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Nightmare Disorder: Symptoms, Causes, Treatments

Written by Andrew

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scary nightmare woods

Most people have woken up from a nightmare in the middle of the night, sweaty, scared and momentarily convinced that the monster under our bed is all too real.

Most people proceed to come to their senses and fall back asleep, knowing their nightmare was a strange apparition that goes away as mysteriously as it comes.

But imagine if it came again. And again. And again.

Enter nightmare disorder—a sleep condition characterized by recurrent, vivid dreams that induce feelings of terror, stress or severe discomfort. This is not your run of the mill dream about being late for class, but something much more serious. Living with nightmare disorder is like being haunted by Freddie Krueger, a looming specter that threatens to make sleep a terrifying experience.

Read on to learn what we know about the symptoms, causes and potential treatments of nightmare disorder.

Symptoms of Nightmare Disorder

It’s probably redundant to acknowledge that nightmares are at the heart of nightmare disorder. Most people are familiar with the characteristics of a nightmare. They are dreams in which we experience extreme fear, stress, terror or any other very unpleasant feeling. Typically we wake from these dreams with a start or recall them with bitterness in the morning. But they are fleeting most of the time.

With nightmare disorder, these unpleasant events happen with alarming frequency. Essentially, nightmares become a disorder when they occur so often that it begins to affect a person’s waking life.

According to the Mayo Clinic, these are the symptoms that set nightmare disorder apart from simply having a nightmare:

  • Frequent occurrences
  • Major distress or impairment during the day, such as anxiety or persistent fear, or bedtime anxiety about having another nightmare
  • Problems with concentration or memory, or you can’t stop thinking about images from your dreams
  • Daytime sleepiness, fatigue or low energy
  • Problems functioning at work or school or in social situations
  • Behavior problems related to bedtime or fear of the dark

While nightmares are common, it is relatively rare that people develop diagnosable nightmare disorder at all. The American Academy of Sleep Medicine (AASM) reports that only 4 percent of all people suffer from nightmares so severe as to be diagnosed with nightmare disorder.

The Causes of Nightmare Disorder are Mixed

Nightmares occur from a complex web of factors. The AASM lists the following conditions as possible triggers or factors that can increase the chance of having regular or intense nightmares:

  • Another sleep disorder
  • A medical condition
  • Medication use (especially antidepressants, medicine for Parkinson’s disease and medicine for hypertension)
  • A mental health disorder such as depression, anxiety, stress or post-traumatic stress disorder
  • Substance abuse
  • Poor sleep hygiene (irregular, poor sleep)
  • High stress levels

Additionally, there is some evidence that adult women experience nightmares more often than men do. However, researchers also note that women tend to be more open and honest when discussing their dreams.

Children are also more prone to nightmares than adults. While it’s rare that children get diagnosed with nightmare disorder, they are much more likely to suffer from severe nightmares that interfere with sleep.

Nightmare Disorder is a form of Parasomnia

Parasomnias are a very specific type of sleep disorder characterized by unconscious, unintentional and otherwise unwanted physical acts that occur when we sleep. They have also been called “partial arousals,” for they put our bodies and minds in the strange area of showing signs of being awake and asleep at the same time.

Other parasomnias include sleepwalking, sleep terrors, REM behavior disorder, sleep paralysis, confusional arousal and more. While each of these is slightly different, they group them based on what part of the sleep cycle they take part in.

Nightmare disorder, along with sleep paralysis and REM sleep behavior disorder, takes place during the rapid eye movement (REM) stage. During this time, vivid dreams are common; as a result, many of the parasomnias occurring during REM sleep are linked to dream-like experiences. Like dreams, but unlike non-rapid eye movement (NREM) parasomnias, REM parasomnia episodes can often be recalled the next morning.

woman lying awake

Diagnosis and treatment options

There is no specific test or metric that a doctor will use to diagnose patients with nightmare disorder. If you feel that nightmares are severely disturbing your sleep, your doctor will likely spend time talking through your symptoms and possibly giving you a physical exam. If they believe the cause of your nightmares may be related to another underlying sleep disorder, it is common to prescribe an overnight sleep study. This will help clinicians offer an accurate diagnosis of your sleep habits and rule out any confounding sleep disturbances.

