Nightmares

Nightmares are vivid nocturnal events that cause feelings of fear and terror, with or without feeling anxiety. In most cases, a person having a nightmare will be abruptly awakened from REM sleep and is able to give a detailed account of what he dreamt about. Also, the person having a nightmare has difficulty returning to sleep. Episodes typically occur in the latter half of the night. Following the awakening, the individual becomes fully alert and profoundly anxious. There is vivid recall of the preceding dream as well as difficulty returning to sleep. Compared to sleep terrors, there is less autonomic activation, and tachycardia and tachypnea, if present, are not as severe. Episodes can be precipitated by illness, traumatic experiences, and alcohol and medication use, such as antidepressants and beta-antagonist antihypertensive agents.

Nightmares affect 20 to 39 percent of children between five and 12 years of age. Contrary to popular belief, frequent nightmares in children do not suggest underlying psychopathology. Nightmares and night terrors in children are usually disturbing to parents and family members; therefore, proper diagnosis and education of family members are important components of management. It is essential to control the environment by removing dangerous objects and providing barriers to prevent escape from a safe sleeping environment. Reassurance and support are often the only therapy required because these disorders rarely, if ever, reflect underlying illness and usually disappear with maturity. Pharmacologic intervention is not usually indicated; in fact, it should be discouraged because it may contribute to further sleep disruption. Behavioral methods for treatment of frequent nightmares are effective in older children.

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