A nightmare is a dream that occurs during sleep that brings out strong feelings of fear, terror, distress, or anxiety. Nightmares usually happen in the second part of the night and wake up the sleeper, who is able to remember the content of the dream.

See also:

• Generalized anxiety disorder
• Night terror
• Post-traumatic stress disorder
• Sleep disorders

Dreams - bad; Bad dreams

Nightmares tend to be more common among children and become less frequent toward adulthood. About 50% of adults have occasional nightmares, women more often than men.

Anxiety and stress are the most common causes of nightmares. A major life event occurs before the nightmare in some cases.

Other causes of nightmares include:

• Abrupt alcohol withdrawal
• Breathing disorder in sleep (sleep apnea)
• Death of a loved one (bereavement)
• Excessive alcohol consumption
• Illness with a fever
• Recent withdrawal from a drug, such as sleeping pills
• Side effect of a drug
• Sleep disorder (for example, narcolepsy or sleep terror disorder)
• Eating just before going to bed, which raises the body's metabolism and brain activity

If you are under stress, ask for support from friends and relatives. Talking about what is on your mind can help.

Follow a regular fitness routine, with aerobic exercise if possible. You will find that you will be able to fall asleep faster, sleep more deeply, and wake up feeling more refreshed.

Learn techniques to reduce muscle tension (relaxation therapy), which will help reduce your anxiety.

Practice good sleep hygiene. Go to bed at the same time each night, and wake up at the same time each morning. Avoid long-term use of tranquilizers, as well as caffeine and other stimulants.

If your nightmares started shortly after you began taking a new medication, contact your health care provider. He or she will let you know whether to stop taking that medication, and may recommend an alternative.

For nightmares caused by the effects of "street drugs" or regular alcohol use, ask for advice from your doctor on the safest and most successful ways to quit.

Contact your health care provider if:

• You have nightmares more than once a week
• Nightmares stop you from getting a good night's rest, or from keeping up with your daily activities for a long period of time

Your doctor will examine you, ask you questions, and possibly recommend tests. You may be asked any of the following questions:

• Time pattern
  • How often do you have nightmares?
  • Do they occur in the second half of the night?
• Quality
  • Do you wake up suddenly from sleep?
• Other issues
  • Do the nightmares cause you intense fear and anxiety?
  • Can you remember a particular nightmare (one with vivid images and a story-like plot)?
• Aggravating factors
  • Have you had a recent illness?
  • Did you have a fever?
  • Were you in a stressful situation recently?
• Other
  • Do you use alcohol? How much?
  • What medications do you take?
  • Do you take "street drugs?" If so, which ones?
  • Do you take natural supplements or alternative remedies?
  • What other symptoms do you have?

Tests that may be done include:

• Blood cell measurements
• Liver function tests
• Thyroid function tests
• EEG (which painlessly measures brain waves with electrodes placed on the head)

If reducing stress, medication side effects, and substance use do not improve the nightmares, your health care provider may want to send you to a sleep medicine specialist for a sleep study (polysomnography). In some cases, certain medications may help reduce nightmares.

Moore DP, Jefferson JW. Nightmare disorder. In: Moore DP, Jefferson JW, eds. Handbook of Medical Psychiatry. 2nd ed. Philadelphia, Pa:Mosby Elsevier;2004:chap 123.

Moser SE, Bober JF. Behavioral problems in children and adolescents. In: Rakel RE, ed. Textbook of Family Medicine. 7th ed. Philadelphia, Pa:Saunders Elsevier;2007:chap 33.