If you are diagnosed with nightmare disorder, there is treatment available to many patients. Some of the most commonly prescribed treatment options include:

  • Treating underlying medical conditions: Since nightmare disorder is often seen in conjunction with other medical conditions, treating underlying problems can greatly decrease the frequency and intensity of nightmares. Mental health issues like stress, anxiety, depression and especially PTSD are commonly cited as factors. Which leads to the development of nightmare disorder.
  • Changing sleeping habits: Improving sleep hygiene can help reduce the chance that nightmares will occur. Making sure to consider how any recent changes made to diet, lifestyle and schedule will affect sleep is a good first step. Avoid consuming media or any disturbing content close to bedtime, as well as caffeine and alcohol. If you find the themes of your nightmares to be related to any content you are consuming, try avoiding it completely.
  • Therapy: Some therapies have been recommended for the treatment of nightmare disorder. Cognitive-behavioral therapy has proven effective, especially for patients suffering from PTSD. Image rehearsal therapy, in which individuals are coached on how to replace negative images with positive ones in their dreams, also shows promise. Some evidence even suggests hypnosis may improve prognosis.
  • Medication: Certain medications are sometimes prescribed to patients to help alleviate the symptoms of nightmare disorder. Talk to your doctor about what may be right for you and take care to discuss any current medication you already take for other conditions, as these may conflict with new medications or be what’s exacerbating your nightmare disorder in the first place.

 

What Are Nocturnal Emissions? (AKA Wet Dreams)

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There’s no getting around the awkwardness of this topic. It’s one of those things that is much more easily joked about than discussed in any semblance of seriousness. So, like all subjects that are “too taboo” to warrant open conversations, misinformation and ignorance fog over most people’s understanding of the actual science and physiology behind nocturnal emissions. The result is that too many people, especially those most prone to experience them, feel shame or worry about something that is completely natural.

young man sleeping

Our goal here is to push past that initial discomfort and bring to light all that we know about nocturnal emissions so you can feel confident in understanding what they are, how they work and why there should be no stigma surrounding a phenomenon that is more common than you probably know.

What exactly are nocturnal emissions?

Nocturnal emissions are more commonly referred to outside of the medical community as “wet dreams.” They are rooted in a wider phenomenon known as nocturnal orgasm; this is the act of reaching a sexual climax while asleep and is a normal experience that both men and women can have.

Nocturnal emission refers to a situation when an orgasm results in the ejaculation of semen from the penis for men or significant vaginal lubrication for women during sleep. According to the International Society for Sexual Medicine, both women and men experience nocturnal orgasms and nocturnal emissions, though it is possible to have an orgasm during sleep that does not result in an emission.

It is also important to note that having either a nocturnal emission or orgasm does not require masturbation or the touching of genitals at all. Sometimes clothes or bedding material may work to stimulate the genitals, however.

What causes nocturnal emissions?

Most people who have discharges during the night will cite an accompanying dream as the cause of their experience.

A widely cited statistic stemming from a 2007 paper in the American Academy of Sleep Medicine holds that about 8% of all dreams had by sexually mature men and women involve sexual activity. The paper also claimed that half of those dreams, about 4%, resulted in orgasm. While direct sexual intercourse with another person was the most commonly reported act in these dreams, people also reported having dreams involving, “sexual propositions, kissing, fantasies and masturbation.”

In any case, it is not always certain that achieving orgasm in a dream will result in nocturnal emissions. Nor is it the case that all nocturnal emissions or nocturnal orgasms for that matter are linked to dreams that can be recalled the next day. In other words, it is possible that a person may have no recollection of a sexual dream even if they find they have experienced nocturnal emissions while they slept.

There is anecdotal evidence claiming that, among males, the frequency of wet dreams may be related to the frequency of ejaculation in waking life. One sex researcher explained in an interview with an online publication that men may experience nocturnal emissions as a way to be rid of older sperm in favor of more potent, and more “fresh” sperm.

Furthermore, sexually mature males often experience erections during rapid eye movement sleep (REM), a part of the sleep cycle in which dreaming occurs the most and at its most intense. Sexual dreams, combined with erections and possible stimulation against bedding materials, can also result in emissions as well.

Who is most likely to experience nocturnal emissions?

The most common demographic associated with nocturnal emissions is, surprise surprise, young men entering puberty. It has been reported that for many young men around the ages of 11 to 16 when puberty typically begins, nocturnal emission may be their first experience with ejaculation or sexual arousal. Generally, these episodes decrease over time for men.

