- Dream and Nightmare Laboratory: FAQs and facts
- Frightening Dreams: The Nightmare
- Nightmares and Disorders of Dreaming
- 5 Mind-Bending Facts About Dreams
A peaceful night of slumber can leave you feeling more energized and alert when you wake up. But sleep quality As the saying goes, silence is golden.
Dream and Nightmare Laboratory: FAQs and facts
Sleeping in a noisy space not only disrupts the quality of your sleep, For many people, the moment of turning out the light and lying back on a soft pillow is the ultimate What Is Sleep Satisfaction? Sleep satisfaction , Diseases affecting the functioning of the brain such as narcolepsy, REM sleep behaviour disorder, Parkinson's disease. Many drugs can increase the frequency and intensity of dreams including dopaminergic drugs, beta blockers and antidepressants.
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Frightening Dreams: The Nightmare
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Nightmares and Disorders of Dreaming
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Nightmares are vivid and terrifying nocturnal episodes in which the dreamer is abruptly awakened from sleep. Typically, the dreamer wakes from REM sleep and is able to describe a detailed, associative, often bizarre dream plot. Usually, the dreamer has difficulty returning to sleep.
5 Mind-Bending Facts About Dreams
Nightmares are also common. In a two-week prospective study of college students, 47 percent described having at least one nightmare. Increased awakenings Daytime memory impairment and anxiety. Stereotypic dreams of the trauma Intense rage, fear or grief. Significant trauma Daytime hyperarousability and anxiety. Deep sleep, early in sleep period i. Stages 3 and 4 arousals on polysomnogram.
No pathology in children Psychiatric and neurologic disorders in adults.
Nightmares affect 20 to 39 percent of children between five and 12 years of age. They rarely define issues as being black and white, but instead see themselves and the world in shades of gray.
Nightmares are also associated with the use of medication, primarily those medications that affect neurotransmitter levels of the central nervous system, such as antidepressants, narcotics or barbiturates. Intense, frightening dreams may occur during the withdrawal of drugs that cause REM sleep rebound, such as ethanol, barbiturates and benzodiazepines Table 2. Medications that alter central nervous system neurotransmitter levels.
Monoamine oxidase inhibitors. Selective serotonin reuptake inhibitors. Beta blockers. Rauwolfia alkaloids. Alpha agonists. Levodopa Larodopa. Selegiline Eldepryl. Nightmares are a defining symptom in post-traumatic stress disorder PTSD. These nightmares are often associated with disturbed sleep and altered daytime behavior, which is best described as hyperarousability. The occurrence of PTSD following trauma varies. Thirty percent of veterans of the Vietnam War were affected by PTSD, as were 68 percent of veterans who were in the Arab-Israeli conflict of and 8 percent of veterans of the Gulf War.
However, among some groups of patients, such as immigrant psychiatric patients, the incidence of PTSD approaches 40 percent. The frequency of PTSD increases with severity of trauma, hostility, depression, poor health habits and poor coping skills. Persons with PTSD generally report awakening from dreams that involve reliving the trauma. In these dreams, they experience strong emotions, such as rage, intense fear or grief, that would have been appropriate reactions to the original traumatic event.
Nightmares related to PTSD generally happen during REM sleep but also occur at sleep onset, which can interfere with the initiation of sleep. This phenomenon is similar to that occurring in patients with narcolepsy. Symptoms of PTSD can persist for decades after the traumatic experience; however, the occurrence of PTSD after trauma is the exception rather than the rule. Nightmares can occur in patients with psychiatric illness. Depression is sometimes associated with themes of masochism and poor self-image in dreams. Panic attacks can occur during REM sleep in patients who have panic disorders and depression, and in patients who have asthma and breathing disorders of sleep.
The REM sleep rebound related to withdrawal from alcohol and sedative-hypnotics, which chronically suppress REM sleep, may present as disturbing nightmares.
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A strong association exists between REM sleep and dreaming. A variety of REM-associated parasomnias can alter dreaming Table 3. Arousal disorders usually associated with deep sleep. Information from The international classification of sleep disorders, revised: diagnostic and coding manual. Rochester, Minn. REM-sleep—associated apnea e.
REM behavior disorder most commonly affects middle-aged men. Patients with this disorder often present with a history of sleep-associated injuries to themselves or a sleeping partner. REM behavior disorder is characterized by vivid, action-filled, violent dreams that the dreamer acts out, sometimes resulting in injury to the dreamer or the sleeping partner. REM behavior disorder often occurs without concomittant pathophysiology, but can be associated with neurodegenerative neurologic disorders.
The most common of these disorders are Parkinson's disease, primary dementia and narcolepsy. Night terrors are nocturnal episodes of extreme terror and panic that usually occur early in the sleep period. Persons with night terrors are often difficult to arouse and have limited recall of their dream content. Adults who have night terrors are more likely than children to have psychopathology, mainly substance abuse and affective disorders. Often, nightmares and night terrors can be diagnosed on the basis of the patient's history.
In persons who have a history of nocturnal injuries, polysomnography is required to diagnose REM behavior disorder or nocturnal seizures. To diagnose REM behavior disorder, the use of additional electromyographic arm leads is required. In up to 25 percent of patients with epilepsy, the condition may present only as nocturnal seizures. Nocturnal seizures can be grand mal, petit mal, partial-complex, vegetative or paroxysmal nocturnal dystonias. All parasomnias more commonly affect persons who have breathing disorders during sleep. Polysomnography is appropriate for any patient with symptoms or signs of obstructive sleep apnea, such as daytime hypersomnolence, nocturnal hypoxia, loud snoring and increased neck circumference.
REM behavior disorder often occurs concomitantly with degenerative neurologic illnesses that may require further evaluation. In adults, the onset of arousal disorders such as somnambulism and night terrors may reflect underlying neurologic disease. Thus, neurologic evaluation, including imaging of the central nervous system, may be indicated. 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.
Clonazepam Klonopin , in a dosage of 0. Long-term efficacy and safety have been reported, along with relapse when the medication is discontinued. PTSD can be a short-term, limited problem or a lifelong, chronic illness that results in recurrent hospitalizations, impaired social relationships and aggressive or self-destructive behavior. Although many different approaches to treatment have had limited success, psychotherapy, individually or in a group setting, is generally indicated and can help with resocialization. Cognitive restructuring, eye movement desensitization and reprocessing therapy, prolonged exposure flooding therapy and nightmare imagery techniques can decrease symptoms in patients with PTSD for months after therapy.
Nightmares that occur after the patient has experienced trauma or stress may lead to an interpersonal integration of the event. On the other hand, long-term persistence the habitual pattern of recurrent nightmares not associated with recent trauma can cause a decline in daytime functioning without apparent benefit. Behavioral approaches in the treatment of nightmares have been successful and can result in short- and long-term reduction of nightmare frequency in more than 70 percent of patients.