Nightmare disorder involves frequent awakenings with memories of frightening dreams threatening safety.
Sporadic nightmares in children typically occur at night or early morning during Rapid eye movement sleep.
Polysomnographic studies show sudden REM awakenings occur before nightmare reports at night.
Reassurance and conservative management are indicated to treat sporadic nightmares. Identify daytime stressors and resolve them while bedtime stressors should be safe with reading and conversation.
Nightmares are repeated awakenings from sleep with vivid, disturbing dreams featuring including fear, anxiety, and other negative emotions.
Nightmares are common, transient concerns for children, and typically normal for development.
Epidemiology
Nightmares vary by age with imaginary creatures prevalent in 7 to 9 years old and kidnapping thoughts in 10 to 12 years old.
Sleep disorders affect 35–45% of children, including sleepwalking, sleep talking, night terrors, and nightmares.
Three quarters of children experience nightmares at least once. Nightmares occur in 2–11% of young children always and often and in 15–31% now and then due to varying criteria.
Nightmares affect all races and cultures equally. Young children show no sex differences in nightmares and peaks up at ages of 7-9 years old.
Anatomy
Pathophysiology
Sleep is divided into 2 states as rapid eye movement (REM) and nonrapid eye movement (non-REM).
REM and non-REM sleep both alternate in 90- to 100-minute cycles each. REM sleep resembles wakefulness in EEG, while older children and adults spend 75% in non-REM’s four stages.
REM sleep features frequent dreams and nightmares in the night’s second half.
Nightmares differ from night terrors, which involve panic, confusion, and physical responses. Night terrors leave children unresponsive and unable to remember dreams.
Etiology
The causes of nightmare disorder are:
Genetic and biological factors
Psychological and emotional factors
Medications and substance use
Poor sleep hygiene
Genetics
Prognostic Factors
PTSD-related nightmares are persistent and hard to treat, but effective management of symptoms can improve their frequency and intensity.
Anxiety, depression, and mood disorders may worsen prognosis due to their relationship with emotional distress and nightmares.
Poor sleep hygiene and disorders worsen prognosis to improves outcomes significantly.
Stress management, exercise, and mindfulness enhance individual’s overall well-being and prognosis.
Clinical History
Collect details including presenting nightmare characteristics, associated mental health conditions, sleep patterns and hygiene to understand clinical history of patient.
Physical Examination
Neurological examination
Respiratory system examination
Cardiovascular examination
Endocrine system examination
Age group
Associated comorbidity
Associated activity
Acuity of presentation
Acute symptoms are:
Emotional distress, anxiety, and poor sleep quality with frequent awakenings and difficulty returning to sleep
Chronic symptoms are:
Sleep disruption, chronic fatigue, mood disturbances, and avoid sleep due to fear of nightmares.
Differential Diagnoses
Post-Traumatic stress disorder
Sleep terrors
REM sleep behavior disorder
Insomnia disorder
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
Reassurance and conservative management treat sporadic nightmares, identify and resolve daytime stressors.
Bedtime should be safe and comfortable for reading and talking. Parents must limit media exposure and avoid TV 2 hours before bedtime.
Cognitive-behavioural methods and hypnosis are both effective treatments for nightmares in children and adults.
Clonazepam and venlafaxine these are not suitable treatment for adult nightmare disorder.
Image rehearsal therapy is recommended for PTSD nightmares; CBT and eye movement desensitization are alternative treatments.
Procedural interventions for nightmare disorders indicated image rehearsal therapy, continuous positive airway pressure therapy, and eye movement desensitization to address underlying causes or coexisting conditions.
use-of-phases-in-managing-nightmare-disorder
Developmental and Behavioral
Initial treatment phase includes diagnosis, underlying causes, and assessing the severity of symptoms.
Pharmacologic therapy is effective in the treatment phase as it includes use of alpha-blockers, central alpha agonists, and atypical antipsychotics.
In supportive care and management phase, patients should receive required attention such as lifestyle modification and intervention therapies.
The regular follow-up visits with the pediatric are scheduled to check the improvement of patients along with treatment response.
Nightmare disorder involves frequent awakenings with memories of frightening dreams threatening safety.
Sporadic nightmares in children typically occur at night or early morning during Rapid eye movement sleep.
Polysomnographic studies show sudden REM awakenings occur before nightmare reports at night.
Reassurance and conservative management are indicated to treat sporadic nightmares. Identify daytime stressors and resolve them while bedtime stressors should be safe with reading and conversation.
Nightmares are repeated awakenings from sleep with vivid, disturbing dreams featuring including fear, anxiety, and other negative emotions.
Nightmares are common, transient concerns for children, and typically normal for development.
