Sleep & Nightmares
What is a nightmare?
A nightmare is a very distressing dream which usually forces at least partial awakening. The dreamer may feel any
number of disturbing emotions in a nightmare, such as anger, guilt, sadness or depression, but the most common feelings
are fear and anxiety. Nightmare themes may vary widely from person to person and from time to time for any one
person. Probably the most common theme is being chased. Adults are commonly chased by an unknown male figure
whereas children are commonly chased by an animal or some fantasy figure.
Who has nightmares?
Just about everyone has them at one time or another. The majority of children have nightmares between the ages of three
or four and seven or eight. These nightmares appear to be a part of normal development, and do not generally signal
unusual problems. Nightmares are less common in adults, though studies have shown that they too may have nightmares
from time to time. About 5-lO% have nightmares once a month or more frequently.
What causes nightmares?
There are a number of possibilities. Some nightmares can be caused by certain drugs or medications, or by rapid
withdrawal from them, or by physical conditions such as illness and fever. The nightmares of early childhood likely reflect
the struggle to learn to deal with normal childhood fears and problems. Many people experience nightmares after they
have suffered a traumatic event, such as surgery, the loss of a loved one, an assault or a severe accident. The nightmares
of combat veterans fall into this category. The content of these nightmares is typically directly related to the traumatic
event and the nightmares often occur over and over. Other people experience nightmares when they are undergoing
stress in their waking lives, such as difficulty or change on the job or with a loved one, moving, pregnancy, financial
concerns, etc. Finally, some people experience frequent nightmares that seem unrelated to their waking lives. These
people tend to be more creative, sensitive, trusting and emotional than average.
What can be done about nightmares?
It really depends on the source of the nightmare. To rule out drugs, medications or illness as a cause, discussion with a
physician is recommended. It is useful to encourage young children to discuss their nightmares with their parents or other
adults, but they generally do not need treatment. If a child is suffering from recurrent or very disturbing nightmares, the
aid of a therapist may be required. The therapist may have the child draw the nightmare, talk with the frightening
characters, or fantasize changes in the nightmare, in order help the child feel safer and less frightened .
The nightmares which repeat a traumatic event reflect a normal psychic healing process, and will diminish in frequency
and intensity if recovery is progressing. If after several weeks no change is noted, consultation with a therapist is
Adults' nightmares offer the same opportunity as other dreams for self-exploration and understanding. With practice, the
dreamer can often learn to decode the visual and symbolic language of the dream and to see relationships between the
dream and waking life. The nightmare by nature is distressing, however, and the dreamer may need to reduce the distress
before looking more closely at the meaning of the dream. Some techniques for reducing the distress of the nightmare
include writing it down, drawing or painting it, talking in fantasy to the characters, imaging a more pleasant ending, or
simply reciting it over several times. The more relaxed the dreamer can be while using these techniques the better. A
number of good books are available for learning how to understand dreams. Alternately, the dreamer may wish to ask a
therapist for assistance.
Sometimes nightmares are related to intense stress or emotional conflict that is best dealt with in consultation with a
therapist. One should not hesitate to consult a therapist when in doubt.
It may be surprising to learn that many people are not really disturbed by their nightmares, even though the experiences
themselves are distressing. Research has shown that about half of people who have quite frequent nightmares regard
them as fascinating and creative acts of their minds, and either view them as very interesting or dismiss them as "just
dreams". This illustrates the fact that one's attitude toward nightmares is quite important.
What about night terrors?
Night terrors are something quite different. Nightmares tend to occur after several hours of sleep, screaming or moving
about is very uncommon, the dream is usually elaborate and intense, and the dreamer realizes soon after wakening that
he or she has had a dream. Night terrors, on the other hand, occur during the first hour or two of sleep, loud screaming
and thrashing about are common, the sleeper is hard to awaken and usually remembers no more than an overwhelming
feeling or a single scene, if anything. Nightmares and night terrors arise from different physiological stages of sleep.
Children who have night terrors also may have a tendency to sleepwalk and/or urinate in bed. The causes of night terrors
are not well understood. Children usually stop having them by puberty. They may be associated with stress in adults. A
consultation with a physician may be useful if the night terrors are frequent or especially disturbing.