Spooked Sleeping? Identifying Nightmares and Their Causes

You wake up, panting, from a deep sleep. You went to work naked. You fell into a bottomless pit. You got swept into a tornado, and then fought off a wicked witch and flying monkeys in an unfruitful trek to Oz. If any of this sounds familiar, join the club. Research suggests that more than 85 percent of adults occasionally experience nightmares—at least once a month for 8 to 29 percent, and once a week for 2 to 6 percent. If you're someone who snoozes peacefully through the night, understand that nightmares are no ordinary dreams. They're "vivid, disturbing dreams, with an emotional connection that tends to wake us up," says Matthew Mingrone, an otolaryngologist and lead physician for EOS Sleep California centers.
If your slumber resembles a bad horror movie, learning about your nightmares and why they happen may help you sleep better.

Nightmares vs. Sleep Terrors
First, recognize that nightmares are not night terrors. The latter, also known as sleep terrors, happen earlier in sleep, during a non-rapid eye movement (REM) stage. Typically, you'd wake up in the first 90 minutes of sleep, perhaps panicked and yelling, with a much fuzzier memory of the dream than you'd have after a nightmare. Your heart rate may jump to 180 beats per minute during night terrors, says Tore Nielsen, director of the Dream and Nightmare Laboratory and a psychiatry professor at the University of Montreal. He adds that folks with night terrors can be destructive when they wake up—by fighting or jumping from windows—and yet, they often don't remember the episode later.

If the idea of sleep terrors sounds, well, nightmarish, at least it's only a reality for about 4 or 5 percent of adults. For the 85 percent of us who get plain old nightmares, you know the drill. "Nightmares occur primarily in the last third of the night, when your REM sleep is the strongest," Nielsen says. So if you go to bed at 10, a night terror would wake you with a fright around 11:30 p.m., whereas a nightmare would haunt you closer to 6 a.m. Sometimes nightmares wake us up, and sometimes they don't, but we can almost always remember the nightmare's plot to some extent.
What Causes Nightmares, and Who Gets Them?
"There are post-traumatic dreams, and there are idiopathic ones, which means we really don't know where they come from," says Nielsen. "It hasn't been scientifically documented very well." Generally, idiopathic nightmares don't reflect traumas, but perhaps intra-personal relationships, like those with spouses or parents, Nielsen adds.
Stress and anxiety can also lead to nightmares, says Mingrone. Job losses, break-ups, failed tests—although they're not considered traumas per say, these stressful events can all trigger a bout of bad dreams.

Nightmares have also been linked to certain medications, specifically those that affect neurotransmitter levels, such as antidepressents, narcotics, or barbiturates, according to a 2000 report in American Family Physician. People with depression, those relapsing from schizophrenia, and those experiencing withdrawal from alcohol and sedative-hypnotics may also face a higher risk.
There's another crew of nightmare-prone people that the report mentions: "Creative persons who demonstrate 'thin boundaries' on psychologic tests." Nielsen deciphers: "For some people, their mental boundaries are thinner in that they have much more access to their imaginative and emotional lives."
Getting Back to Sleep (If You Can)
"I don't think you can get back to sleep immediately, because you might be emotionally aroused quite a bit, or afraid," says Nielsen, adding that, if you do try to reclaim a few zzz's, evoke whatever relaxation techniques you know, like deep breathing and progressive muscle relaxation. Or "meditate on positive experiences," Mingrone suggests.

If it's clear you're too wound up to fall back asleep anytime soon, it may be best to get up for a half hour or so. "It couldn't hurt to write down the nightmare so you can reflect on it later," Nielsen says, or "try to re-script the nightmare so it's more to your liking."

Treatment
Only about five percent of adults have a clinical problem with nightmares, in that the dreams are so frequent and/or severe that they seek help. "It's really a question of how much distress it's causing," Nielsen says. If the nightmares are regularly disturbing your sleep, then you should probably visit a sleep clinic, where specialists can diagnose if your only problem is nightmares, or if you have something more serious, like sleep apnea.
"Sleep deprivation is like having a loan out from the bank," says Mingrone. "You've got to pay the sleep debt back."

For some, relief may come not from a sleep clinic, but from a psychologist's office. "The best way to avoid nightmares is to deal with any underlying anxiety problems," Nielsen says. The deep dark secret; the car crash that scarred you; the wicked aunt-turned witch—if these stressors are seeping into your dreams and disrupting precious REM sleep, it may be worth hashing it out consciously, with a specialist.
At the end of the day, or rather, at the end of the scary night, most people don't need or want treatment for nightmares. In fact, many don't mind them. "Often people come in and say [their nightmares] are a source of creativity or they're quite interested in them." Nielsen says. "They don't want to lose them."

source: http://health.usnews.com/