Nightmares: Causes, Diagnosis, Treatment, and Prevention
Thu, September 29, 2022

Nightmares: Causes, Diagnosis, Treatment, and Prevention



Nightmares are disturbing and themes can vary between people; however, the most common ones involve falling, getting chased, or feeling lost or trapped, explained Ann Petriangelo of Healthline, a health and medical information website. Nightmares cause you to feel a range of emotions such as anger, anxiety, fear, and guilt.

Anyone can have nightmares, regardless of their age. But they commonly occur in children below 10 years old. Nightmares are not usually signs of an underlying medical condition or mental illness, except for people that have PTSD (post-traumatic stress disorder). Nightmares can be a problem if they repeatedly occur and interrupt your sleep, causing you to develop insomnia and impairing your daily functioning.



What Do People Have Nightmares About?

Amerisleep, an American manufacturer of memory foam mattresses, surveyed over 2,000 people about their nightmares and dreams, finding that 64.7% of respondents had nightmares of falling and 63.3% had nightmares of being chased, reported McKenzie Hyde. Other respondents had nightmares about death (54.9%), feeling lost (53.8%), feeling trapped (52.4%), being attacked (49.5%), missing an important event (43.7%), waking up late (42.5%), and a death of a loved one (35.8%).

Gender-wise, more women had nightmares about a loved passing (60.6%) than men (39.3%). More women than men reported having nightmares about being visited by a deceased friend/family (64.3% versus 35.6%). For 65.7% of men, they had more nightmares that involved technology malfunction than 34.2% of women. Moreover, more men (56.8%) than women (43.1%) had nightmares about attacking someone.

Regarding the fears that most often exhibited in people’s nightmares, 52.5% of respondents said they had nightmares that were about their general well-being/life threat, followed by work/career (16.6%), relationships (12.5%), family (12.5%), social (3.4%), and health (2.5%). By profession, those working as broadcasters and journalists or in the publishing, scientific, and transportation and warehousing sectors experienced nightmares about missing a deadline.


Respondents in the legal and mining industry were likely to have nightmares about coming into work unprepared. Respondents in the construction, education, manufacturing sectors had nightmares about being late to work. Those working in the telecommunications industry were plagued by nightmares about getting fired.

In another survey by Sleep Zoo, a sleep resource, 64% of 1,750 working American adults had a nightmare about work, causing them to feel stressed and worried upon waking up (versus 36% who said no). The most frequent work-related nightmares the respondents had were having sex with a co-worker (60%), late to work (47%), messing up a project (34%), getting fired (21%), and being naked at work (19%).

When asked if they are stressed about anything at work, 78% said yes while 22% said no. The biggest sources of stress at work included an overwhelming workload (37%), having issues with their boss or co-workers, work-life balance (19%), low pay (10%), and lack of job security (7%).




What Are the Differences Between Night Terrors and Nightmares?

Nightmares occur during REM sleep, occurring late at night or early in the morning, said, a leading expert in the field of sleep science and health for nearly three decades. This is when your brain is likely to conjure vivid dreams. Night terrors only occur during non-REM sleep. Nightmares are vivid and you can recall some events that have taken place in your dream. If you suffer from night terrors, you may shout, sleepwalk, or appear scared for several minutes before going back to sleep. You will only have a vague memory of the night terror later on.

Likewise, night terrors are more common in children than in adults, particularly if the former is between four and eight-years-old. Night terrors go away as a child gets older, but people of various ages can experience nightmares. In some cases, adults who are under stress may experience night terrors and may have vague memories of it.



What Are the Causes of Nightmares?

They can be triggered by scary books, movies, or videogames, PTSD, illness or fever, medications, or alcohol or drug abuse. Narcolepsy, sleep apnea, stress, anxiety, depression, and over-the-counter sleep aids can also cause nightmares.



How Are Nightmares Diagnosed and Treated?

Consult your doctor if nightmares occur for a period of time, interrupt your sleep, or interfere with daily functioning. Your doctor will inquire about your use of stimulants like alcohol, caffeine, or certain illegal drugs. They will also ask if you are currently taking prescription or over-the-counter medications and supplements.

If you think a new medication is triggering nightmares, request your doctor for another treatment. There are no tests for diagnosing nightmares, but your doctor may recommend you to participate in a sleep study. You will spend the night in the laboratory during a sleep study and sensors will help monitor various functions like your heartbeat, brain waves, breathing, eye movements, and more. Your doctor may perform other tests if they think that your nightmares may be caused by PTSD or anxiety.

According to Mayo Clinic, an American non-profit academic medical center, they may ask about your family history of sleep problems. They may also ask you or your partner about your sleep behaviors and explain the possibilities of having other sleep disorders. In general, nightmares do not require treatment, but any underlying medical or mental disorders should be diagnosed and addressed. If your nightmares occur due to PTSD, your doctor may prescribe prazosin, a blood pressure drug, to treat nightmares.

Another treatment is imagery rehearsal therapy, which is often used for those diagnosed with PTSD. This treatment involves changing your remembered nightmare’s ending so that it is not threatening to you. Keep envisioning the new ending. Further, imagery rehearsal therapy may help reduce the occurrence of nightmares. Your doctor may also recommend counseling or stress-reducing techniques if anxiety, depression, or stress is causing you to have nightmares.   



What Can I Do to Prevent Nightmares?

Exercising at least three times a week, limiting alcohol and caffeine intake, practicing relaxation techniques like yoga or meditation, establishing a bedtime routine, and avoiding tranquilizers may help minimize the frequency of nightmares.  If your child has nightmares, help your child relax by engaging in deep breathing exercises, encouraging them to keep a dream journal, or instructing them to rewrite their dream’s ending.

Nightmares are terrifying, inducing a maelstrom of feelings of fear or guilt. Nightmares differ from night terrors, as the former occurs during REM sleep while the latter happens during non-REM sleep. If nightmares continue to persist, an individual can consult a doctor for treatment or tests.