NIGHTMARE DISORDER (307.47) This is also referred to as dream anxiety disorder. It is a DSM-V disorder given to individuals who have frequent severe nightmares. Nightmare disorder is a parasomnia, characterized by having abnormal experiences while falling asleep, waking up, or sleeping. While having nightmares is common and interrupt sleep, those with the disorder have frequent nightmares that occur during different aspects of sleep (going to sleep, between stages of sleep, or upon awakening). The prevalence is around five percent of the population. The patient with a nightmare awakens when the feeling of terror is at its greatest with a sense of panic. Orientation is fairly rapidly attained and the autonomic symptoms will begin to dissipate upon awakening. Things that precipitate nightmares include sleep deprivation and other psychological or medical conditions. Symptoms include having frequent episodes of disturbing dreams that awaken the individual, dysphoria around the content of the dreams, awakening with a clear recall of the dream, difficulty falling asleep after the episode, and episodes occurring in REM sleep (the last third of the sleep cycle). The diagnosis is made by patient history, including whether or not they use substances. A sleep diary may be necessary to make the diagnosis. EEG and sleep studies can be done if the diagnosis is in question. There are various medications that can cause nightmares, including antidepressants (SSRIs), barbiturates, beta blockers, and narcotics. Withdrawal from benzodiazepines, barbiturates, and alcohol can contribute to the presence of nightmares. Stress and anxiety can lead to nightmares. Trauma and PTSD are a major contributor to nightmares and affect up to 80 percent of people with PTSD. Nightmares are also associated with schizophrenia, major depression, borderline personality disorder, and individuals who are considered to be creative and/or artistic. There may be a genetic component to getting nightmares and individuals who eat at night (who may subsequently develop reflux) seem to be predisposed to getting nightmares. Things in the
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