But despite popular belief, any sexually mature person may experience nocturnal orgasm and emission regardless of their age or gender. The onset of puberty typically marks the opening of a window of possibility that lasts an adult’s entire life.

But there is a troubling lack of research on the topic of nocturnal orgasm and emissions. Perhaps due to the taboo associated with the subject, or to the logistical difficulties of studying such a phenomenon, not enough data exists to provide an accurate breakdown of what groups experience nocturnal emissions most frequently.

woman sitting up in bed

Are there any negative effects of experiencing these?

There is no scientific evidence that nocturnal emissions result in any type of negative health outcomes for either men or women at any age. Nor do these emissions seem to be a symptom of any larger health concerns.

In fact, experiencing emissions during sleep is a healthy, normal part of sexual maturation. It indicates that individuals are sexually healthy and able to achieve orgasm. For many people, the experience is overwhelmingly pleasurable, as the dreamed sexual scenarios leading to nocturnal orgasm can theoretically indulge sexual fantasies that might not be otherwise possible in waking life.

The negative outcomes of nocturnal emission are more likely to be related to the logistics of cleaning semen or excess vaginal fluid out of the bedding a person sleeps and nocturnally emits in. Sometimes this can cause sleep disturbances if a person is forced to change their bedding in the middle of the night.

There is also a significant risk of embarrassment or shame associated with the act, especially for younger people who may be less educated on sexual health. It is therefore important that parents and caregivers of children entering puberty to make information available about the normalcy of wet dreams, while still allowing them some level of privacy when it comes to their own habits. Establishing a baseline of sexual education with young adults will ensure they view this common, healthy occurrence with the objectivity necessary to prevent negative feelings should it occur.

 

Your Complete Guide to Lucid Dreaming

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You may have heard the stories of lucid dreaming. Perhaps you have a friend who raves about it. There’s certainly no shortage of articles and YouTube videos waxing poetic about this near-magic experience.

But… is it really possible to control your dreams?

In short, yes it is.

Dreaming to fly

Far from fiction, lucid dreaming is real and possible to achieve. Like any artistic or athletic feat, it is an ability that must be cultivated over time. It requires practice and dedication to achieve success, though the rewards can be immense.

Learning to achieve this requires a bit of background on the science of dreaming, as well as a brief understanding of the sleep cycle. It also requires regular practice and adherence to a strict sleeping routine.

But, if you learn to master the art of lucid dreaming, you will gain access to one of the most interesting realms of human consciousness. Blending reality with fantasy, and control with imagination. Read on to learn about the basics of lucid dreaming, and how to go about experiencing it for yourself.

The Basics: What Is Lucid Dreaming?

While we will go into a short description of the science of lucid dreaming in this article, you can also check out our more in-depth piece on the subject here. If you are really interested in mastering the art we recommend checking out both.

Lucid dreaming, in a nutshell, refers to the sensation of being able to control your dreams. More precisely, the National Sleep Foundation defines it as, “extremely vivid reveries where the dreamer is aware that he or she is dreaming.” The key is that the person has an awareness that what they are experiencing is a dream, though they retain agency to control their actions and thoughts inside of that world.

The science of why this happens is still murky, to be sure. Our most vivid dreams take place during the REM stage of the sleep cycle, which is characterized by intense brain activity and body paralysis. Lucid dreaming occurs during this stage as well—though studies indicate that human brain activity during a lucid state looks much different than it does during a typical dream. This lucidity is created by, or perhaps leads to, brain activity that has qualities of both sleep and wakefulness.

What Can I Expect When Lucid Dreaming?

Lucid dreaming is a strange experience. Over half of all adults have experienced lucid dreaming, so you may already be familiar with the sensation. But if you are not, you can expect an interesting mix of the fantastical and the mundane.

As mentioned before, lucid dreaming is a kind of skill that can be cultivated over time. The more you do it, the more control you will likely feel over what occurs and what you are able to do in your dream. Many people think they are quite scary, especially at first. It can feel like an all-too-real nightmare that you can’t quite wake from.

practicing magic while learning lucid dreamingBut the more you practice having them, the more comfortable you will be within them. People who are experts in the state claim they are able to experience things like flying, meeting famous people or dead relatives. Even traveling to places they’ve never before seen. The main takeaway is that you will likely be able to control your body, and the environment around you too if you practice the craft enough.

