward those with whom they have the most trouble in establishing their autonomy: parents and siblings. At the same time, children also experience anxiety from speculating about what would happen if their feelings were ever directly expressed. This intellectual and emotional combination gives rise to vividly intense nightmares, what children commonly refer to as "bad dreams."

In addition to aggressive impulses, nightmares may involve big dogs, snakes, insects, other dangerous animals, monsters, giants, a "bad person," or harm coming to oneself or someone in one's family. During nightmares, people sense their own helplessness and vulnerability, which adds to the awful feelings experienced afterward. Those who dream that they are victorious over the threat—for example, they beat up the monster—usually report that they have had "good dreams" and are not frightened. Dreams typically occur during rapid eye movement (REM) sleep. Rapid awakening after any dream is associated with good recall, which is also true with nightmares.

Nightmares affect males and females equally, although individuals experience them or recall the experience with wide-ranging frequency, particularly in childhood. Some will have few nightmares throughout the preschool period, and others will have many. The frequency may change throughout an individual's life, with most people experiencing fewer nightmares after the age of ten. Regardless of the baseline, it is common for people to experience an increase in frequency during times of worsening stress. Oftentimes both children and adults struggling with post-traumatic stress disorder will experience greater numbers of vivid nightmares. Both a marked increase in the frequency of nightmares and the experience of having a single frequently recurring nightmare have psychological significance and causes. Some mental disorders and medical conditions can make nightmares more likely, so can frightening stimuli, such as films or stories. Certain physical factors, ranging from eating before sleep to sleeping in an unusual position or having a fever, are also thought to also affect the incidence of nightmares, as are some medications, alcohol, and illegal drugs.

Though nightmares are common and can be distressful, they usually do not represent a significant health concern. However, if an individual has very frequent nightmares, they can disrupt regular sleep habits and even make one avoid sleeping. Because adequate sleep is necessary for good health, nightmares can thus prove to be a concern, negatively impacting the quality of waking life and potentially causing or exacerbating various conditions. When daily functioning is disturbed by the prevalence of bad dreams, an individual may be diagnosed with nightmare disorder.

Night terrors also begin around the time children develop complex emotions; however, unlike nightmares, not all children experience them. They occur with regularity only between the ages of two and six. Night terrors are characterized by screaming and rapid awakening from deep sleep during the first third of the night, with vague or no recollection of the scary dream or image that presumably caused them. The victim is terrified, hard to comfort, and difficult to awaken fully. Episodes last from ten to twenty minutes. It is often more upsetting for parents to witness a child thrashing and screaming than it is for the children who experience night terrors, as there is usually no recollection of the episodes the next morning.

Tests using electroencephalography (EEG) during night terrors show the electrical activity in the brain as similar to that which occurs during small seizures, although night terrors are neither seizures nor caused by seizures and should not be treated as such. Usually, when night terrors occur, either the preceding day or the period right before bedtime has been particularly challenging or difficult. Night terrors may be a way in which children work off the psychological steam that they have built up as a result.

Even with advanced technology, a science does not exist to explain in clear terms the cause and meanings of nightmares or other dreams. Research has been ongoing, with experts examining the impact and occurrence of nightmares in both children and adults. Some studies have even investigated the difference in subject matter regarding nightmares experienced by women versus men. Others have sought to establish whether nightmares could, in fact, be a kind of learned behavior.

Treatment and Therapy

Nightmares in children are often problematic because parents are uncertain about what to do. Do they look under the bed or in the closet for the "bogeyman"? Do they keep the lights on all night? Do they let the child sleep with them after having a nightmare? Parents can help a child who has had a bad dream and who is afraid of monsters by looking under the bed or opening the closet together, while reassuring the child that they both know nothing is there.

All children experience imagined fears like monsters or spiders. These fears need to be taken seriously because they are real to the children having them. It is important that parents not scold or embarrass already frightened children or tell them that they should not feel the way they do. Parents should not discount or dismiss fears of imaginary and fantasized threats. Children need to feel that when their fantasies and worries get out of control, as in nightmares, someone can take charge and provide safety, security, and reassurance. Children must know that their worries and fears are important to their parents and caregivers.

When nightmare frequency begins to signal an underlying adjustment problem, nightmares should be thought of as an expression of intense anxiety caused by something or someone. In such cases, professional help in the form of a child therapist should be sought.

Night terrors, as disturbing as they can be, usually do not require professional intervention. In most cases, a calm, reassuring parent is all that a child needs to be comforted, to settle down, and to resume the sleep cycle. When the frequency of night terrors becomes problematic, parents should consult a sleep disorder specialist, whose professional discipline is usually medicine or psychology. In both disciplines, sleep disorders constitute a specialized area of clinical practice, and most physicians and psychologists are not trained to treat them.

Bibliography

Adler, Shelley R. Sleep Paralysis: Nightmares, nocebos, and the Mind-Body Connection. Rutgers U, 2010.

Brazelton, T. Berry, and Joshua D. Sparrow. Sleep: The Brazelton Way. Perseus, 2003.

Brazelton, T. Berry, and Joshua D. Sparrow. Touchpoints: Your Child’s Emotional and Behavioral Development. Addison, 1994.

Caldwell, J. Paul. Sleep: The Complete Guide to Sleep Disorders and a Better Night’s Sleep. Rev. ed., Firefly, 2003.

Cohen, George J., ed. American Academy of Pediatrics Guide to Your Child’s Sleep: Birth Through Adolescence. Villard, 1999.

Ferber, Richard. Solve Your Child’s Sleep Problems. Rev. ed. Simon, 2006.

Fireman, Gary D., Ross Levin, and Alice W. Pope. "Narrative Qualities of Bad Dreams and Nightmares." Dreaming, vol. 24, no. 2, 2014, pp. 112–124.

McNamara, Patrick. Nightmares: The Science and Solution of Those Frightening Visions during Sleep (Brain, Behavior, and Evolution). Praeger, 2008.

Nadorff, M. R., S. Nazem., and A. Friske. Insomnia Symptoms, Nightmares, and Suicide Risk: Duration of Sleep Disturbances Matters, vol. 43, no. 2, 2013, pp. 139–149.

Nathanson, Laura Walther. The Portable Pediatrician: A Practicing Pediatrician’s Guide to Your Child’s Growth, Development, Health, and Behavior from Birth to Age Five. 2nd ed., HarperCollins, 2002.

"Nightmare Disorder." Mayo Clinic, 5 June 2021, www.mayoclinic.org/diseases-conditions/nightmare-disorder/symptoms-causes/syc-20353515. Accessed 25 July 2023.

Spurr, Pam. Understanding Your Child’s Dreams. Sterling, 1999.