Nightmares Health Article

Nightmares

A frightening dream that occurs during REM (rapid eye movement) sleep.

Nightmares—frightening dreams—are the most common type of sleep disturbance in early childhood. They are distinguished from night terrors (pavor nocturnus), another childhood sleep disturbance, by the fact that night terrors occur during a different phase of sleep and do not involve dreaming. Nightmares are thought to be caused by a central nervous system response, and are related to other parasomnias such as sleepwalking.

Nightmares begin between the ages of 18 months and three years and increase in frequency and intensity around the ages of four and five years. Children this age have an exceptionally vivid fantasy life that carries over into their sleep. Their nightmares are typically characterized by feelings of danger and helplessness and often involve fleeing from monsters or wild animals. It is not unusual for a normal child this age to have nightmares as often as once or twice a week. The increase in nightmares among preschoolers reflects not only their capacity for vivid fantasy but also the fact that as they become increasingly active, their daily lives hold more opportunities for frightening experiences, and growing interaction with peers and siblings produces added potential for conflict and tension. Separation anxiety and exposure to frightening programs on television are additional sources of emotional turbulence.

When children have nightmares, parents generally spend some time holding and reassuring them; a parent may explain that the events in the nightmare are not real and can't hurt the child. (Although some parents take the opposite tack and pretend to scare away the monster or whatever else was frightening the child in the nightmare.) The lights in the bedroom can be turned on, as a child's familiar bedroom surroundings can have a calming effect. Sometimes it is more effective for the child to leave the bedroom and go to another part of the house for a while (although some experts caution against letting children sleep in the parents' bed in order to avoid having this become a habit). Parents can help reduce their children's nightmares by making sure that they are not under unusual or excessive stress in the daytime, which includes monitoring their television viewing and perhaps even eliminating it in the evening. A soothing evening ritual that calms a child at bedtime—such as a snack and a bedtime story or quiet game—may also reduce the frequency or intensity of nightmares.

Although nightmares are frequent in preschoolers, a child this age should not be having them every night. Excessive nightmares indicate stress that may call for professional counseling. The American Psychiatric Association's Diagnostic and Statistical Manual (DSM IV) recognizes an anxiety disorder characterized by persistent, severe nightmares (Nightmare Disorder, formerly Dream Anxiety Disorder) but cautions that intense nightmares are normal in children between the ages of 3 and 5, in whom this diagnosis is only warranted if there is significant distress and if the nightmares interfere with other aspects of daily life. DSM-IV points out that between 10 and 50% of all young children have nightmares that are severe enough to alarm their parents. Generally, Nightmare Disorder is found only in children who have experienced severe psychological stress.

Although the intense nightmares of the preschool period abate after the age of five, children continue to experience more nightmares than adults until about the age of 10, after which there is a marked decline in their frequency. The average college student has between four and eight nightmares per year, and this figure generally drops to one or two in adults.