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Nightmare sleep Disorder

Individuals who suffer from nightmare disorder DSM-5 307.47 (F51.5) have frequent dreams that brings about anxiety, fear. These nightmares involve the individuals being in dangerous situations that they are attempting to escape. Once awakening from the nightmare, the individual can readily and easily remember and recall these dreams. The frequency of nightmares increases through childhood into adolescence. Additionally, individuals who experience sleep deprivation or inconsistent sleep-wake schedules may be at a higher risk of developing nightmare disorder.

Diagnostic Criteria for Nightmare sleep Disorder

The DSM-5 criteria for nightmare disorder are as follows:

1. Recurrent episodes of extended, extremely dysphoric, and well-remembered dreams involving efforts to avoid threats to survival or security, or physical integrity. The nightmares usually occur in the second half of a major sleep episode.

2. On waking from the nightmare, the individual rapidly becomes oriented and alert.

3. The episodes cause significant distress or impairment in social, occupational, or other areas of functioning.

4. The symptoms cannot be explained by the effects of a drug of abuse or medication.

5. The nightmares cannot be attributed to another mental disorder or condition (i.e., posttraumatic stress disorder, delirium).

In addition, nightmare disorder is specified by duration: acute (<1 month), subacute (1–6 months), persistent (>6 months); and by the severity based on frequency: mild (less than one episode a week), moderate (multiple time a week), severe (nightly).

Psychotherapy and Pharmacotherapy for Nightmare sleep Disorder

Nightmare disorder can be treated in several ways, usually with therapy, medication, or a combination of both. Treatment isn’t usually needed unless one may be experiencing long periods of extreme distress or sleep disturbance, which can interfere with functioning. It’s always important to consider the cause of the nightmare disorder before starting treatment. Some suggested treatment are:

  • Medical Treatment: If there is underlying medical problem a medical treatment can target the underlying cause.
  • Stress/Anxiety Treatment: If stress or anxiety is the cause, stress-reduction methods or therapy may be utilized to help.
  • Imagery Rehearsal Therapy (IRT): Those who have nightmares due to PTSD may benefit from imagery rehearsal therapy. IRT works to change the ending of a remembered nightmare while awake. 
  • Medication: Though it is rarely used may be recommended to help those with PTSD suffering from severe nightmares, e.g. (Prazosin, Atypical Antipsychotics, Benzodiazepines, Clonidine, Gabapentin, Nabilone, SSRI’s, Topiramate, Trazadone, and TCA),

Clinical features

Nightmare disorder symptoms include repeated awakenings from the major sleep period with a detailed recollection of the extended and extremely frightening dreams, involving threats to survival, security, or self-esteem. There is no known single cause of nightmare disorder, but instead, there are various underlying or contributing factors. Common symptoms of nightmare disorder are; frequent intensely disturbing dreams that wake the patient, emotions such as anger and sadness, waking up with clear recall of the dream, difficulty falling asleep after the nightmare, and the occurrence of nightmares in the latter half of the sleep cycle.

References

American Academy of Sleep Medicine (2014). International Classification of Sleep Disorders. 3rd ed. American Academy of Sleep Medicine.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).Author.

Gabbard, G. O. (2014). Gabbard’s treatment of psychiatric disorders (5th ed.).

American Psychiatric Publications.

Karmos (2012) Do people really get nightmares from eating late?: http://www.health.harvard.edu/staying-healthy/do-people-really-get-nightmares-from-eating-late

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s synopsis of psychiatry: Behavioralsciences/clinical psychiatry (11th ed.).