II. Epidemiology

  1. Gender predominance
    1. Children: Equal among girls and boys
    2. Adults: More common in women
  2. Prevalence
    1. Children (ages 3 to 5 years): 10-50%
    2. Children (ages 5 to 12 years): 20-39% within 1 week
    3. College Students: 47% within prior two weeks
    4. Adults in general: 5-8%
  3. Timing
    1. Onset of Nightmares between ages 3 and 6 years old
    2. Peak Incidence between ages 6 and 10 years old

IV. Pathophysiology

  1. Most commonly associated with REM Sleep

V. Symptoms

  1. Vivid, terrifying dreams
  2. Occurs late in sleep, during second half of sleep cycle (4 to 6 am)
  3. Sudden awakening from sleep
  4. Detailed recall of bizarre dream
  5. Difficulty returning to sleep after dream
  6. Increasing reluctance to go to sleep
  7. Increased sympathetic drive
    1. Tachycardia
    2. Tachypnea
    3. Diaphoresis

VI. Differential Diagnosis

  1. See Medication Causes of Nightmares
  2. Night Terror (Children under age 8 years)
  3. Post-Traumatic Stress Disorder
  4. Depression
  5. Anxiety Disorder with Panic Attacks
  6. Schizophrenia
  7. Chemical Dependency with Drug Withdrawal
    1. Alcohol Abuse with withdrawal
    2. Benzodiazepine Abuse with withdrawal
    3. Barbiturate Abuse with withdrawal
  8. REM Behavior Disorder associated neurologic disorder
    1. Parkinson's Disease
    2. Narcolepsy
    3. Dementia

VII. Management

  1. See Post-Traumatic Stress Disorder
  2. See Night Terrors for Management in Children
  3. Offer reassurance
    1. Episodes tend to resolve spontaneously
  4. General measures
    1. Treat as with other Parasomnias
    2. See Sleep Walking
    3. Ensure adequate sleep and consistent sleep schedule
    4. Ensure safe home
  5. REM Behavior Disorder
    1. Consider Selective Serotonin Reuptake Inhibitor (SSRI)
    2. Consider Clonazepam 0.5 to 1.0 mg nightly as needed (adults)
  6. Recurrent Nightmares
    1. Cognitive-Behavioral therapy effective in 70% of patients

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Ontology: Nightmares (C0028084)

Definition (NCI) A sleep disorder characterized by the repeated occurrence of frightening dreams which precipitate awakenings from sleep; on awakening, the individual becomes fully alert and oriented and has detailed recall of the nightmare, which usually involves imminent danger or extreme embarrassment to the individual.
Concepts Mental or Behavioral Dysfunction (T048)
MSH D004325
ICD10 F51.5
SnomedCT 192459009, 268775007, 154927001, 111487009, 419145002
DSM4 307.47
English NIGHTMARES, PARONIRIA, nightmare, nightmares, nightmare disorder, nightmare disorder (diagnosis), dream anxiety disorders, nightmares (symptom), Frightening dreams, Terrifying dreams, Paroniria, dream anxiety disorder, terrifying dreams, Nightmare Disorder, [X]Dream anxiety disorder, [X]Nightmares, [X] Nightmares or dream anxiety disorder, [X] Nightmares or dream anxiety disorder (disorder), Dream anxiety disorder, Nightmare disorder, Nightmare, Dream anxiety disorder (disorder), Nightmare, NOS, Nightmares, Nightmares NOS, Nightmares (finding)
Portuguese PESADELOS, Sonhos aterradores, Paroniria, Perturbação onírica de ansiedade, Perturbação de pesadelo, Pesadelos, PARONIRIA, Pesadelo
Spanish PESADILLAS, pesadilla (hallazgo), pesadilla, Trastorno de ansiedad por los sueños, Sueños aterradores, Paroniria, Trastorno con pesadillas, Sueños terroríficos, Pesadillas, PARONIRIA, crisis de ansiedad del sueño (trastorno), crisis de ansiedad del sueño, pesadillas, trastorno por pesadillas, Pesadilla
Italian Incubo, Disturbo ansioso onirico, Paroniria, Sogni terrificanti, Incubi
Dutch nachtmerries en angstdromen, angstaanjagende dromen, nachtmerries, beangstigende dromen, nachtmerrie, Nachtmerries
French Rêves effrayants, Rêves terrifiants, Rêves angoissants, Paronirie, Cauchemars, CAUCHEMARS, PARONIRIE, Cauchemar
German furchterregende Traeume, Alptraeume, erschreckende Traeume, Schlafstoerung durch Angsttraeume, Schlafstoerung durch Alptraeume, Paroniria, Alpträume, ALPTRAEUME, ANGSTTRAEUME, Alptraeume [Angsttraeume], Alptraum
Japanese 悪夢, 夢不安障害, 悪夢障害, 恐い夢, 魔夢, アクム, マム, ユメフアンショウガイ, コワイユメ, アクムショウガイ
Czech Noční můry, Porucha s nočními můrami, Děsivé sny, Porucha s úzkostnými sny, Hrozivé sny, Noční můra, zlý sen, noční můra, noční můry, zlé sny
Korean 악몽
Hungarian Rémálmok, Rémálom, Ijesztő álmok, Kóros álmodás, Szorongásos álom zavar, Rémálom betegség
Norwegian Mareritt