Nightmares

K K Jain MD (Dr. Jain is a consultant in neurology and has no relevant financial relationships to disclose.)
Originally released August 22, 1995; last updated September 18, 2017; expires September 18, 2020

This article includes discussion of nightmares, distressed dreaming, disturbed dreaming, dream anxiety attacks, and incubus. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.

Overview

American Academy of Sleep Medicine classifies nightmares as 1 of the REM sleep parasomnias and defines them as "disturbing mental experiences that usually awaken the dreamer from REM sleep." Nightmares are associated with several neurologic and neuropsychiatric disorders, which include Parkinson disease, posttraumatic stress disorder, schizophrenia, and temporal lobe epilepsy. Adverse effects of several drugs manifest as nightmares. This article includes a discussion of possible pathomechanisms and differential diagnoses of nightmares. Approaches to management include behavioral or psychological treatment programs as well as pharmacotherapy including drugs such as gabapentin and prazosin.

Key points

 

• Infrequent nightmares are common.

 

• Frequent nightmares may occur in association with some psychiatric and neurologic disorders.

 

• Behavioral or psychological treatment approaches have been used with a variable degree of success.

 

• Several pharmacological agents such as benzodiazepines and antiepileptic drugs have been used for symptomatic control.

 

• An alpha1-adrenergic antagonist prazosin has been proposed as a treatment for nightmares associated with posttraumatic stress disorder.

Historical note and terminology

The term "nightmare,” meaning a fearful awakening from sleep, appears in the medical literature as early as 1753. Jones quotes Bond's An Essay on the Incubus or Nightmare from that year, in which Bond describes nightmares as:

 

seizing people sleeping on their backs, and often begin with frightful dreams that are soon succeeded by a difficult respiration, a violent oppression on the breast, and a total privation of voluntary movement...[after which] they are affected with strong palpitation, great anxiety, languor and uneasiness which gradually abate and are succeeded by the pleasing reflection of having escaped such imminent danger (Jones 1951).

Two hundred years later, Jones stressed the same 3 components as the essentials of nightmares: (1) agonizing dread, (2) a sense of oppression or weight at the chest that interferes with respiration, and (3) a conviction of helpless paralysis. A term that is used interchangeably in the early literature is "incubus.” Other terms currently in use are "dream anxiety attack" and "disturbed (or distressed) dreaming.”

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