Thirty-three-year-old Ranjan Shah (name changed to protect privacy) had been experiencing persistent nightmares which would assail him with a terrifying force that he began to dread every time night fell.
While he had no history of trauma, he had of late been extremely stressed due to work-related issues but did not understand how this could traipse over to the night and interfere with his subconscious to appear as nightmares.
He sought the help of a professional who after a few discussions about his condition, prescribed him medication. “The medicines were only administered initially as we needed to curb the anxiety issues. Post that, we shifted him to therapy for almost six months. Slowly he started getting better with the incidence of one nightmare occasionally which is relatively normal as anybody can have a nightmare sometimes,” says Dr Trideep Choudhury, psychiatrist, department of mental health and behavioural sciences, Fortis, Vasant Kunj, Delhi.
What are nightmares?
According to The Diagnostic and Statistical Manual of Mental Disorders (fourth edition) and the International Classification of Sleep Disorders (second edition), nightmares are intensely disturbing dreams that awaken the dreamer to a fully conscious state. They generally occur in the latter half of the sleep period.
Nightmares are not the same as bad dreams. A bad dream will wake one up during the night, while a person might continue sleeping through a nightmare.
Nightmare disorder
Nightmares, if they occur frequently, could indicate a condition called nightmare disorder.
If the frequency of the nightmares is less than one per week, it is called mild nightmare disorder. If the frequency is one to two a week, it is called a moderate disorder; if it is every night, it is considered a severe disorder. That is when one should seek professional help, experts say.
What causes nightmares/nightmare disorder?
The cause of nightmares could be either related to post-traumatic stress disorder (PTSD) or idiopathic in nature (nightmares with unknown aetiology, and unrelated to a specific traumatic event or PTSD).
According to Dr Monika Sharma, chief consultant and researcher, behavioural sleep medicine and founder of Sleep Moksha, Delhi, “Nightmares [if it is PTSD] are complex issues and a full-blown psychiatric disorder; it can continue for 40 to 50 years after the original trauma. As for the less harmful idiopathic ones may be due to sleep onset or insomnia, frequent awakenings, worse sleep quality, asthma, snoring and sleep apnea.”
According to a paper published in the Journal of Sleep Research, both traumatic experiences and early childhood adversity facilitate distress and the development of a nightmare disorder.
Idiopathic nightmares when compared with nightmares due to PTSD, are associated with less frequent and shorter awakenings, that is, thresholds to arousal are high in idiopathic nightmares compared to that in PTSD. Moreover, idiopathic nightmares tend to occur comparatively in the latter parts of the sleep than in PTSD-related ones.
What are the themes in a nightmare?
Most often nightmares contain themes of catastrophe.
According to the study, ‘Thematic and Content Analysis of Idiopathic Nightmares and Bad Dreams’ by Geneviève Robert and Antonio Zadra from the department of psychology, Université de Montréal, dreamers are usually the victim of death, physical injury and social affront, with unsuccessful attempts to cope with danger.
The predominant emotions when a person wakes up from a nightmare are fear and anxiety.
Can a nightmare disorder be treated?
“Treatments could be behavioural interventions with imagery rehearsal therapy. This is currently the treatment strategy recommended for all people with idiopathic nightmares. Here the nightmare is initially recalled and then it is written down with details of emotional sensitivity. It is then read by the client (patient). After that, the theme is modified to make it more favourable with the end of the story being changed and rewritten. The rewritten dream is then rehearsed so that it becomes more acceptable and replaces the nightmare if it occurs. Some studies say that pharmacotherapy [treatment of a disorder with medication] using alpha antagonists [alpha blockers] like prazosin may be used, but other studies say it is ineffective in idiopathic nightmares and effective only in nightmares due to PTSD,” explains Dr Choudhury.
