Causes and risk factors
Nightmares generally occur during REM phase of sleep. [Rapid eye movement]. The exact cause of nightmares is not known. But it can be triggered by sleep disorders, mental stress, post-traumatic stress disorder [PTSD] i.e. after an accident, injury or any other traumatic event, reading scary books or watching scary movies close to bedtime. Eating close to bedtime can sometimes cause nightmares. It is also caused in presence of an illness. Certain medications such as antidepressants, narcotics, barbiturates, etc. can lead to nightmares. Abuse of alcohol or other drugs may also trigger the condition.
Clinical presentation
A nightmare can be about anything from a monster to a problem at home or work. The actual dream will depend upon the person’s age and his life circumstances. But the following characteristics help to identify a nightmare. The person is woken up by the dream. He experiences heart pounding, perspiration, palpitations. He looks confused and terrified. The dream creates feelings of fear, anxiety, anger or disgust. The person is able to recollect the dream upon waking up. The dream occurs towards the end of the person’s sleep time. The dream prevents the person from falling back to sleep easily.
Investigation
Medical history by the patient and Clinical examination by the doctor helps in diagnosis. Sleep study may be recommended.
Treatment
No treatment is required for nightmares. Medications such as anxiolytics, sedatives [sleeping pills] are prescribed only in cases with severe anxiety leading to sleep disturbance. Psychotherapy and counseling contribute further to the treatment. Good sleep hygiene, avoidance of alcohol , tobacco, light diet during dinner, exercise, yoga, reading books which have content full of positive thoughts will contribute further to the treatment.
Other Modes of treatment
The other modes of treatment can also be effective in treating nightmares. Homoeopathy is a science which deals with individualization considers a person in a holistic way. This science can be helpful in combating the symptoms. Similarly the ayurvedic system of medicine which uses herbal medicines and synthetic derivates are also found to be effective in treating nightmares.
