Nightmare

A nightmare, also known as a bad dream,[1] is an unpleasant dream that can cause a strong emotional response from the mind, typically fear but also despair, anxiety, disgust or sadness. The dream may contain situations of discomfort, psychological or physical terror, or panic. After a nightmare, a person will often awaken in a state of distress and may be unable to return to sleep for a short period of time.[2] Recurrent nightmares may require medical help, as they can interfere with sleeping patterns and cause insomnia.

Nightmares can have physical causes such as sleeping in an uncomfortable position or having a fever, or psychological causes such as stress or anxiety. Eating before going to sleep, which triggers an increase in the body's metabolism and brain activity, can be a potential stimulus for nightmares.[3]

The prevalence of nightmares in children (5–12 years old) is between 20 and 30%, and prevalence in adults is between 8 and 30%.[4] In common language, the meaning of nightmare has extended as a metaphor to many bad things, such as a bad situation or a scary monster or person.

## Contents

* 1 Etymology
* 2 History and folklore
* 3 Signs and symptoms
* 4 Classification
* 5 Cause
* 6 Treatment
* 6.1 Post-traumatic stress disorder
* 6.2 Medication
* 7 See also
* 8 References
* 9 Further reading
* 10 External links

## Etymology

The word nightmare is derived from the European folklorical "mare" ( Old English: mare, mære, Old Norse: mara), a mythological female demon or thereof, which sits on the chest of sleeping people and brings on frightening dreams. The term has no known etymological connection with the Modern English word for a female horse ( cognate Swedish: märr).[5] The word nightmare has cognates in various European languages: Dutch: nachtmerrie, German: Nachtmahr (dated), Swedish: mardröm (lit. sv – lit. mare-dream). Male equivelants also exist in European folklore, like the alp.

Originally, "mare" or "nightmare" referred more specifically to sleep paralysis, in which an experience of terror and paralysis during sleep can be associated with a sense of pressure on the chest and the dreamed presence of entities often pictured as demons, sometimes sitting on the chest. The words also referred to such a "demon," which was also referred to as a hag and the experience as being "hag-ridden." The meaning of "nightmare" had generalized from sleep paralysis to any bad dream by 1829.[1] In other languages, the word for "bad dream" similarly evolved in sense from words for "sleep paralysis," often with senses related to the pressure on the chest. For example, French cauchemar (the first element from old French chauchier "to press, trample," the second related to "mare"); Spanish pesadilla, from pesada "weight"; or Hungarian lidércnyomás, from nyomás "pressure."

## History and folklore

The sorcerous demons of Iranian mythology known as Divs are likewise associated with the ability to afflict their victims with nightmares.[6] The mare of Germanic and Slavic folklore were thought to ride on people's chests while they sleep, causing nightmares.[7]

## Signs and symptoms

Those with nightmares experience abnormal sleep architecture. The impact of having a nightmare during the night has been found to be very similar to that of insomnia. This is thought to be caused by frequent nocturnal awakenings and fear of falling asleep.[8] When awoken from REM sleep by a nightmare, the dreamer can usually recall the nightmare in detail. They may also awaken in a heightened state of distress, with an elevated heart rate or increased perspiration.[9] Nightmare disorder symptoms include repeated awakenings from the major sleep period or naps with detailed recall of extended and extremely frightening dreams, usually involving threats to survival, security, or self-esteem. The awakenings generally occur during the second half of the sleep period.[10]

## Classification

According to the International Classification of Sleep Disorders-Third Edition (ICSD-3), the nightmare disorder, together with REM sleep behaviour disorder (RBD) and recurrent isolated sleep paralysis, form the REM-related parasomnias subcategory of the Parasomnias cluster.[11] Nightmares may be idiopathic without any signs of psychopathology or associated with disorders like stress, anxiety, substance abuse, psychiatric illness or PTSD (>80% of PTSD patients report nightmares).[12] As regarding the dream content of the dreams they are usually imprinting negative emotions like sadness, fear or rage.[4] According to the clinical studies the content can include being chased, injury or death of others, falling, natural disasters or accidents. Typical dreams or recurrent dreams may also have some of these topics.[13]

