Psychology

Nightmares are frightening dreams that each and every individual has experienced at least once in life. It can be defined as a dream occurring during rapid eye movement (REM) sleep that arouses feelings of intense, inescapable fear, terror, distress, or extreme anxiety that usually awakens the sleeper (Harris, 2004). It is believed that nightmares are the result of a central nervous system response. Nightmares are dreams that occur during rapid eye movement sleep which result in feelings of fear, anxiety and extreme terror. Nightmares happen in the latter part of the night and make the sleeper awake. The sleeper will be able to recall the matter in the dream. Most nightmares may be a normal reaction to stress, and some clinicians believe they aid people in working through traumatic events (Harris, 2004). Frequent nightmares can be considered as a disorder. This disorder can negatively influence the social, personal, occupational and other crucial spheres of the life of the individual. It is often termed as repeated nightmares or nightmare disorder. Earlier it was termed as dream anxiety disorder. Repeated nightmares are otherwise explained as a series of nightmares that have a recurring theme. Nightmares are not considered normal unless they disturb sleep and other developments like psychosocial development. Nightmares are frequent in childhood and less common in adulthood. Nightmares start from the age of 10. Nightmares are found to be more common in girls than boys. Adult nightmares are mostly related to outside stressors or it can exist along with other psychological disorders. In both children and adults, night terrors, fears and nightmares are initiated by painful events, traumatic events and unresolved psychological conflicts. Emotional traumas (that are often overlooked by parents) can disturb the sleep of children. Emotional traumas and fears can make them vulnerable to nightmares. For example, loss of a favorite toy or watching a fight between parents can make children susceptible to nightmares. Even though nightmares, night terrors and fears need not be considered seriously, frequent occurrence of nightmares must not be ignored. 

Nevertheless, about 50 percent of adults experience occasional nightmares, women more often than men, and do not require any treatment (Harris, 2004). Stress or anxiety is considered as the most common cause of nightmares. In majority of the cases, a sudden event (painful, fearful or stressful) precedes the commencement of nightmares. Sleeping immediately after eating would increase brain activity and body metabolism. This may result in nightmares. In adults, prescription drugs like reserpine, beta blockers, levedopa, and antidepressants can makes nightmares. Sudden withdrawal from addictive substances can also trigger nightmares. Heavy drinking is yet another practice that can cause nightmares. Other drugs suspected of causing nightmares include heart drugs, antibiotics such as ciprofloxacin, antihistamines, appetite suppressers such as fenfluramine, antidepressants, Parkinsons drugs such as levodopa, and   ulcer drugs (cimetidine) (Harris, 2004). Other major causes of nightmares include
Death of a relative or loved one (bereavement)
Extreme fear for something
Illness accompanied by a fever
Side effects of a drug
Breathing disorders during sleep (sleep apnea)
Sudden alcohol withdrawal
Sleep disorders (sleep terror disorder, narcolepsy)
Individual who suffer from nightmares should share their problems with their friends and relatives. It is also recommended that the individual follow a regular and strict fitness routine. Proper aerobic exercises would be of great help. Proper physical exercise would help the individual have a deep sleep. This would lessen the chance of nightmares. The individual can also perform relaxation therapy to lessen muscle tension and thereby reduce anxiety.  Individuals who experience nightmares frequently are advised to seek help. People who suffer from nightmares are also asked by physicians to avoid continuous use of tranquilizers. They are also advised to avoid caffeine and other similar stimulants. If a person gets nightmare shortly after starting a new medication, he is advised to contact his health-care provider. He will be asked to stop using that medication and consider a better alternative. For nightmares caused by the effects of drug usage or persistent alcohol use, the individual is advised to seek counsel and treatment for discontinuing usage. The individual with nightmare is advised to seek the help of a health-care provider if nightmares are so frequent and prolonging. The individuals medical history and other background will be examined and physical examination would be performed to trace the real cause of the nightmares. Physical examination of the individual would include neurological, physical, and psychological examination. If treatment options addressing stress and anxiety, side effects of medication and substance use, do not resolve the problem, your health-care provider may send you to a sleep specialist who will perform a sleep study (polysomnography) (Harris, 2004). Patients will be given proper medication to induce good sleep, thereby preventing nightmares. The health-care provider will perform a detailed examination followed by a diagnosis that would relate the nightmares to the individuals personal medical record.
Medical history questions associated with nightmares include
Do you see nightmares frequently (repeatedly)
Do you see nightmares in the second half of the night
Do you suddenly, fully awake from sleep following a nightmare
Does nightmare intensify your fear and anxiety
Do you have any memory of frightening dream (are you able to recall the image or plot) 
Did you have any illness or fever recently
Any stressful or emotional situation happened to you recently
You consume alcohol How much How often
Do you use medications or drugs Which ones
Do you use natural supplements (home remedies or alternative medicine)
What all sleep difficulties you face 

Diagnosis of nightmares will be based upon the history of the individual. Certain individuals have major psychological problems that would result in nightmares or bad dreams. It is important to consider psychotherapy to pinpoint major life stressors, past traumatic events and depression that might be causing bad dreams (Harris, 2004). If the individual is taking some medications, he should consult with the prescribing physician to understand whether the pills are causing nightmares.

Chronic nightmares can also be treated using desensitization method. This treatment method makes use of the instruction regarding the rehearsal of the bad dream (night mare) and assuming a different end for it. In one study, patients were instructed to select a recent nightmare and write it down, change the nightmare in any way they wished, write down the changed version and rehearse the changed nightmare in an imagery relaxed state (Harris, 2004). Patients were asked to rehearse the new version of the dream once in a day for few (consecutive) days after each bad dream or until the dream completely vanishes away. It is believed that desensitization or rehearsal method would lessen distress and reduce the frequency of nightmares.
A proper night sleep is supposed to cure nightmare problems. Going to bed on a regular time and getting up on same time every morning is a healthy habit that would boost sleep. Sleep disruptions can result in insomnia and nightmare problems. Exercise is also believed to help the individual have a good sleep. Avoiding caffeine is yet another healthy step. Sources of caffeine include chocolate, coffee, soft drinks, non-herbal tea, diet drugs and few pain killers. Smokers have light sleep and they wake up early in the morning as their body is subjected to nicotine withdrawal. Alcohol robs people of deep sleep and REM sleep, keeping them in the lighter stages (Harris, 2004). Relaxing before bed time would help the individual have a good sleep. For example, a warm bath would relax the body and reduce stress symptoms that cause nightmares. Engaging in interesting activities during bedtime is also helpful. Waking up early in the morning and exposing body to sunlight would be a good step for having proper sleep. Doctors recommend exposure to morning sunlight for individuals who suffer from sleep disorders. People who suffer from nightmare are advised not to lie awake in bed. If not getting sleep immediately, it is best to watch TV, enjoy music or do something which is interesting to the individual. Maintaining comfortable temperature in the room is supposed to help people have good sleep that would eliminate the possibility of nightmares. Extreme heat or cold can trigger sleep problems. Scientists have been successful in locating the real reasons of nightmares and they have come up with measures that can control nightmares. In one experiment, subjects were trained to play the computer game, Tetris, involving the manipulation of pieces of a falling wall (Harris, 2004). The scientists monitored the subjects dreams over the first two nights, and more than half of the subjects reported dreaming of falling Tetris pieces (Harris, 2004). These types of initiatives are found to be effective in solving nightmare problems