Nightmares vary by age with imaginary creatures prevalent in 7 to 9 years old and kidnapping thoughts in 10 to 12 years old.
Sleep disorders affect 35–45% of children, including sleepwalking, sleep talking, night terrors, and nightmares.
Three quarters of children experience nightmares at least once. Nightmares occur in 2–11% of young children always and often and in 15–31% now and then due to varying criteria.
Nightmares affect all races and cultures equally. Young children show no sex differences in nightmares and peaks up at ages of 7-9 years old.
Sleep is divided into 2 states as rapid eye movement (REM) and nonrapid eye movement (non-REM).
REM and non-REM sleep both alternate in 90- to 100-minute cycles each. REM sleep resembles wakefulness in EEG, while older children and adults spend 75% in non-REM’s four stages.
REM sleep features frequent dreams and nightmares in the night’s second half.
Nightmares differ from night terrors, which involve panic, confusion, and physical responses. Night terrors leave children unresponsive and unable to remember dreams.
The causes of nightmare disorder are:
Genetic and biological factors
Psychological and emotional factors
Medications and substance use
Poor sleep hygiene
PTSD-related nightmares are persistent and hard to treat, but effective management of symptoms can improve their frequency and intensity.
Anxiety, depression, and mood disorders may worsen prognosis due to their relationship with emotional distress and nightmares.
Poor sleep hygiene and disorders worsen prognosis to improves outcomes significantly.
Stress management, exercise, and mindfulness enhance individual’s overall well-being and prognosis.
Collect details including presenting nightmare characteristics, associated mental health conditions, sleep patterns and hygiene to understand clinical history of patient.
Neurological examination
Respiratory system examination
Cardiovascular examination
Endocrine system examination
Acute symptoms are:
Emotional distress, anxiety, and poor sleep quality with frequent awakenings and difficulty returning to sleep
Chronic symptoms are:
Sleep disruption, chronic fatigue, mood disturbances, and avoid sleep due to fear of nightmares.
Post-Traumatic stress disorder
Sleep terrors
REM sleep behavior disorder
Insomnia disorder
Reassurance and conservative management treat sporadic nightmares, identify and resolve daytime stressors.
Bedtime should be safe and comfortable for reading and talking. Parents must limit media exposure and avoid TV 2 hours before bedtime.
Cognitive-behavioural methods and hypnosis are both effective treatments for nightmares in children and adults.
Clonazepam and venlafaxine these are not suitable treatment for adult nightmare disorder.
Image rehearsal therapy is recommended for PTSD nightmares; CBT and eye movement desensitization are alternative treatments.
Pediatrics, General
Developmental and Behavioral
Use comfortable beds and a supportive mattress to promote restful sleep. A quiet environment can prevent sudden awakenings.
Use blackout curtains to minimize light from devices to promote a deeper sleep.
Use dim and warm-toned lights an hour before bed. Avoid electronic devices minimum 30 to 60 minutes before bed.
Avoid caffeine, alcohol, or nicotine in the hours up to bedtime.
Proper awareness about nightmare disorders should be provided and its related causes with management strategies.
Appointments with a pediatric and preventing recurrence of disorder is an ongoing life-long effort.
Pediatrics, General
Developmental and Behavioral
Prazosin:
It reduces noradrenergic activity during REM sleep to diminish the intensity of nightmares.
Pediatrics, General
Developmental and Behavioral
Trazodone:
It increases the amount of serotonin in the brain that helps maintain mental balance.
Pediatrics, General
Developmental and Behavioral
Clonidine:
It reduces sympathetic nervous system activity, and frequency of nightmares.
Pediatrics, General
Developmental and Behavioral
Olanzapine:
It balances the levels of dopamine and serotonin in your brain to regulate mood and thoughts.
Pediatrics, General
Developmental and Behavioral
Procedural interventions for nightmare disorders indicated image rehearsal therapy, continuous positive airway pressure therapy, and eye movement desensitization to address underlying causes or coexisting conditions.
Pediatrics, General
Developmental and Behavioral
Initial treatment phase includes diagnosis, underlying causes, and assessing the severity of symptoms.
Pharmacologic therapy is effective in the treatment phase as it includes use of alpha-blockers, central alpha agonists, and atypical antipsychotics.
In supportive care and management phase, patients should receive required attention such as lifestyle modification and intervention therapies.
The regular follow-up visits with the pediatric are scheduled to check the improvement of patients along with treatment response.
Nightmare disorder involves frequent awakenings with memories of frightening dreams threatening safety.
Sporadic nightmares in children typically occur at night or early morning during Rapid eye movement sleep.
Polysomnographic studies show sudden REM awakenings occur before nightmare reports at night.
