Nightmare disorder

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Kiran Singh, M.D. [2]

Overview

Nightmare disorder is a sleep disorder characterized by frequent awakening from nightmares with a vivid remembrance of the dream. It is often caused by a major stressful event or from the use of SSRIs, such as Prozac and Effexor. Most cases reported begin at the age of 10 after a stressful life event. The frequency of the episodes is varied form person to person; generally one will suffer from three or four episodes every week.

Differential Diagnosis

• Bereavement
• Breathing-related sleep disorders
• Medication or substance use

• Antidepressants
• Amphetamine
• Antihypertensives
• Beta-adrenergic antagonists
• Cocaine
• Dopaminergics
• Melatonin
• smoking cessation aids

• Narcolepsy
• Nocturnal seizures
• Panic disorder
• REM sleep behavior disorder
• Sleep terror disorder
• Sleep-related dissociative disorders

Epidemiology and Demographics

The prevalence of nightmare disorder is:

• 6,000 per 100,000 (6%) monthly among adults

• 1,000-2,000 per 100,000 (1%-2%) frequently among adults

Risk Factors

• Genetic predisposition
• Irregular sleep-wake schedules
• Past adverse events
• Sleep deprivation
• Sleep fragmentation

Diagnostic Criteria

DSM-V Diagnostic Criteria for Nightmare disorder

“

A. Repeated occurrences of extended, extremely dysphoric, and well-remembered dreams that usually involve efforts to avoid threats to survival, security, or physical integrity and that generally occur during the second half of the major sleep episode. AND B.On awakening from the dysphoric dreams, the individual rapidly becomes oriented and alert. AND C.The sleep disturbance causes clinically significant distress or impairment in social, occupational,or other important areas of functioning. AND D.The nightmare symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication). AND E.Coexisting mental and medical disorders do not adequately explain the predominant complaint of dysphoric dreams. Specify if: During sleep onset Specify if: With associated non-sleep disorder, including substance use disorders With associated other medical condition With associated other sleep disorder Specify if: Acute: Duration of period of nightmares is 1 month or less. Subacute: Duration of period of nightmares is greater than 1 month but less than 6 months. Persistent: Duration of period of nightmares is 6 months or greater. Specify current severity: Severity can be rated by the frequency with which the nightmares occur: Mild: Less than one episode per week on average. Moderate: One or more episodes per week but less than nightly. Severe: Episodes nightly.

”