Please note, however, that lucid dreaming looks different for everyone. It might terrify some while others find it joyous. It all depends on you, and what you are comfortable with.

The Steps

With all these things in mind, here are a few tips that experts say will allow you to experience lucid dreaming, and even get better at it as time goes by. We’ve broken this section up into the steps you can take to prepare while you’re awake. And what things you can do while you are dreaming.

While you’re awake:

  • Keep a dream journal: Write down anything you can recall, as soon as you wake up. This will help you to recognize the patterns and sensations that reoccur during your subconscious. The technique works because the more you can recognize these things, the better chance you will have of becoming aware you are dreaming which helps guide you to a state of lucidity.
  • Keep a regular sleep schedule: The more you are able to stick to a set time for going to bed and waking up, the better chance you have of maintaining the healthy sleep cycles necessary for entering the REM state and thereby giving yourself a better chance to dream and be cognizant of the fact that you are dreaming.
  • Meditate before bed: Relaxation is important for good sleep, as well as dreaming. Meditation before bed will help you to relax the mind enough for sleep and provides you with the added benefit of relieving some of the anxiety that might contribute to nightmares or sleep anxiety.
  • Count, repeat and visualize: As you lie in bed ready to sleep, count down from 100 while repeating the phrase “I’m having a dream,” in your head. It sounds corny, but the more you remember to acknowledge that you are dreaming, the likelier you will. Visualizing the type of dream you want to have is helpful as well.
  • Wake up and go back to bed: You can also set an alarm to go off during the middle of the night, about 4-6 hours after you’ve gone to bed. When you wake up, get back in bed and repeat the visualization step above. This will help stimulate your body by going into the REM state. This is where you have the best chance at a lucid dream.

When you think you might be dreaming:

Soaring through the clouds in your dreams

  • Learn to do “reality checks”: If you’ve seen the film Inception, you might be familiar with this exercise. This means coming up with a way to see if what you are experiencing is reality or… something else. It can be as simple as staring at your hand to make sure it looks the way it should. Or as complicated as throwing a ball up in the air to check that physics conforms to regular life on earth.
    In Inception, Leo DiCaprio spins a top to check whether it falls over, as it would in real life. You might look weird doing this in your day-to-day life. However, as time goes on the habit will stick and you are likely to perform these checks in your dreams.

Lucid Dreaming: Fact or Fiction

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Imagine lucid dreaming (LD) a bit like this: You walk up to the edge of a cliff. Wind blows through your hair and ruffles your clothes as you peer over into the abyss. But instead of fear, you feel excitement. You bend your knees, raise your arms, and all of a sudden, you shoot up into the sky and begin flying.

Dreaming boy in a field

Somewhere between your first midair loop-de-loop and the moment when you hover directly across from a plane carrying all of your exes and elementary school teachers you have a realization…you’re not awake, in fact, you’re still in bed.

Such is the purported course of the much-discussed lucid dream—a situation where a person becomes aware that they are dreaming. Most of the time we experience dreams in the same way we experience everyday life, assuming what we see and feel is reality. But in this case, it breaks down, allowing us to navigate the strange world of our subconscious minds with some degree of awareness.

So what exactly is this experience? Are there benefits to it? Could it be dangerous?

What is Lucid Dreaming?

Lucid dreaming refers to the phenomenon in which people having dreams become subjectively aware that they are not experiencing everyday normal reality, but are in fact in a dream state. In its most simple form, a dream can be considered lucid if this awareness check is present. However, these sleepers also frequently report an ability to have control over certain aspects of their dreams, including the setting and people that appear or the actions that take place.

As fantastical as it sounds, lucid dreaming is also surprisingly common. The National Sleep Foundation reports that over half of all people say they have had at least one in their life. Like most, lucid dreams usually begin during the rapid eye movement (REM) portion of the sleep cycle, a time when our brains are extremely active.

However, scientists are still very much unsure about the exact physiological mechanisms that cause this type of dreaming.

