| *~Devils of the Dreamland~* |
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*~NIGHTMARES~*
Nightmares are distressful, anxiety provoking dreams often referred to as dream anxiety attacks. It may not be the content of the dream that is actually frightening; it is the experience of the dream as negative that is distressing. Nightmares usually occur in REM sleep, during the longer periods of REM in the latter half of the night and are considered parasomnias. Termination of the nightmare usually occurs with an awakening, sometimes due to body movements in response to the fear.
Upon awakening, the person reports a long, distressing dream that becomes more frightening towards the end. Nightmare frequency is highest, 10-50%, between the ages of 3 and six years when the child is experiencing the many stressors of toilet training, dealing with aggression and sexual impulses.
The frequency of childhood nightmares usually decreases significantly within weeks or months of initial onset. Nightmare frequency continues to fluctuate with stress levels throughout adult life, increasing as stress increases. The content of adult nightmares usually reflects being pursued or attacked, particularly following trauma (rape, childhood abuse, etc.). The nightmares following trauma may occur during stage two sleep.
Estimates of the ratio of women to men experiencing nightmares range from 2:1 to 4:1. This ratio may be influenced by a willingness to seek help for nightmares displayed by the female population. Physiological changes associated with the acute stress of a nightmare are usually only evident in an elevated heart rate, sometimes mild tachypnea, and the sleep study/polysomnogram shows a rapid awakening from REM sleep.
The REM periods during which the nightmares occur are usually at least ten minutes long and are associated with increased REM density. Nightmares are also correlated with:
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Physical illness accompanied by high fever. -
Withdrawal from REM suppressing medications such as tricyclic antidepressants and -
acute alcohol withdrawal, due in part to the REM rebound -
Mental illnesses such as personality disorders and schizophrenia -
The use of L-Dopa (and related medications) and beta-adrenergic blockers.
According to the International Classification of Sleep Disorders 1990 manual, nightmares occurring less than once per week are considered mild, providing the person is not displaying any decrements in psycho-social functioning. Moderate nightmare frequency is more than once per week, but less than nightly. A person experiencing moderate nightmares may display impaired psycho-social functioning.
Severe nightmares occur nightly and may cause moderate or severe impairment of psycho-social functioning. Acute nightmares continue for one month or less, subacute for one to six months and chronic continue for more than six months. Although these frequency criteria are generally agreed upon, nightmare distress is a much better indicator of whether an individual is disturbed by nightmares or will seek therapy for nightmares, than nightmare frequency.
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