Mood disturbance (e.g., persistence of nightmare affect, anxiety, dysphoria)Ģ. The dream experience, or the sleep disturbance produced by awakening from it, causes clinically significant distress or impairment in social, occupational, or other important areas of functioning as indicated by the report of at least one of the following:ġ. On awakening from the dysphoric dreams, the person rapidly becomes oriented and alert.Ĭ. Repeated occurrences of extended, extremely dysphoric, and well-remembered dreams that usually involve threats to survival, security, or physical integrity.ī. In addition to these characteristics, the American Psychiatric Association in its Diagnostic and Statistical Manual of Mental Disorders (DSM-5) also stipulates that a frequency criterion be met: nightmares should occur at least once a week for a positive diagnosis to be made.
On awakening from such dreams, the individual becomes alert quickly, but the dream experience and/or the sleep disturbance caused by the dysphoric dream cause clinically significant distress that can result in mood disturbance, social and cognitive impairments, and negative impacts on other areas of social, occupational, and educational functioning. According to the ICSD-3 (Table (Table1), 1), nightmare disorder consists of repeated occurrences of extended, extremely dysphoric, and well-remembered dreams that usually involve threats to survival, security, or physical integrity.
The dream content of these nightmares is remembered on awakening and can cause significant distress or impairment, including a subsequent fear of going back to sleep through fear that the nightmare may continue or re-occur. Nightmare disorder is characterized by repeated nightmares. The most effective therapy consists of avoiding those factors. Predisposing factors include sleep deprivation, irregular sleep–wake schedules, and jetlag. Variations in circadian rhythm genes might be involved in their pathogenesis. Sleep paralysis represents a dissociated state, with persistence of REM atonia into wakefulness. Isolated sleep paralysis can be accompanied by very intense and vivid hallucinations. Isolated sleep paralysis is experienced at least once by up to 40% of the general population, whereas recurrence is less frequent. Nonmedication treatment, in particular imagery rehearsal therapy, is especially effective. Nightmare disorder is particularly frequent in psychiatric disorders and posttraumatic stress disorder. Hyperarousal and impaired fear extinction are involved in nightmare generation, as well as brain areas involved in emotion regulation. Nightmare disorder can cause insomnia due to fear of falling asleep through dread of nightmare occurrence. Nightmare disorder and recurrent isolated sleep paralysis are rapid eye movement (REM) parasomnias that cause significant distress to those who suffer from them.
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