One 2008 study examined the hypothesis that lucid dreaming might be a kind of hybrid state between wakefulness and dreaming. The experiment aimed to measure the brain activity of dreamers as they moved from normal REM state into states of lucid dreaming. Their results indicated that lucid dreaming may be a sort of hybrid state in which the brain demonstrates activity usually seen in REM sleep as well.

man happily having a lucid dreamMore recent studies have also confirmed that brain activity during lucid dreaming episodes is measurably different from what is typically seen during REM dreaming.

What are benefits to lucid dreaming?

A quick web search online will net hundreds of thousands of results focused on trumpeting wonders of this strange phenomenon. Videos on the subject rack up millions of views. Why is there so much interest in the subject?

The answer could lie in the purported benefits of the activity.

For one, there is the intangible yet most obvious benefit—a technique to potentially control everything that happens in a fantasy world. This could mean gaining the ability to fly, having romantic encounters with whomever you choose, or any other thing one could imagine. For many people, this is reason enough to attempt lucid dreaming.

Another potential benefit is that lucid dreaming may allow people who suffer from frequent nightmares to confront their fears. In combination with therapy designed to teach people how to respond to nightmare situations, becoming lucid during such an episode can allow people to break their typical response habits, and realize there is nothing to fear by confronting the imagined stressor in your imagination.

Others have pointed out that lucid dreaming could be helpful in reducing anxiety, as well as increasing motor skills. Keeping a journal or log during the night and often performing reality testing can yield better results.

Can LD be dangerous?

First and foremost, there is no evidence that dying during one of these events will result in death, despite mountains of anecdotal examples in pop culture. Falling from the sky mid-flight while sleeping may be terrifying, but you are much more likely to wake with a start when you hit the ground than you are to never wake again. Sorry, Christopher Nolan.

That being said, these types of events have been linked to some negative outcomes due to the way it seems to disrupt the normal sleep cycle. One opinion article by sleep researchers analyzed many of the most prevalent experiments on lucid dreaming and determined that there was significant evidence to, “fear an adverse effect on sleep and health of a regular use of LD induction methods or of an increased LD frequency…”

Since lucid dreaming occurs in a state outside of the normal stages of sleep, they argue, significant time spent lucid dreaming might mean people do not spend the appropriate amount of time in those regular stages while asleep. This in turn could result in sleep deprivation and lead to drop-offs in health and wellness.

Some sleepers who engage in the practice often have also reported difficulty distinguishing reality from dreaming over time, a phenomenon known as derealization. This is relatively uncommon for lucid dreamers, but can be a very dangerous condition that requires medical intervention.

lucid dreaming at night in the dark woods

Lucid dreaming has also been linked to narcolepsy, a sleep disorder that has demonstrable negative effects on health. Growing evidence suggests that narcoleptics, who are prone to suffering from disturbing nightmares, could benefit from lucid dreaming as a way to combat the trauma of such disturbing experiences. A 2015 study out of the Max-Plank-Institute of Psychiatry in Germany found that 70 percent of narcolepsy patients reported relief from nightmares when they gained this level of control during their dreams.

With these things being said, there seems to be much more enthusiasm for the potential benefits of lucid dreaming than there is caution against its negative outcomes. Like most things in life, moderation appears to be the key to success when it comes to training your mind on this technique.

 

 

Your Sleep Guide to Dreaming

Written by Andrew

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There isn’t a more mysterious, more hotly debated, or more baffling activity of the human brain. For as long as we have been sleeping, we have been dreaming. For just as long, we have been theorizing and experimenting and wondering just how and why our brains take us on those strange nighttime journeys.

Dreaming 101

Some say they are a reflection of the unconscious—famously, Sigmund Freud and Carl Jung built immense psychological theories around that idea. The odd symbolism we encounter when dreaming can sometimes feel like it has roots in our everyday life.

“The dream is a sort of substitution for those emotional and intellectual trains of thought”
-Sigmund Freud

But what do we know for sure about dreaming? In recent years, and especially since the advancement of modern neurological monitoring techniques, scientists know more than ever about what is really going on in our heads when we enter a dream state.

Man in bed daydreaming

What exactly are dreams?

We all know what it feels like to have one. There is the feeling of awakeness, that you are moving around in the world interacting as if you weren’t in bed asleep. Often there are little bits of strangeness to the scenarios we encounter. Symbolism, unreality, and emotional response are all common elements of imagination.