## Cause

Scientific research shows that nightmares may have many causes. In a study focusing on children, researchers were able to conclude that nightmares directly correlate with the stress in children's lives. Children who experienced the death of a family member or a close friend or know someone with a chronic illness have more frequent nightmares than those who are only faced with stress from school or stress from social aspects of daily life.[14] A study researching the causes of nightmares focuses on patients who have sleep apnea. The study was conducted to determine whether or not nightmares may be caused by sleep apnea, or being unable to breathe. In the nineteenth century, authors believed that nightmares were caused by not having enough oxygen, therefore it was believed that those with sleep apnea had more frequent nightmares than those without it. The results actually showed that healthy people have more nightmares than sleep apnea patients.[15] However, another study supports the hypothesis. In this study, 48 patients (aged 20–85 yrs) with obstructive airways disease (OAD), including 21 with and 27 without asthma, were compared with 149 sex- and age-matched controls without respiratory disease. OAD subjects with asthma reported approximately 3 times as many nightmares as controls or OAD subjects without asthma.[16] The evolutionary purpose of nightmares then could be a mechanism to awaken a person who is in danger.

Lucid-dreaming advocate Stephen LaBerge has outlined a possible reason for how dreams are formulated and why nightmares occur. To LaBerge, a dream starts with an individual thought or scene, such as walking down a dimly lit street. Since dreams are not predetermined, the brain responds to the situation by either thinking a good thought or a bad thought, and the dream framework follows from there. If bad thoughts in a dream are more prominent than good thoughts, the dream may proceed to be a nightmare.[17]

A panel from the early 20th century comic Dream of the Rarebit Fiend, whose protagonists regularly suffer nightmares after eating cheese.

There is a view, possibly featured in the story A Christmas Carol, that eating cheese before sleep can cause nightmares, but there is little scientific evidence for this.[18] A single, biased study conducted by the British Cheese Board in 2005 argued that consuming cheese could trigger more vivid dreams, but this study was not backed up with sufficient research, and contradicts existing studies which found that consuming dairy products is associated with better overall sleep quality.[19]

Nightmares can also be caused by viewing content in the horror genre, especially right before going to sleep.[20]

While no definitive studies directly link spicy foods to causing nightmares, they may lead to more vivid or remembered dreams due to increased body temperature and metabolism, which can sometimes lead to experiencing nightmares in a similar way that fevers can. This heightened physiological state can disrupt sleep and promote wakefulness, making you more likely to recall any dreams, including disturbing ones, that occur during the night. Eating spicy foods close to bedtime can also lead to digestive discomfort, which can further disturb sleep and contribute to a greater awareness of your dreams.[21]

Severe nightmares are also likely to occur when a person has a fever; these nightmares are often referred to as fever dreams.

Recent research has shown that frequent nightmares may precede the development of neurodegenerative diseases, such as Parkinson's disease and dementia.[22][23][24]

## Treatment

Sigmund Freud and Carl Jung seemed to have shared a belief that people frequently distressed by nightmares could be re-experiencing some stressful event from the past.[25] Both perspectives on dreams suggest that therapy can provide relief from the dilemma of the nightmarish experience.

Halliday (1987) grouped treatment techniques into four classes. Direct nightmare interventions that combine compatible techniques from one or more of these classes may enhance overall treatment effectiveness:[26]

* Analytic and cathartic techniques
* Storyline alteration procedures
* Face-and-conquer approaches
* Desensitization and related behavioral techniques

### Post-traumatic stress disorder

Recurring post-traumatic stress disorder (PTSD) nightmares in which traumas are re-experienced respond well to a technique called imagery rehearsal. This involves dreamers coming up with alternative, mastery outcomes to the nightmares, mentally rehearsing those outcomes while awake and then reminding themselves at bedtime that they wish these alternative outcomes should the nightmares recur. Research has found that this technique not only reduces the occurrence of nightmares and insomnia[27] but also improves other daytime PTSD symptoms.[28] The most common variations of imagery rehearsal therapy (IRT) "relate to the number of sessions, duration of treatment, and the degree to which exposure therapy is included in the protocol".[29]

