Have you ever been so terrified by a dream that you woke up in a panic? It’s normal. In fact, 80 to 90% of adults may have experienced a nightmare in their lifetime.

Nightmares are intermittent, or persistent recurring dreams that become so frightening they actually awaken the sleeper. Though most adults only experience nightmares from time to time, they are a recurrent problem for two to eight percent of the adult population.  They are also very common among children.

What causes nightmares?

“For years, people thought nightmares were related to some sort of personality issue, or there was psychopathology involved, whether it was depression or other psychiatric problems,” says Samuel Szumstein, M.D., a pulmonologist and sleep medicine specialist at Piedmont. “But there have been reports that 50 percent of people who have nightmares don’t have any pathology.”

Dr. Szumstein says adult nightmares can be triggered by: 

• Normal stress and anxiety
• Psychiatric disorders like schizophrenia
• Post-traumatic stress disorder (PTSD) or exposure to acute trauma
• Certain medications, like amphetamines, beta-blockers, sleeping pills and dopamine
• Withdrawal from alcohol, barbiturates and antidepressants

Why are nightmares so frightening?

Nightmares typically occur during rapid eye movement (REM) sleep, when the brain is most active, and the body is temporarily paralyzed. 

“We remember dreams much better when we have them during REM sleep,” Dr. Szumstein says. “And we have a much better recollection of the detail that goes from the beginning to the end of the dream. This is often very frightening to the sleeper. So they wake up and may have a little bit of anxiety.”

Nightmares belong to a category of sleep disorders called parasomnias, or unwanted experiences that occur during sleep.

“There is a lot of activity that happens throughout the night that is abnormal,” Dr. Szumstein says. “Nightmares are one of those that specifically occur during REM sleep.”

How do nightmares impact sleep?

"Nightmares wake people up, so it causes sleep fragmentation,” Dr. Szumstein says. “Sometimes people can’t go back to sleep, so it causes sleep deprivation. And a lot of times people are afraid to go to sleep because of the nightmare. And when that happens, you can have a lot of issues with insomnia and sleepiness, because you are not getting enough sleep.”

How to treat nightmares

Most adults don’t seek medical treatment for nightmares. But if they do become a recurrent problem, Dr. Szumstein says the main treatment is cognitive behavioral therapy.

 “It involves making a lot of behavioral changes and incorporates relaxation techniques,” Dr. Szumstein says. “Some people use imagery to try to desensitize the dreaming, so it won’t be as frightening.”

In very rare circumstances, patients with PTSD will have to start taking an antidepressant that suppresses REM sleep.  But this only occurs when nightmares affect sleep in a chronic and severe way.

To learn more about treatment for sleep disorders, visit Piedmont Sleep Services.

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