Early interpretations of their meaning were rooted in the idea that during sleep, humans were able to bridge some gap between two worlds. That idea later morphed into the Freudian concept of dreams being a portal into the unconscious mind. In both cases, dreams were seen as a way to experience some revelatory journey of meaning for the dreamer–a play of sorts designed to discern deeper meaning in our lives.

Today, scientists view them as more of an intentional act of our physical body than a passive experience for our mind. Modern technology, especially the EEG machine and discovery of sleep cycles, has allowed us to peer into the dreaming brain to discover a tremendous amount of neurological activity taking place.

What happens when we dream?

In many ways, your nighttime brain activity is simply one more piece of the complicated process of recovery which our brains undergo every night when we sleep. As we move through the sleep cycle and our brain moves from one task to another, we actually experience different types of fantasies, suggesting that our imagined experiences are linked directly to our brain activity.

During non-REM sleep, studies have shown that people do have dreams, though they are often more like hazy memories than crazy fantasies. These dreams are also much more difficult to remember, even if one is woken up right in the middle of it.

During this phase of sleep, brain activity in the hippocampus is focused on memory consolidation, or the process of taking processed experiences from the day and turning them into long-term memories. It may be the case that non-REM dreams are somehow a consequence of that function.

Woman smiling and dreamingScientists have linked the most vivid, bizarre and memorable types of dreams to REM (rapid eye movement) phase of the sleep cycle. This is likely related to the fact that REM sleep brings the highest levels of brain activity compared to any other phase. Scientists believe it is during this part of our sleep cycle that information from the day is processed so that it can later be transferred to long term memory during non-REM sleep.

Interestingly, this phase of the sleep cycle is also characterized by several physical changes, including most notably the back and forth pacing of the eyes, mixed with the relaxation of muscles elsewhere in the body. It has been theorized that this kind of intentional paralysis is intended to prevent our bodies from physically acting out our dreams.

Why do we dream?

Even though scientists have come a long way in breaking down the neurological characteristics of how we dream, the truth is that we are still not exactly sure why we dream.

Many believe, as discussed above, that dreaming is simply a by-product of the information organizing and storage processes that parts of the brain engage in as we sleep. Under this logic, dreams are a kind of abstract lens through which to view the content our brain is trying to codify and store for future use.

Another school of thought, called “threat simulation theory,” holds that our ability to dream evolved over time as a way to help us protect ourselves from threats in our environment. Scientists in this camp believe that dreams are an exercise of sorts, a kind of “dry-run” our minds can engage with and can practice reacting to threatening situations and themes.

Some sleep researchers still believe in dreams as manifestations of the Freudian subconscious and think that dreams provide our minds the ability to grapple with complex or troubling emotional concepts in an abstracted way.

All of these theories illustrate the lack of consensus in the community about dreaming’s value to the individual. But the good news is that research continues at a steady pace in this field. Much of that research will likely be published in the scientific journal dedicated entirely to the subject, aptly named Dreaming.

lady sleeping and smiling

Can sleep be productive?

Absolutely! Regardless of which theory you subscribe to, it is clear that all of them play a role in the idea that dreams have the ability to help us process complicated information. With that said, here are a few tricks to try and make the most out of your dreams:

  • Maintain a healthy sleep cycle: Good sleep hygiene will help ensure that you are getting to dream in the first place. Getting plenty of exercise, avoiding screens before bed, and limiting your alcohol and drug consumption will increase the likelihood that you move between the sleep cycles naturally.
  • Think about a problem you’d like to solve as you drift off: If you’ve ever been faced with a problem or difficult decision, you’ve likely been advised by someone, at some point, to “sleep on it.” There’s a reason this advice has endured. A good night’s sleep can be just what you need to come up with creative solutions to problems big or small. Try contemplating the situation at hand as you fall asleep and it’ll increase the chances that your brain will incorporate those concepts into your dreams. But if it is a problem that you’re meditating on, It’s important not to stress about it, as that may make it more difficult to fall asleep.
  • Keep a dream journal close to your bed: It can be hard to remember your dreams if you don’t write them down as soon as you wake up. The more time you spend trying to remember dreams, the better you become at it.
  • Try taking a nap: Short naps can be sneaky ways to hack our brain into lucid dreams. The secret to becoming a lucid dreamer lies in our tendency to fall into REM sleep quickly when napping— especially if we missed out on it the night before.