Understanding Nightmares and Sleep Terrors

A friend came to spend the weekend at my place because her fiance was travelling for business. While I enjoyed myself during the day and loved that she was around to have our girlie chats and we could unwind together at the poolside, the two nights she spent weren't the best for me. She would wake up to tell me she had a nightmare, and I began to wonder if she was manufacturing these images at every point when she closed her eyes. Writing this, I am laughing as I remember that every moment she closed her eyes, she was going into the dream world, but this time, it was going to be nightmares but in reality, it isn't funny you know. In my post, I will be looking at Nightmares and Sleep (night) terrors.

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The night can be very difficult for a person that has Parasomnia disorder, leading to an undesirable sleep disturbance that disrupts their sleep quality. Nightmares and Sleep (night) terrors can be categorized as sleep-wake disorders/Parasomnia disorders.

Nightmares disorder occurs during the rapid eye movement (REM) sleep stage. Let's not forget that in the REM sleep stage, the body is temporarily paralyzed, and the eyes move rapidly. While Parasomnia disorders are very common in children as a result of immature neural circuits, there are cases when there are neuroanatomical abnormalities causing Parasomnia in adults. Nightmares are vivid and usually portray in a story-like manner. they are dysphoric, causing fear, anger, sadness, and in a few cases disgust. Nightmare is common in young children, in fact, as a child, I used to have nightmares once in a while. About 2%-8% of adults have nightmare disorder, and like I said before that neurodegenerative conditions such as frontotemporal Dementia, and Lewy Body Dementia can increase the frequency of nightmares. Also, people who suffer from PTSD, Insomnia, depression, and anxiety disorder. People who have nightmare disorder often experience shortness of breath, sweating, and restless leg syndrome, and the patient may not wake up abruptly.

Nightmares can be posttraumatic or idiopathic. Posttraumatic nightmares occur as a result of real trauma in reality. It usually replicates part or all of a person's traumatic past event. People with Posttraumatic nightmares have increased nocturnal awakenings, feeling of helplessness, restlessness and a strong response to the nightmare. Idiopathic nightmares are nightmares not related to any prior traumatic event. These nightmares are usually imagery and not based on real-life events. Nightmares can also be divided based on timeframe into acute (Less than 1 month), subacute (1 to 6 moths), and persistent nightmares (Greater than 6 months).

Night (Sleep) terrors occur during the non-rapid eye movement (NREM) sleep stage, as a result of disruption in the slow-wave sleep stage or in some cases, as a result of Serotonergic dysregulation. Sleep Terror usually occurs in the first third part of sleep, and it is often accompanied by a partial awakening from Slow Wave Sleep. The images are vague, in some cases simple, and usually frightening images. Risk Factors for Sleep Terrors include stress, genetic predisposition, sleep deprivation, fever, Migraine headaches, alcohol usage and abuse, and medications. About 2.2% of adults have reported night terror, it is more likely to affect children between the age of 4 to 12 years old, than adults. People who just had Sleep Terror find it hard to remember the images, and they are often disoriented. Sleep terror comes with partial awakening, panicking, tachycardia, tachypnea (increased breathing rate), sweating, screaming, and crying in children, and agitation in adults.

Diagnosing Nightmare Disorder According to DSM-5 Criteria will be;

• Recurrent episodes of the nightmare, happen in the second half of the sleep episode.
• The nightmare can cause clinical impairment, or distress in social domains, or at work or school.
• Patient is alert when awakening from the nightmare.
• Not caused by another psychiatric or medical disorder.

Diagnosing Sleep Terrors according to the American Academy of Sleep Medicine:

• Partial and incomplete awakening episodes
• Episodes are accompanied by terror, vocalization and screaming
• The dreams have less imagery
• Partial or Complete Amnesia of dream images
• Episodes come along with tachycardia, diaphoresis, tachypnea, and mydriasis.

Treatments of Nightmare disorders include:

• Nightmare is developmentally normal in young children, most children outgrow it
• Avoiding Stress
• Anticipatory awakening
• Medication

Treatment for Night Terror includes

• Treating the underlying condition
• Waking a child with sleep terror is not a right idea, it is important that you provide comfort for the child.
  *Children outgrow sleep terror, and it is important to educate parents about it.
  *Breaking the sleep cycle could help reduce the likelihood of sleep terror.

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Post Reference

• Night Terrors
• A case of adult night terrors
• dysplasia
• What are Sleep Disorders?
• Night Terrors
• Nightmares and Night Terrors
• Aetiology and treatment of nightmare disorder: State of the art and future perspectives
• Nightmares
• Thematic and Content Analysis of Idiopathic Nightmares and Bad Dreams
• Management of Nightmare Disorder in Adults
• Sleep terrors (night terrors)