What causes nightmares and night terrors in adults?

What are nightmares and night terrors?

Nightmares are vivid, disturbing dreams that often wake the individual from sleep. They typically occur during REM (rapid eye movement) sleep, the sleep phase most associated with dreaming. Upon waking, the person can usually recall the nightmare in detail, often accompanied by feelings of fear or anxiety which make it difficult to return to sleep.

Night terrors, also known as sleep terrors, are sudden episodes of intense fear, screaming, and thrashing that occur during NREM (non-rapid eye movement) sleep, specifically in the deep stages. Unlike nightmares, night terrors do not usually wake the individual completely, and they typically have no memory of the event the next morning. After an episode, the person they might exhibit signs of sweating, a rapid heartbeat, and confusion.

What causes of nightmares and night terrors?

Nightmares can be triggered by various factors:

• Emotional distress, such as stress and anxiety, often plays a significant role in the occurrence of frequent nightmares.
• Trauma is another critical factor; individuals with post-traumatic stress disorder (PTSD) commonly experience chronic nightmares.
• Sleep disorders, like sleep apnoea, can disrupt sleep patterns, leading to nightmares.
• Certain medications can induce nightmares. For example, selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine and sertraline, and tricyclic antidepressants like amitriptyline, are known to cause vivid dreams. Beta-blockers, used for heart conditions and hypertension, such as propranolol and metoprolol, also have this side effect.
• The use of alcohol and recreational drugs can interfere with sleep architecture, exacerbating the likelihood of nightmares.

Night terrors, while less well understood, are believed to be influenced by several factors too:

• Sleep deprivation significantly increases the likelihood of night terrors, as does high stress levels. Disruptions in sleep patterns, such as irregular sleep schedules or travelling, can also contribute to these episodes.
• Underlying conditions, particularly sleep disorders like obstructive sleep apnoea or restless legs syndrome, are often associated with night terrors.
• There is evidence to suggest a genetic component, as night terrors may run in families.

Unlike nightmares, night terrors typically do not involve detailed recollection of the event, adding to their mysterious nature.

How to prevent and manage nightmares and night terrors?

1. Addressing underlying causes is a fundamental step. Conditions like PTSD or sleep apnoea, which can contribute to the frequency of nightmares and night terrors, need to be treated appropriately. This involves targeted therapies for PTSD or the use of CPAP machines for sleep apnoea.
2. Stress reduction techniques play a crucial role. Engaging in mindfulness practices, meditation, and relaxation exercises can significantly help in managing stress, thus reducing the incidence of nightmares.
3. Maintaining healthy sleep hygiene is another key factor. This includes adhering to a consistent sleep schedule, creating a restful sleep environment, and avoiding stimulants like caffeine and heavy meals close to bedtime.
4. For night terrors, ensuring safety during episodes is paramount. This involves making the sleep environment safe by removing sharp objects and installing safety gates to prevent injuries.

When to seek professional help to treat nightmares and night terrors?

While occasional nightmares and night terrors are not usually a cause for concern, frequent and severe episodes warrant professional evaluation. You should consult a healthcare provider if:

• Sleep disturbances are causing significant distress or impairment in daily functioning.
• Nightmares or night terrors occur several times a week.
• There is a risk of injury due to night terrors.
• The episodes are associated with other symptoms like daytime sleepiness, mood changes, or cognitive impairment.

A healthcare provider can help identify and treat any underlying sleep disorders. Therapies such as cognitive-behavioural therapy (CBT) and imagery rehearsal therapy (IRT) have been shown to be effective in reducing nightmare frequency by helping individuals alter their reactions to disturbing dreams and reframe their content.

For managing severe and frequent night terrors, medication may be prescribed as a last resort. Benzodiazepines, such as clonazepam, are sometimes prescribed due to their calming effect on the central nervous system. Anticonvulsant drugs like gabapentin or topiramate are also sometimes used to stabilize mood and reduce episodes of night terrors, particularly if they are thought to be linked to a seizure disorder or other neurological issues.

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