### Medication

* Prazosin (alpha-1 blocker) appears useful in decreasing the number of nightmares and the distress caused by them in people with PTSD.[30][31]
* Risperidone (atypical antipsychotic) at a dosage of 2 mg per day, has been shown in a case report to lead to the remission of nightmares on the first night.[31]
* Trazodone (antidepressant) has been shown in a case report to treat nightmares associated with depressed patients.[31]

Trials have included hydrocortisone, gabapentin, paroxetine, tetrahydrocannabinol, eszopiclone, Sodium oxybate, and carvedilol.[31]

## See also

* Bogeyman
* False awakening
* Hag § In folklore
* Horror and terror
* Incubus
* Mare (folklore)
* Night terror
* Nightmare disorder
* Nocnitsa
* Sleep disorder
* Sleep paralysis
* Succubus
* A Nightmare on Elm Street, 1984 film

## References

1. ↑ 1.0 1.1 Harper, Douglas. "nightmare". Online Etymology Dictionary. https://www.etymonline.com/?term=nightmare. Retrieved 11 July 2016.
2. ↑ American Psychiatric Association (2000), Diagnostic and Statistical Manual of Mental Disorders, 4th ed, TR, p. 631
3. ↑ Stephen, Laura (2006). "Nightmares". http://www.psychologytoday.com/conditions/nightmare.html.
4. ↑ 4.0 4.1 Peter, Helga; Penzel, Thomas; Jörg, Hermann Peter (2007). Enzyklopädie der Schlafmedizin. Heidelberg: Springer Medizin Verlag. ISBN 978-3-540-28839-8.
5. ↑ Liberman, Anatoly (2005). Word Origins And How We Know Them. Oxford: Oxford University Press. p. 87. ISBN 978-0-19-538707-0. https://books.google.com/books?id=sMiRc-JFIfMC&pg=PA87. Retrieved 29 March 2012.
6. ↑ "DĪV, Volume VII, Fasc. 4". Encyclopædia Iranica. 28 November 2011. pp. 428–431. http://www.iranicaonline.org/articles/div. Retrieved 3 July 2021.
7. ↑ Bjorvand and Lindeman (2007), pp. 719–720.
8. ↑ Simor, Pé, et al. "Disturbed Dreaming and Sleep Quality: Altered Sleep Architecture in Subjects with Frequent Nightmares."European Archives of Psychiatry and Clinical Neuroscience 262.8 (2012): 687–96. ProQuest. Web. 24 April 2014.
9. ↑ "Nightmares" (in en). https://stanfordhealthcare.org/medical-conditions/sleep/nighttime-sleep-behaviors/nightmares.html.
10. ↑ Grohol, John M.; Read, Psy D. (2016-05-17). "Nightmare Disorder Symptoms" (in en-US). https://psychcentral.com/disorders/nightmare-disorder-symptoms/.
11. ↑ Sateia, Michael J (2014). "International Classification of Sleep Disorders-Third Edition". Chest 146 (5): 1387–1394. doi:10.1378/chest.14-0970. ISSN 0012-3692. PMID 25367475.
12. ↑ Morgenthaler, Timothy I.; Auerbach, Sanford; et, al. (2018). "Position Paper for the Treatment of Nightmare Disorder in Adults: An American Academy of Sleep Medicine Position Paper". Journal of Clinical Sleep Medicine 14 (6): 1041–1055. doi:10.5664/jcsm.7178. ISSN 1550-9389. PMID 29852917.
13. ↑ Schredl, Michael; Göritz, Anja S. (2018). "Nightmare Themes: An Online Study of Most Recent Nightmares and Childhood Nightmares". Journal of Clinical Sleep Medicine 14 (3): 465–471. doi:10.5664/jcsm.7002. PMID 29458691.
14. ↑ Schredl, Michael, et al. "Nightmares and Stress in Children." Sleep and Hypnosis 10.1 (2008): 19–25. ProQuest. Web. 29 April 2014.
15. ↑ Schredl, Michael, et al. "Nightmares and Oxygen Desaturations: Is Sleep Apnea Related to Heightened Nightmare Frequency?" Sleep and Breathing 10.4 (2006): 203–209. ProQuest. Web. 24 April 2014.
