Nightmares

What are nightmares?

Nightmares are scary dreams. Nightmares awake the children and make them afraid to go back to sleep.

One out of every 4 children has nightmares more than once a week.

Nightmares may happen for no known reason, but sometimes occur when your child has seen or heard things that upset him/her.

Most nightmares happen very late in the sleep period (usually between 4 a.m. and 6 a.m.).

Your child may wake up and come to you for comfort. Usually, he or she will be able to tell you what happened in the dream and why it was scary. Sporadic nightmares may be normal responses to stress whereas chronic nightmares can be troublesome.

Nightmare syndrome involves dreams during REM sleep and is associated with unusual psychologic tests and psychiatric disorders. The onset of nightmares in an adult is often associated with medication or illness.

Nightmares are common, sporadically occurring in 80 percent of the general adult population and in an even greater proportion of children. Much like transient insomnia, sporadic nightmares may be a normal response to stress.

Dreams occur during various sleep stages, including sleep onset (stage 2), delta wave sleep (stages 3 and 4) and rapid eye movement (REM) sleep.

Dreams vary in the various sleep stages, with each stage having dreams characterized by specific mentation and distinct electroencephalographic (EEG) wave changes.

Confusion regarding nightmares has been primarily due to a tendency to view all nightmares as being the same. Recently, it has become apparent that persons with chronic nightmares can be categorized into diagnostic and healing groups on the basis of the sleep stage in which the nightmare occurs and the patient's personality type.

More than 10 percent of individuals in the general population report that they are concerned by recurrent nightmares. On the average, the nightmares have persisted for 12 years, with one-quarter of them beginning in childhood.

The incidence of nightmares may be as high as 50 percent in hospitalized patients with chronic medical problems.

Nightmare Syndrome

The classic psychoanalytic nightmare occurs during the last REM sleep period of the night. Often it involves feelings of horror, cruelty, humiliation and failure.

Usually in a nightmare, the dreamer must choose between being killed or committing suicide, at which point the dreamer panics and awakens with a sense of relief that the experience was only a dream.

In most nightmares, the dreamer is the victim. Most people experience several nightmares a year; however, in nightmare syndrome, such dreams occur much more frequently.

Most people suffering from nightmare syndrome progress with supportive therapy. Desensitization is the classic treatment for recurrent nightmares and has been used by both psychotherapists and the shamans of many cultures.

During therapy, the patient describes his or her dream in detail. The therapist then advises the patient to change his or her action during the next nightmare so that the dreamer turns and attacks the tormenter. Such dream manipulation often ends a set of recurrent nightmares.

Since individuals with nightmare syndrome may be vulnerable to schizophrenia, support systems may be important for these patients. Patients requiring antipsychotic medications should be reevaluated for dosage adjustment or observance if an increase in nightmares occurs.

Recreational drug use must be avoided, and concepts of balanced and safe social behavior should be discussed with such patients. If the nightmare involves suicide by the patient, an assessment of suicide risk should be made.

Hospitalization may be required if the patient has symptoms of psychosis or depression, concrete plans for suicide or a history of suicidal gestures.

How to help a child with nightmares:

• Comfortness, reassurance, and cuddling helps your child.
• Leave the bedroom door open (never close the door on a fearful child).
• Help your child talk about the bad dreams during the day.
• Protect your child from seeing or hearing frightening movies and television shows.
• Provide a "security blanket," or toy for comfort.
• Let your child go back to sleep in his/her own bed.
• During the bedtime routine, before your child goes to sleep, talk about happy or fun things.
• Read some stories to your child about getting over nighttime fears.

When to call a physician:

Consult your child's physician if you notice any of the following:

• The fear interferes with daytime activities
• You have other concerns or questions about your child's nightmares
• The nightmares become worse or happen more often.