A nightmare is a dream occuring during rapid eye movement (REM) sleep that brings out feelings of strong fear, terror, distress, or extreme anxiety. Nightmares are usually in the latter part of the night and wake up the sleeper, who is able to remember the content of the dream.

See also:

• Night terror
• Sleep disorders

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 most 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
• Reaction to or side effect of a drug
• Recent withdrawal from a drug, such as sleeping pills
• Sleep disorder (narcolepsy, sleep terror disorder)

Eating just before going to bed, which raises the body's metabolism and brain activity, may cause nightmares to occur more often.

If you are under severe stress, ask for support from friends and relatives. Talking about what is on your mind can really help. Also, 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 also 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 you noticed that your nightmares started shortly after you began taking a new medication, contact your health care provider. He or she will let you know how to stop taking that medication if necessary, and can recommend an alternative.

For nightmares caused by the effects of "street drugs" or regular alcohol use, ask for advice on the best ways to quit. An Alcoholics Anonymous group, for example, might suggest a safe way for you to stop drinking without putting your health at risk. You can attend their regularly scheduled meetings. See also: Alcoholism - support group.

Also, look at your lifestyle -- friends, work, family -- to find and change factors that encourage substance abuse.

Contact your health care provider if:

• You have nightmares more often than on a weekly basis
• Nightmares stop you from getting a good night's rest and keeping up with your daily activities for a prolonged period of time

The doctor will examine you. The physical exam may include physical, neurological, and psychological tests. You may be asked any of the following questions:

• Time pattern
  • Do you have nightmares often (recurrent)?
  • 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?
  • Do you remember a frightening dream (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 tests (such as CBC or blood differential)
• Liver function tests
• Thyroid function tests
• EEG

If therapies for stress and anxiety, medication side effects, and substance use do not treat the problem, your health care provider may want to send you to a sleep medicine specialist for a sleep study (polysomnography). In very rare cases, patients need to take special medications that suppress or reduce REM sleep to prevent 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.