16. ↑ Wood, James M.; Bootzin, Richard R.; Quan, Stuart F.; Klink, Mary E. (December 1993). "Prevalence of nightmares among patients with asthma and chronic obstructive airways disease.". Dreaming 3 (4): 231–241. doi:10.1037/h0094382. ProQuest 1023291364 EBSCOhost 1994-18130-001.
17. ↑ Stephen, LaBerge (1990). Exploring the World of Lucid Dreaming. New York: Ballantine Books. pp. 65–66.
18. ↑ Hammond, Claudia (17 April 2012). "Does cheese give you nightmares?". BBC. http://www.bbc.com/future/story/20120417-does-cheese-give-you-nightmares.
19. ↑ "Does cheese really give you vivid dreams?". 18 November 2021. https://www.bbc.com/future/article/20211117-does-cheese-really-give-you-vivid-dreams.
20. ↑ "7 Reasons You’re Having Nightmares" (in en). https://health.clevelandclinic.org/what-causes-nightmares.
21. ↑ "Can spicy food really give you nightmares?". 15 February 2013. https://www.nbcnews.com/healthmain/can-spicy-food-really-give-you-nightmares-1c8388656.
22. ↑ Otaiku, Abidemi (2022). "Distressing dreams and risk of Parkinson's disease: A population-based cohort study". eClinicalMedicine 8 (48). doi:10.1016/j.eclinm.2022.101474. PMID 35783487.
23. ↑ Otaiku, Abidemi (2022). "Distressing dreams, cognitive decline, and risk of dementia: A prospective study of three population-based cohorts". eClinicalMedicine 21 (52). doi:10.1016/j.eclinm.2022.101640. PMID 36313147.
24. ↑ Otaiku, Abidemi (2023). "Distressing dreams in childhood and risk of cognitive impairment or Parkinson's disease in adulthood: a national birth cohort study". eClinicalMedicine 8 (48). doi:10.1016/j.eclinm.2023.101872. PMID 37064510.
25. ↑ Coalson, Bob (1995). "Nightmare help: Treatment of trauma survivors with PTSD.". Psychotherapy: Theory, Research, Practice, Training 32 (3): 381–388. doi:10.1037/0033-3204.32.3.381.
26. ↑ Cushway, Delia; Sewell, Robyn (2012). Therapy with Dreams and Nightmares: Theory, Research & Practice (2 ed.). SAGE Publications Ltd. p. 73. ISBN 978-1-4462-4710-5.
27. ↑ Davis, J. L.; Wright, D. C. (2005). "Case Series Utilizing Exposure, Relaxation, and Rescripting Therapy: Impact on Nightmares, Sleep Quality, and Psychological Distress". Behavioral Sleep Medicine 3 (3): 151–157. doi:10.1207/s15402010bsm0303_3. PMID 15984916.
28. ↑ Krakow, B.; Hollifield, M.; Johnston, L.; Koss, M.; Schrader, R.; Warner, T. D.; Tandberg, D.; Lauriello, J. et al. (2001). "Imagery Rehearsal Therapy for Chronic Nightmares in Sexual Assault Survivors with Posttraumatic Stress Disorder: A Randomized Controlled Trial". JAMA: The Journal of the American Medical Association 286 (5): 537–45. doi:10.1001/jama.286.5.537. PMID 11476655.
29. ↑ Lu, M.; Wagner, A.; Van Male, L.; Whitehead, A.; Boehnlein, J. (2009). "Imagery rehearsal therapy for posttraumatic nightmares in U.S. Veterans". Journal of Traumatic Stress 22 (3): 236–239. doi:10.1002/jts.20407. PMID 19444882. , p. 234
30. ↑ El-Solh, AA (2018). "Management of nightmares in patients with posttraumatic stress disorder: current perspectives.". Nature and Science of Sleep 10: 409–420. doi:10.2147/NSS.S166089. PMID 30538593.
31. ↑ 31.0 31.1 31.2 31.3 Waltman, Scott H.; Shearer, David; Moore, Bret A. (2018-10-11). "Management of Post-Traumatic Nightmares: a Review of Pharmacologic and Nonpharmacologic Treatments Since 2013". Current Psychiatry Reports (Springer Science and Business Media LLC) 20 (12): 108. doi:10.1007/s11920-018-0971-2. ISSN 1523-3812. PMID 30306339.

