Diagnosis
There are no tests routinely done to diagnose nightmare disorder. Nightmares are considered a disorder only if disturbing dreams cause you distress or keep you from getting enough sleep.
To diagnose nightmare disorder, your healthcare professional:
- Talks with you about your symptoms. Nightmare disorder is diagnosed based on your symptoms and how much nightmares affect your sleep and daily life. Your healthcare professional also may ask other people in your household about your sleep behaviors. Information about your symptoms may help to tell if you also have other sleep disorders.
- Does a physical exam. This can help to find any health conditions that may be causing the nightmares. Your healthcare professional may ask if members of your family have a history of sleep disorders. If you have anxiety, your healthcare professional may suggest you talk with a mental health professional.
- May do an overnight sleep study. Also called a polysomnography, this nighttime sleep study doesn't diagnose nightmare disorder but can help find if the nightmares are linked to another sleep disorder. In the test, sensors are placed on your body. During sleep, the sensors record and monitor brain waves, oxygen level in your blood, heart rate, breathing, and eye and leg movements. A videotape may record behavior during sleep cycles.
Treatment
Treatment for occasional nightmares isn't usually needed. But if nightmares cause distress, disrupt sleep and interfere with daily functioning, treatment can help.
The cause of the nightmare disorder helps determine treatment. Treatment options may include:
- Medical treatment. If the nightmares are related to an underlying medical condition, treatment for that condition may help lessen nightmares.
- Stress or anxiety treatment. If a mental health condition, such as stress or anxiety, is linked to the nightmares, stress-lowering techniques and counseling or therapy with a mental health professional can help.
- Imagery rehearsal therapy (IRT). This involves changing the ending to a remembered nightmare when awake so that it's no longer threatening. You can write down the new ending or review it in your mind. This approach can lessen how often nightmares happen and how much distress they cause. IRT can be especially helpful for people who have nightmares as a result of PTSD.
- Medicine. Medicine is rarely used to treat nightmares. Medicine can sometimes be used for severe nightmares linked with PTSD.
Lifestyle and home remedies
If nightmares cause distress for you or your child, try these tips:
- Create a regular, relaxing routine before bedtime. A regular sleep and wake schedule and bedtime routine can help. Do quiet, calming activities, such as reading books or soaking in a warm bath before bed. Meditation, deep breathing or relaxation exercises may help, too. Also, make the bedroom comfortable and quiet for sleep.
- Offer reassurances. If your child is struggling with nightmares, be patient, calm and reassuring. After your child awakens from a nightmare, respond quickly and soothe your child at the bedside.
- Talk about the dream. Describe the nightmare. What happened? Who was in the dream? What made it scary? Remember that nightmares aren't real and can't hurt you.
- Rewrite the ending. Imagine a happy ending to the nightmare. Draw a picture of the nightmare, "talk" to the characters in the nightmare or write about the nightmare in a journal.
- Put stress in its place. If stress or anxiety is an issue, talk about it. Practice some simple stress-relief activities, such as meditation, deep breathing or relaxation. Contact a mental health professional if needed.
- Give comfort measures. Your child might feel more secure sleeping with a favorite stuffed animal, blanket or other comfort object. Leave doors open at night to offer a feeling of being connected to others. You also can better hear if your child calls out for comfort. A night light in the room may be reassuring when waking up in the night.
Preparing for your appointment
Talk to your healthcare professional if nightmares disrupt sleep or if you're concerned about an underlying health condition. Your healthcare professional may refer you to a sleep specialist or a mental health professional.
Keep a sleep diary for two weeks before your appointment. This can help your healthcare professional understand more about your sleep schedule, issues affecting your sleep and when nightmares occur. In the morning, record as much as you recall about bedtime rituals, quality of sleep and dreams. At the end of the day, record behaviors that may affect sleep, such as sleep schedule changes, alcohol use and any medicines taken.
Along with the sleep diary, you may want to bring a person from your household along to the appointment. That person may be able to give more information about your sleep habits.
What you can do
Before your appointment, make a list of:
- Any symptoms you have, including any that may not seem related to the reason for the appointment.
- Key personal information, including any major stresses or recent life changes.
- All medicines, vitamins, herbs or other supplements being taken, and the doses.
- Questions to ask the healthcare professional to help make the most of your time together.
Questions to ask may include:
- What is likely causing these symptoms?
- What are other possible causes?
- What kinds of tests are needed?
- Is the condition likely short term or ongoing?
- What treatment do you suggest?
- What are other treatment options?
- Are there things I can try to help with better sleep?
- Do you recommend seeing a specialist?
- Are there any brochures or other printed material that I can have? What websites do you recommend?
Feel free to ask other questions during your appointment.
What to expect from your doctor
Your healthcare professional may ask:
- When did symptoms begin?
- How often do nightmares occur, and what are they about?
- What is the usual bedtime routine?
- Is there a history of sleep problems?
- Does anyone else in your family have sleep nightmares or a sleep disorder?
Be ready to answer questions so that you have time to talk about what's most important to you.