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 The Nightmare (Henry Fuseli, 1781)
uncomfortable position or having a fever, or psychological Detroit Institute of Arts
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 Nightmare
nightmares.[3]
Specialty Sleep medicine, psychology,
psychiatry
The prevalence of nightmares in children (5–12 years
old) is between 20 and 30%, and prevalence in adults Causes Stress, anxiety, fever
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.

Etymology
The word nightmare is derived from the Old English mare, a mythological demon or goblin who torments
others with frightening dreams. The term has no connection with the Modern English word for a female
horse.[5] The word nightmare is cognate with the Dutch term nachtmerrie and German Nachtmahr
(dated).

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] 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]

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] A panel from the early 20th century comic
Dream of the Rarebit Fiend, whose
Severe nightmares are also likely to occur when a person has protagonists regularly suffer nightmares
a fever; these nightmares are often referred to as fever after eating cheese.
dreams.

Recent research has shown that frequent nightmares may precede the development of neurodegenerative
diseases, such as Parkinson's disease and dementia.[20][21][22]

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.[23] 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:[24]

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[25] but also
improves other daytime PTSD symptoms.[26] 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".[27]

Medication
Prazosin (alpha-1 blocker) appears useful in decreasing the number of nightmares and the
distress caused by them in people with PTSD.[28][29]
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.[29]
Trazodone (antidepressant) has been shown in a case report to treat nightmares associated
with depressed patients.[29]
Trials have included hydrocortisone, gabapentin, paroxetine, tetrahydrocannabinol, eszopiclone, Sodium
oxybate, and carvedilol.[29]

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

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Further reading
Anch, A. M.; Browman, C. P.; Mitler, M. M.; Walsh, J. K. (1988). Sleep: A Scientific
Perspective (https://archive.org/details/sleepscientificp00anch). New Jersey: Prentice-Hall.
ISBN 978-0-13-812918-7.
Harris, J. C. (2004). "The Nightmare". Archives of General Psychiatry. 61 (5): 439–40.
doi:10.1001/archpsyc.61.5.439 (https://doi.org/10.1001%2Farchpsyc.61.5.439).
PMID 15123487 (https://pubmed.ncbi.nlm.nih.gov/15123487).
Husser, J.-M.; Mouton, A., eds. (2010). Le Cauchemar dans les sociétés antiques. Actes
des journées d'étude de l'UMR 7044 (15–16 Novembre 2007, Strasbourg) (in French).
Paris: De Boccard.
Jones, Ernest (1951). On the Nightmare. W W Norton & Company Incorporated. ISBN 978-
0-87140-912-6.
Forbes, D.; et al. (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 (https://doi.org/10.1023%2FA%3A1011133422340).
PMID 11469167 (https://pubmed.ncbi.nlm.nih.gov/11469167). S2CID 44630028 (https://api.
semanticscholar.org/CorpusID:44630028).
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 (https://archive.org/details/gothicfourhundre00dave). North Point Press. pp. 160–61 (ht
tps://archive.org/details/gothicfourhundre00dave/page/160). ISBN 978-0-86547-544-1.
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 (https://doi.org/10.1037%2F0033-3204.32.3.381).
"Nightmares? Bad Dreams, or Recurring Dreams? Lucky You!" (https://web.archive.org/web/
20120319134910/http://www.nightmares.info/nightmares.htm). Archived from the original (ht
tp://www.nightmares.info/nightmares.htm) on 19 March 2012. Retrieved 8 December 2015.
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 (https://doi.org/10.
1016%2F0272-7358%2887%2990041-9).
Doctor, Ronald M.; Shiromoto, Frank N., eds. (2010). "Imagery Rehearsal Therapy (IRT)".
The Encyclopedia of Trauma and Traumatic Stress Disorders (https://archive.org/details/enc
 yclopediaoftr0000doct). New York: Facts on File. p. 148 (https://archive.org/details/encyclop
ediaoftr0000doct/page/148). ISBN 978-0-8160-6764-0.
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 (https://doi.org/10.1037%2Fa00
19895).

External links
Night-Mares: Demons that Cause Nightmares (https://www.pitt.edu/~dash/nightmare.html)

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