## Further reading

* Anch, A. M.; Browman, C. P.; Mitler, M. M.; Walsh, J. K. (1988). Sleep: A Scientific Perspective. New Jersey: Prentice-Hall. ISBN 978-0-13-812918-7. https://archive.org/details/sleepscientificp00anch.
* Harris, J. C. (2004). "The Nightmare". Archives of General Psychiatry 61 (5): 439–40. doi:10.1001/archpsyc.61.5.439. PMID 15123487.
* Husser, J.-M.; Mouton, A., eds (2010) (in fr). Le Cauchemar dans les sociétés antiques. Actes des journées d'étude de l'UMR 7044 (15–16 Novembre 2007, Strasbourg). Paris: De Boccard.
* Jones, Ernest (1951). On the Nightmare. W W Norton & Company Incorporated. ISBN 978-0-87140-912-6.
* Forbes, D. (2001). "Brief Report: Treatment of Combat-Related Nightmares Using Imagery Rehearsal: A Pilot Study". Journal of Traumatic Stress 14 (2): 433–442. doi:10.1023/A:1011133422340. PMID 11469167.
* Siegel, A. (2003). "A mini-course for clinicians and trauma workers on posttraumatic nightmares". https://www.asdreams.org/magazine/articles/seigel_nightmares.htm.
* Burns, Sarah (2004). Painting the Dark Side : Art and the Gothic Imagination in Nineteenth-Century America. Ahmanson-Murphy Fine Are Imprint. University of California Press. ISBN 978-0-520-23821-3.
* Davenport-Hines, Richard (1999). Gothic: Four Hundred Years of Excess, Horror, Evil and Ruin. North Point Press. pp. 160–61. ISBN 978-0-86547-544-1. https://archive.org/details/gothicfourhundre00dave.
* Hill, Anne (2009). What To Do When Dreams Go Bad: A Practical Guide to Nightmares. Serpentine Media. ISBN 978-1-887590-04-4.
* Simons, Ronald C.; Hughes, Charles C., eds (1985). Culture-Bound Syndromes. Springer.
* Sagan, Carl (1997). The Demon-Haunted World: Science as a Candle in the Dark.
* Coalson, Bob (1995). "Nightmare help: Treatment of trauma survivors with PTSD". Psychotherapy: Theory, Research, Practice, Training 32 (3): 381–388. doi:10.1037/0033-3204.32.3.381.
* "Nightmares? Bad Dreams, or Recurring Dreams? Lucky You!". http://www.nightmares.info/nightmares.htm.
* Halliday, G. (1987). "Direct psychological therapies for nightmares: A review". Clinical Psychology Review 7 (5): 501–523. doi:10.1016/0272-7358(87)90041-9.
* Doctor, Ronald M.; Shiromoto, Frank N., eds (2010). "Imagery Rehearsal Therapy (IRT)". The Encyclopedia of Trauma and Traumatic Stress Disorders. New York: Facts on File. p. 148. ISBN 978-0-8160-6764-0. https://archive.org/details/encyclopediaoftr0000doct.
* Mayer, Mercer (1976). There's a Nightmare in My Closet. [New York]: Puffin Pied Piper.
* Moore, Bret A.; Kraków, Barry (2010). "Imagery rehearsal therapy: An emerging treatment for posttraumatic nightmares in veterans". Psychological Trauma: Theory, Research, Practice, and Policy 2 (3): 232–238. doi:10.1037/a0019895.

