II. Epidemiology
- Gender predominance
- Children: Equal among girls and boys
- Adults: More common in women
-
Prevalence
- Children (ages 3 to 5 years): 10-50%
- Children (ages 5 to 12 years): 20-39% within 1 week
- College Students: 47% within prior two weeks
- Adults in general: 5-8%
- Timing
- Onset of Nightmares between ages 3 and 6 years old
- Peak Incidence between ages 6 and 10 years old
III. Associated Conditions
IV. Pathophysiology
- Most commonly associated with REM Sleep
V. Symptoms
- Vivid, terrifying dreams
- Occurs late in sleep, during second half of sleep cycle (4 to 6 am)
- Sudden awakening from sleep
- Detailed recall of bizarre dream
- Difficulty returning to sleep after dream
- Increasing reluctance to go to sleep
- Increased sympathetic drive
- Tachycardia
- Tachypnea
- Diaphoresis
VI. Differential Diagnosis
- See Medication Causes of Nightmares
- Night Terror (Children under age 8 years)
- Post-Traumatic Stress Disorder
- Depression
- Anxiety Disorder with Panic Attacks
- Schizophrenia
-
Chemical Dependency with Drug Withdrawal
- Alcohol Abuse with withdrawal
- Benzodiazepine Abuse with withdrawal
- Barbiturate Abuse with withdrawal
- REM Behavior Disorder associated neurologic disorder
VII. Management
- See Post-Traumatic Stress Disorder
- See Night Terrors for Management in Children
- Offer reassurance
- Episodes tend to resolve spontaneously
-
General measures
- Treat as with other Parasomnias
- See Sleep Walking
- Ensure adequate sleep and consistent sleep schedule
- Ensure safe home
- REM Behavior Disorder
- Consider Selective Serotonin Reuptake Inhibitor (SSRI)
- Consider Clonazepam 0.5 to 1.0 mg nightly as needed (adults)
- Recurrent Nightmares
- Cognitive-Behavioral therapy effective in 70% of patients