Reassurance and conservative management are indicated to treat sporadic nightmares. Identify daytime stressors and resolve them while bedtime stressors should be safe with reading and conversation.
Nightmares are repeated awakenings from sleep with vivid, disturbing dreams featuring including fear, anxiety, and other negative emotions.
Nightmares are common, transient concerns for children, and typically normal for development.
Nightmares vary by age with imaginary creatures prevalent in 7 to 9 years old and kidnapping thoughts in 10 to 12 years old.
Sleep disorders affect 35–45% of children, including sleepwalking, sleep talking, night terrors, and nightmares.
Three quarters of children experience nightmares at least once. Nightmares occur in 2–11% of young children always and often and in 15–31% now and then due to varying criteria.
Nightmares affect all races and cultures equally. Young children show no sex differences in nightmares and peaks up at ages of 7-9 years old.
Sleep is divided into 2 states as rapid eye movement (REM) and nonrapid eye movement (non-REM).
REM and non-REM sleep both alternate in 90- to 100-minute cycles each. REM sleep resembles wakefulness in EEG, while older children and adults spend 75% in non-REM’s four stages.
REM sleep features frequent dreams and nightmares in the night’s second half.
Nightmares differ from night terrors, which involve panic, confusion, and physical responses. Night terrors leave children unresponsive and unable to remember dreams.
The causes of nightmare disorder are:
Genetic and biological factors
Psychological and emotional factors
Medications and substance use
Poor sleep hygiene
PTSD-related nightmares are persistent and hard to treat, but effective management of symptoms can improve their frequency and intensity.
Anxiety, depression, and mood disorders may worsen prognosis due to their relationship with emotional distress and nightmares.
Poor sleep hygiene and disorders worsen prognosis to improves outcomes significantly.
Stress management, exercise, and mindfulness enhance individual’s overall well-being and prognosis.
Collect details including presenting nightmare characteristics, associated mental health conditions, sleep patterns and hygiene to understand clinical history of patient.
Neurological examination
Respiratory system examination
Cardiovascular examination
Endocrine system examination
Acute symptoms are:
Emotional distress, anxiety, and poor sleep quality with frequent awakenings and difficulty returning to sleep
Chronic symptoms are:
Sleep disruption, chronic fatigue, mood disturbances, and avoid sleep due to fear of nightmares.
Post-Traumatic stress disorder
Sleep terrors
REM sleep behavior disorder
Insomnia disorder
Reassurance and conservative management treat sporadic nightmares, identify and resolve daytime stressors.
Bedtime should be safe and comfortable for reading and talking. Parents must limit media exposure and avoid TV 2 hours before bedtime.
Cognitive-behavioural methods and hypnosis are both effective treatments for nightmares in children and adults.
Clonazepam and venlafaxine these are not suitable treatment for adult nightmare disorder.
Image rehearsal therapy is recommended for PTSD nightmares; CBT and eye movement desensitization are alternative treatments.
Pediatrics, General
Developmental and Behavioral
Use comfortable beds and a supportive mattress to promote restful sleep. A quiet environment can prevent sudden awakenings.
Use blackout curtains to minimize light from devices to promote a deeper sleep.
Use dim and warm-toned lights an hour before bed. Avoid electronic devices minimum 30 to 60 minutes before bed.
Avoid caffeine, alcohol, or nicotine in the hours up to bedtime.
Proper awareness about nightmare disorders should be provided and its related causes with management strategies.
Appointments with a pediatric and preventing recurrence of disorder is an ongoing life-long effort.
Pediatrics, General
Developmental and Behavioral
Prazosin:
It reduces noradrenergic activity during REM sleep to diminish the intensity of nightmares.
Pediatrics, General
Developmental and Behavioral
Trazodone:
It increases the amount of serotonin in the brain that helps maintain mental balance.
Pediatrics, General
Developmental and Behavioral
Clonidine:
It reduces sympathetic nervous system activity, and frequency of nightmares.
Pediatrics, General
Developmental and Behavioral
Olanzapine:
It balances the levels of dopamine and serotonin in your brain to regulate mood and thoughts.
Pediatrics, General
Developmental and Behavioral
Procedural interventions for nightmare disorders indicated image rehearsal therapy, continuous positive airway pressure therapy, and eye movement desensitization to address underlying causes or coexisting conditions.
Pediatrics, General
Developmental and Behavioral
Initial treatment phase includes diagnosis, underlying causes, and assessing the severity of symptoms.
Pharmacologic therapy is effective in the treatment phase as it includes use of alpha-blockers, central alpha agonists, and atypical antipsychotics.
In supportive care and management phase, patients should receive required attention such as lifestyle modification and intervention therapies.
The regular follow-up visits with the pediatric are scheduled to check the improvement of patients along with treatment response.
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