## External links

* Night-Mares: Demons that Cause Nightmares

Classification|

* ICD-11: 7B01.2
* ICD-10: F51.5
* ICD-9-CM: xxx
* SNOMED CT: 111487009

|

* v
* t
* e

Dreams and oneirology

Phenomena|

* Lucid dream
* Pre-lucid dream
* Rapid eye movement sleep
* Non-rapid eye movement sleep
* Rapture dream
* Recurring dream
* Interobject
* Anxiety dream
* False awakening
* Oneirogen
* Dream speech
* Nightmare
* Nightmare disorder
* Spirit spouse
* PGO waves
* Hypnopompic
* Hypnagogia
* Out-of-body experience

Therapy and interpretation|

* Guided imagery
* Oneironautics
* Dreamwork
* Dream dictionary
* Dream art
* Dream diary
* Dream incubation
* Dream interpretation
* Dream sharing
* Dream yoga
* Dream guide
* Embodied imagination
* Sleep medicine
* Psychoanalytic dream interpretation
* Activation-synthesis hypothesis
* Cognitive neuroscience of dreams
* Oneiromancy
* Thought recording and reproduction device

* v
* t
* e

Psychophysiology: Sleep and sleep disorders (F51 and G47 / 307.4 and 327)

Sleep stages|

* Rapid eye movement (REM)
* Non-rapid eye movement
* Slow-wave

Brain waves|

* Alpha wave
* Beta wave
* Delta wave
* Gamma wave
* K-complex
* Mu rhythm
* Sensorimotor rhythm
* Sleep spindle
* Theta wave

Sleep
disorders|

| Dyssomnia|

* Hypersomnia
* Insomnia
* Kleine–Levin syndrome
* Narcolepsy
* Sleep apnea
* Central hypoventilation syndrome
* Obesity hypoventilation syndrome
* Sleep state misperception

|

Circadian rhythm
disorders

* Advanced sleep phase disorder
* Delayed sleep phase disorder
* Irregular sleep–wake rhythm
* Jet lag
* Non-24-hour sleep–wake disorder
* Shift work sleep disorder

Parasomnia|

* Catathrenia
* Night terror
* Rapid eye movement sleep behavior disorder
* Sleepwalking
* Somniloquy

Other|

* Bruxism
* Cyclic alternating pattern
* Night eating syndrome
* Nocturia
* Periodic breathing
* Nocturnal myoclonus

Benign
phenomena|

* Dream
* Exploding head syndrome
* False awakening
* Hypnagogia / Sleep onset
* Hypnic jerk
* Lucid dream
* Nightmare
* Nocturnal clitoral tumescence
* Nocturnal emission
* Nocturnal penile tumescence
* Sleep paralysis
* Somnolence

Related
topics|

* Bed
* Bunk bed
* Daybed
* Four-poster bed
* Futon
* Hammock
* Mattress
* Sleeping bag
* Bed bug
* Bedding
* Bedroom
* Bedtime
* Bedtime story
* Bedtime toy
* Biphasic and polyphasic sleep
* Chronotype
* Dream journal
* Excessive daytime sleepiness
* Hypnopompic state
* Hypnosis
* Lullaby
* Microsleep
* Nap
* Nightwear
* Power nap
* Second wind
* Siesta
* Sleep and creativity
* Sleep and learning
* Sleep debt
* Sleep deprivation
* Sleep diary
* Sleep hygiene
* Sleep induction
* Sleep inertia
* "Sleeping sickness"1
* Sleeping while on duty
* Sleepover
* Snoring
* Somnology
* Polysomnography
* Sleep medicine

* 1 Not a sleep disorder.

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