Alternate Names: Dreams - bad; Bad dreams

Considerations: Nightmares tend to be more common among children and decrease in frequency toward adulthood. In children, the content of the nightmare may be influenced by daytime experiences such as television viewing, movies, or scary real-life events. In adults, there is a less specific association between nightmares and daytime events. The majority of adults tend not to remember the content of their dreams or nightmares or only small portions of them.

Occasional nightmares without other symptoms are common occurrences requiring no treatment.

Eating just prior to going to bed which raises the body’s metabolism and brain activity, can cause nightmares to occur more often.

Common Causes:

• illness with a fever
• death of a loved one (post-traumatic stress disorder)
• anxiety or stress
• adverse reaction to or side effect of a drug
• recent withdrawal from a drug such as sleeping pills
• effect of alcohol or excessive alcohol consumption
• abrupt alcohol withdrawal

Home Care: For nightmares resulting from the effects of drugs or alcohol, discontinue use. For persistent alcohol problems, join an Alcoholics Anonymous group and attend regularly (see alcoholism - support group). Also, reassess lifestyle--friends, work, family--to identify and alter factors that encourage substance abuse.

For nightmares resulting from anxiety or stress, follow a regular energetic fitness routine, using aerobic exercises if possible. Learn techniques to reduce muscle tension (relaxation therapy).

Avoid long-term use of tranquilizers, and avoid caffeine and other stimulants.

Call If:

• nightmares persists longer that 6 weeks or remain unexplained.

What To Expect: The medical history will be obtained and a physical examination performed.

Medical history questions documenting nightmares in detail may include:

• time pattern
  • Do the nightmares occur repeatedly (recurrent)?
  • Do they occur in the second half of the night?
• quality
  • Is there a sudden full awakening from sleep?
• associated complaints
  • Does the nightmare cause intense fear and anxiety?
  • Is there memory of a frightening dream (one with vivid visual imagery and story-like plot)?
• aggravating factors
  • Has there been a recent illness?
  • Has there been a fever?
  • Has an emotionally stressful situation occurred recently?
• other
  • Is alcohol used? How much?
  • What medications are used?
  • Are "street drugs" being taken? Which?
  • What other symptoms are also present?

• blood tests (such as CBC or blood differential)
• liver function tests
• EEG