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A nightmare, also known as a bad dream,[1] is an unpleasant dream that can cause a strong emotional response from the mind, typically fear but also despair, anxiety, disgust or sadness. The dream may contain situations of discomfort, psychological or physical terror, or panic. After a nightmare, a person will often awaken in a state of distress and may be unable to return to sleep for a short period of time.[2] Recurrent nightmares may require medical help, as they can interfere with sleeping patterns and cause insomnia.

Nightmares can have physical causes such as sleeping in an uncomfortable position or having a fever, or psychological causes such as stress or anxiety. Eating before going to sleep, which triggers an increase in the body's metabolism and brain activity, can be a potential stimulus for nightmares.[3]

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The word nightmare is derived from the Old English mare, a mythological demon or goblin who torments others with frightening dreams. The term has no connection with the Modern English word for a female horse.[5] The word nightmare is cognate with the Dutch term nachtmerrie and German Nachtmahr (dated).

The sorcerous demons of Iranian mythology known as Divs are likewise associated with the ability to afflict their victims with nightmares.[6]The mare of Germanic and Slavic folklore were thought to ride on people's chests while they sleep, causing nightmares.[7]

Those with nightmares experience abnormal sleep architecture. The impact of having a nightmare during the night has been found to be very similar to that of insomnia. This is thought to be caused by frequent nocturnal awakenings and fear of falling asleep.[8] Nightmare disorder symptoms include repeated awakenings from the major sleep period or naps with detailed recall of extended and extremely frightening dreams, usually involving threats to survival, security, or self-esteem. The awakenings generally occur during the second half of the sleep period.[9]

According to the International Classification of Sleep Disorders-Third Edition (ICSD-3), the nightmare disorder, together with REM sleep behaviour disorder (RBD) and recurrent isolated sleep paralysis, form the REM-related parasomnias subcategory of the Parasomnias cluster.[10] Nightmares may be idiopathic without any signs of psychopathology or associated with disorders like stress, anxiety, substance abuse, psychiatric illness or PTSD (>80% of PTSD patients report nightmares).[11] As regarding the dream content of the dreams they are usually imprinting negative emotions like sadness, fear or rage.[4] According to the clinical studies the content can include being chased, injury or death of others, falling, natural disasters or accidents. Typical dreams or recurrent dreams may also have some of these topics.[12]

Lucid-dreaming advocate Stephen LaBerge has outlined a possible reason for how dreams are formulated and why nightmares occur. To LaBerge, a dream starts with an individual thought or scene, such as walking down a dimly lit street. Since dreams are not predetermined, the brain responds to the situation by either thinking a good thought or a bad thought, and the dream framework follows from there. If bad thoughts in a dream are more prominent than good thoughts, the dream may proceed to be a nightmare.[16]

Sigmund Freud and Carl Jung seemed to have shared a belief that people frequently distressed by nightmares could be re-experiencing some stressful event from the past.[18] Both perspectives on dreams suggest that therapy can provide relief from the dilemma of the nightmarish experience.

Halliday (1987) grouped treatment techniques into four classes. Direct nightmare interventions that combine compatible techniques from one or more of these classes may enhance overall treatment effectiveness:[19]

Recurring post-traumatic stress disorder (PTSD) nightmares in which traumas are re-experienced respond well to a technique called imagery rehearsal. This involves dreamers coming up with alternative, mastery outcomes to the nightmares, mentally rehearsing those outcomes while awake, and then reminding themselves at bedtime that they wish these alternate outcomes should the nightmares reoccur. Research has found that this technique not only reduces the occurrence of nightmares and insomnia,[20] but also improves other daytime PTSD symptoms.[21] The most common variations of imagery rehearsal therapy (IRT) "relate to the number of sessions, duration of treatment, and the degree to which exposure therapy is included in the protocol".[22]

A nightmare is a disturbing dream associated with negative feelings, such as anxiety or fear that awakens you. Nightmares are common in children but can happen at any age. Occasional nightmares usually are nothing to worry about.

Nightmares may begin in children between 3 and 6 years old and tend to decrease after the age of 10. During the teen and young adult years, girls appear to have nightmares more often than boys do. Some people have them as adults or throughout their lives.

Although nightmares are common, nightmare disorder is relatively rare. Nightmare disorder is when nightmares happen often, cause distress, disrupt sleep, cause problems with daytime functioning or create fear of going to sleep.

You're more likely to have a nightmare in the second half of your night. Nightmares may occur rarely or more frequently, even several times a night. Episodes are generally brief, but they cause you to awaken, and returning to sleep can be difficult.

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Being in the grips of a nightmare is a common occurrence that we can all relate to, but we may never experience one exactly as a particular artist depicts it. Here Fuseli conjures up a terrifying image filled with mystery and panic, yet with a vague and disturbing familiarity. It suggests the way the woman feels in the grip of a demonic nightmare, not what she sees. The Nightmare was reproduced as an engraving; a copy hung in Sigmund Freud's apartment in Vienna in the 1920s.

Looking at nightmare, you might guess that it is a compound formed from night and mare. If so, your guess is correct. But while the night in nightmare makes sense, the mare part is less obvious. Most English speakers know mare as a word for a female horse or similar equine animal, but the mare of nightmare is a different word, an obsolete one referring to an evil spirit that was once thought to produce feelings of suffocation in people while they slept. By the 14th century the mare was also known as nightmare, and by the late 16th century nightmare was also being applied to the feelings of distress caused by the spirit, and then to frightening or unpleasant dreams.

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According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), nightmare disorder describes repeated instances of extended, profoundly unnerving, and well-remembered dreams.

IRT, a form of cognitive-behavioral therapy (CBT), theorizes that chronic nightmares are rooted in traumatic experiences. The approach is based on the belief that working with nightmare imagery during the day helps to influence dreams at night.

Introduction: Nightmare disorder affects approximately 4% of adults, occurring in isolation or as part of other disorders such as posttraumatic stress disorder (PTSD), and can significantly impair quality of life. This paper provides the American Academy of Sleep Medicine (AASM) position regarding various treatments of nightmare disorder in adults.

Methods: A literature search was performed based upon the keywords and MeSH terms from the Best Practice Guide for the Treatment of Nightmare Disorder in Adults that was published in 2010 by the AASM. The search used the date range March 2009 to August of 2017, and sought to find available evidence pertaining to the use of behavioral, psychological, and pharmacologic therapies for the treatment of nightmares. A task force developed position statements based on a thorough review of these studies and their clinical expertise. The AASM Board of Directors approved the final position statements.

Position statements: The following therapy is recommended for the treatment of PTSD-associated nightmares and nightmare disorder: image rehearsal therapy. The following therapies may be used for the treatment of PTSD-associated nightmares: cognitive behavioral therapy; cognitive behavioral therapy for insomnia; eye movement desensitization and reprocessing; exposure, relaxation, and rescripting therapy; the atypical antipsychotics olanzapine, risperidone and aripiprazole; clonidine; cyproheptadine; fluvoxamine; gabapentin; nabilone; phenelzine; prazosin; topiramate; trazodone; and tricyclic antidepressants. The following therapies may be used for the treatment of nightmare disorder: cognitive behavioral therapy; exposure, relaxation, and rescripting therapy; hypnosis; lucid dreaming therapy; progressive deep muscle relaxation; sleep dynamic therapy; self-exposure therapy; systematic desensitization; testimony method; nitrazepam; prazosin; and triazolam. The following are not recommended for the treatment of nightmare disorder: clonazepam and venlafaxine. The ultimate judgment regarding propriety of any specific care must be made by the clinician, in light of the individual circumstances presented by the patient, accessible treatment options, and resources.

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