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Nightmares

You respond to a benign radio call; as you pull your patrol car around the corner you hear shots being fired. You call for back-up. You see the bad guy running toward you, you try to find cover. The bad guy pulls down, you try to fire your revolver and the cylinder starts to rotate but then the system slowly grinds to a halt almost as if instant rust has seized up the gun. You try again; you are shaking, you pull the trigger, but your weapon still won't discharge. You pull out your backup gun, you aim and fire but the bullets fall to the ground. Your beat partner arrives code three; he fires at the bad guy six times and each round hits him, but he just won't die. Everything is in extreme slow motion. You think you may have been hit.

Nightmares

Nightmares are disturbing visual dreams that cause intense fear. These dreams are complex and often fairly long. During the dream, the sleeper believes that their life or safety has been threatened. As the dream progresses, the threat to the person usually increases, as does their sense of fear. Waking usually occurs just as the threat or danger reaches its climax. After a nightmare, the individual becomes fully awake and is aware of his or her surroundings, and can remember the nightmare with considerable detail.

A frightening dream that does not wake you up is not considered a nightmare; it is simply a bad dream. Individuals may have more than one nightmare in a night. During the course of a nightmare an individual may moan, talk, or move slightly.

There are five stages of sleep that make up one sleep cycle. Most people complete four to six sleep cycles per night (a complete cycle takes about ninety minutes). Nightmares most commonly occur during the fifth stage of a sleep cycle (REM sleep) during the second half of the night. REM sleep usually constitutes about 20-25% of your total sleep time. The REM stage gets longer during each sleep cycle, which means that during the last sleep cycle a person may spend up to an hour in a dream or nightmare.

An individual who experiences recurrent nightmares may be diagnosed with a nightmare disorder. This diagnosis is only given when there is no evidence of PTSD, other sleep disorder, other mental illness or as a result of substance abuse. These nightmares must cause the individual significant distress in important areas of life.

Demographics

Nightmares are extremely common. Almost everyone has had them. Fifty to eighty five percent of adults report having a nightmare at least occasionally. Recurrent nightmares generally decrease and become less intense as individuals age, but for up to eight percent of the general adult population nightmares have been a chronic lifelong problem called a nightmare disorder. For those suffering from PTSD, the statistics are even more startling. One study demonstrated that 52% of combat Veterans with PTSD had nightmares fairly frequently.

Causes

The exact causes of nightmares are not known for certain. Approximately fifty percent of individuals who experience nightmares have an underlying psychological disorder, including PTSD or a nightmare disorder. The other most common cause of nightmares is attributed to life stressors and associated anxiety. Additionally, nightmares can be a side effect of certain medications (Prozac, Effexor, Levodopa); or amphetamine or stimulant drug abuse. Withdrawal from alcohol, barbiturates or benzodiazepines can also induce nightmares.

What Do Nightmares Mean?

Nightmares are typically classified into four categories or usual themes; being chased, attacked, falling or stuck. The dream content of a nightmare most often involves extreme danger. If you have experienced a traumatic event, you will likely have a nightmare about it. Experts contend that nightmares are caused by stress; unfinished business in the waking world. They also contend that the content of a nightmare is significant; your mind is telling you something. For example, if you dream you are trapped or stuck, you may feel trapped in real life.

Sleep Terror Disorder

A nightmare disorder can be confused with a sleep terror disorder. An individual having a sleep terror frequently screams, kicks, thrashes around and may even bolt out of bed. Sleep terror is characterized by a partial arousal from sleep during which the person is generally nonresponsive; it can be extremely difficult to awaken a person who is having a sleep terror. When he does wake up he is very confused, fearful, and anxious and will not be able to recall the sleep terror episode. Sleep terrors usually occur in deep non-REM sleep usually within an hour after the subject goes to bed. These episodes can last five to twenty minutes.

Nightmares and Post-traumatic Stress Disorder

Nightmares are also the most defining symptom of PTSD. Persons with PTSD generally report awakening from dreams that involve reliving the trauma they had previously experienced. These dreams involve intense emotions; rage, intense fear or grief, that would have been appropriate reactions to the original traumatic event. Nightmares related to PTSD usually happen during REM sleep but they may also occur at sleep onset.

Treatment

Frequent nightmares not only affect your sleep, they can have undesirable consequences during your waking hours. Recurrent nightmares can result in insomnia, sleep deprivation, anxiety, depression, irritability, poor concentration and difficulty functioning during the day.

Individuals should be assessed by a sleep specialist if they experience frequent nightmares. Sleep physicians do not typically treat nightmares. Sufferers are usually referred to an experienced counselor or psychologist.

Nightmare disorder and PTSD can last a lifetime; however, a general improvement in symptoms often takes place as the patient gets older. Treatment for any underlying psychological disorders can be very successful.

The most common cause of nightmares is stress. Reduction in stress can help an individual who suffers from nightmares. Psychotherapy with a competent psychiatric clinician allows the individual to help identify the underlying stressors and learn effective skills to deal with issues. Stress reduction techniques such as exercise, meditation, and yoga can also be extremely effective in decreasing stress. Relaxation training will help an individual return to sleep after a nightmare. Hypnosis has also been used to address nightmares. When PTSD is the cause of the nightmares systematic desensitization may work. This treatment gradually exposes the individual to the recurrent dream content.

Medications are not commonly used for nightmares, however, they may be considered in extreme cases. There are medications that can help by reducing the percentage of REM sleep. Research shows that Prazosin is effective in reducing PTSD nightmares.

By the way, have you ever experienced the nightmare of being naked in public? It does not reflect anything sexual. It most likely means you feel unprepared and are afraid that others will see your inadequacies.

Nightmares make lasting impressions upon us. Feelings from the terrifying dream can linger all day. However, nightmares do have a function. They serve as a personal wake-up call that something that is psychologically bothering the individual deep down and they are not dealing with it while they are awake.



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