Nightmares are often a normal part of coping with change in our lives. They are not necessarily a sign of pathology and may be a positive indication that we are actively coping with a new challenge.
Sleep terror disorder (pavor nocturnus) differs from nightmares; sleep terrors are a really bad version of nightmares and occur during deep sleep. The cause of night terrors is unknown but they seem to be triggered by fever, lack of sleep, or periods of emotional tension, stress and conflict.
DIAGNOSE YOURSELF
A nightmare is a dream occurring during rapid eye movement (REM) sleep that brings out feelings of fear, terror, distress or extreme anxiety. It usually wakens the sleeper, who is able to remember the content of the dream.
Ask yourself the following questions:
- Do you have nightmares often? (more often than on a weekly basis)
- Do they occur in the second part of the night?
- Do you wake up suddenly from sleep?
- Do the nightmares cause you fear and anxiety?
- Do you remember a frightening dream (sometimes with a story-like plot and vivid images)?
- Have you been in a stressful situation lately?
- Have you had a recent illness?
- Did you have a fever?
- Do you take street drugs?
- Do you use alcohol frequently?
If you answer ‘yes’ to most of these questions, you need to contact your health care provider because nightmares could be the result of sleep apnoea or the side-effects of a drug.
CAUSES OF NIGHTMARES
The most common causes of nightmares are anxiety and stress, major life events, and unresolved emotional issues. Other causes include bereavement and loss, illness with a fever, recent withdrawal from a drug such as sleeping pills, reaction to or side-effects of a drug, excessive alcohol consumption, abrupt alcohol withdrawal, sleep disorder (narcolepsy, sleep terror disorder) and breathing disorder (sleep apnoea).
SELF-CARE
There is quite a lot one can do to manage nightmares. If you are under severe stress or are going through life changes, you should ask for support from friends and relatives. You can also consider consulting with a mental health care provider. Talking about what is bugging you can really help.
Consider following a fitness routine, or relaxation therapy. Practise good sleep hygiene. Go to bed at the same time each night, and wake up at the same time each morning. Prepare your mind for sleep with a relaxing bath or by taking a warm drink before bed. Avoid long-term use of tranquillisers or sleeping tablets. For nightmares caused by the effects of street drugs or regular alcohol use, ask for advice on the best ways to quit or get involved in a support group.
CHILDREN AND NIGHTMARES
Night-time fears and nightmares are extremely common in children, especially preschool children, but they occur in older children and adolescents as well. They are part of normal development – as their imagination develops children begin to understand that there are things that can hurt them. There are also times when fears and nightmares result from a frightening experience, ranging from being scared of an animal to watching the news.
The silver lining of nightmares is that through the often transparent symbolism they shine a spotlight on issues that are upsetting yet inexpressible for the child. Every nightmare, no matter how distressing, contains vital information about crucial emotional challenges in your child’s life such as entering school, the birth of a sibling, parental quarrels, or moving into a new house.
What can you do when your child has nightmares or is afraid to go to sleep?
- Avoid scary television shows. The effects of scary movies or TV stories continue for a long time after the TV has been turned off.
- Provide an object of security. Remember your teddy bear or soft toy? Soft toys or a trusty object provide a sense of security.
- Teach your child coping skills such as alternative ways to respond, positive thinking, challenging irrational thoughts, and facing fears. This will serve your child well in future as well.
- Read stories to your child about other children experiencing the same fears (biblio-therapy). There are wonderful stories available in libraries that present children with situations and solutions they can identify with.
- If your child is afraid reassurance is important and the idea of safety should be communicated constantly.
- Listen and try to understand your child’s fears and don’t dismiss them or make fun of them.
- Play and have fun in the dark. Try a treasure hunt, search for things that glow in the dark or play flashlight tag.
- The soft light from a nightlight offers reassurance, as does leaving the bedroom door open at night so that your child doesn’t feel cut off from the rest of the family.
- Use your imagination and be creative. ‘Monster spray’ might assist in coping with fears, as could the proximity of a pet or even a softly glowing fish tank.
- Try to get your child to stay in her bed and experience it as a safe place rather than getting into your bed. If she has a nightmare it is much better to stay with the child in her room until her fears are addressed or take her back and tuck her in gently.
- Kids will do anything for attention and some kids get reinforced or rewarded for being scared at night by getting lots of attention for being afraid.
- Set limits. Although you should reassure your child and not ridicule his fears you should also set limits so that you do not reward scared or manipulative behaviour.
- Establish a bedtime routine and prepare your child’s brain for restful sleep. A child can be provided with simple pre-sleep steps that will teach the brain that sleep is not far away, e.g. playing soothing music, warm bedtime milk, story reading, etc.
- The four R’s that spell nightmare relief are reassurance, re-scripting (imagine changes in the outcome of the dream or rewriting the plot), rehearsal (practising solutions to nightmares threats) and resolution (when you get to the bottom of the nightmare).
CONCLUSION
Self care goes a long way, but nightmares, sleepwalking and talking in one’s sleep should be monitored as they may indicate an emotional or neurological issue.
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