While nightmares are most often associated with children, for many people they don’t go away with age. In 60 percent of all adult nightmares, a major life event precedes their onset, according to sleep researchers. And a 2009 study from the University of West England found women experience adult nightmares more frequently than men.

Nightmares aren’t just bad dreams. They are bad dreams that seem so real and become so increasingly disturbing to the dreamer as to awaken them. The nightmare convinces the dreamer he or she is in imminent physical danger or in other emotionally-distressing situations. Emotions typically associated with nightmares include anxiety, fear, terror, anger, rage, embarrassment, or disgust, according to the American Academy of Sleep Medicine (AASM).

And women’s nightmares differ from men’s, according to a recent study published in the January 2014 issue of Sleep by psychology researchers at the University of Montreal, which found nightmares involving interpersonal conflicts were twice as frequent in woman than men, who were more likely to have nightmares of disasters, such as earthquakes or war.

As coordinator for behavioral sleep medicine at Capital Health’s Center for Sleep Medicine in Hamilton, N.J., Rochelle Zozula, Ph.D., DABSM has seen patients of both sexes who complain of frequent nightmares and vivid dreams.

“The problem is multi-factorial and needs to entertain all the underlying causes for the ongoing presence of nightmare-related symptoms,” says Dr. Zozula.

If you experience nightmares or other unusual activity during sleep, also known as parasomnias, you should be screened by a qualified physician for the following, says Dr. Zozula:

Primary sleep disorders: Sleep apnea, periodic limb movement disorder, or chronic insufficient sleep may curtail the presence of REM sleep, which may exacerbate nightmares.

Medication usage, both prescription and over-the-counter: Commonly used drugs, such as beta-blockers, OTC antihistamines (such as diphenhydramine), and some of the SSRI or SRM medications used to treat depression may impact REM sleep and cause nightmares. This can occur both with starting some of these medications and weaning off the medications.

Drugs and alcohol: Chronic alcohol consumption or other recreational drugs may also be associated with nightmare occurrence.

Physical and mental conditions: Depression, anxiety, and post traumatic stress disorder (PTSD) are commonly associated with the presence of nightmares. Though less common, nightmares may also signal a schizoaffective disorder, which is a combination of both schizophrenia and a mood disorder, such as mania or depression. Physical stressors, such as surgery, diagnosis of medical illnesses, such as cancer, cardiac, or pulmonary diseases, can all exacerbate the presence of nightmares.

Pregnancy: There may be some changes associated with fluctuating levels of hormones, says Dr. Zozula, but most of the reports are anecdotal. “It is hard to find a balanced, controlled, ‘objective’ study of women during all stages of pregnancy,” she explains.

Sleep researchers found nightmares among pregnant women and new mothers is a common occurrence, with the nightmares often involving anxiety, complicated labor or delivery, or of their baby in danger, according to a 2007 study by the Sleep Research Centre at Sacred Heart Hospital in Montreal.

You can reduce or eliminate your nightmares once you identify the underlying cause, but most sleep physicians do not take care of nightmares as an isolated entity, says Marcella Frank, DO, FCCP, co-director for Capital Health’s Center for Sleep Medicine. “When nightmares are associated with sleep apnea or REM behavior disorder, we commonly treat the underlying sleep disorder, and the nightmares often improve,” says Frank.

Sometimes the reason for a nightmare can be as strange as the nightmare itself. Something as simple as eating right before bedtime increases the body’s metabolism and also the likelihood you’ll have a nightmare, according to AASM. For those without an underlying cause, who still suffer from nightmares, visualization techniques, where you can learn to control the outcome of your nightmare—while you’re in it—is a method shown to work and recommended by the AASM.

The bottom line is, if nightmares ruin your good night’s sleep, or worse, don’t be embarrassed to seek help. You’re not the only adult sleeping with the light, and there is something you can do to snuff out the boogeyman for good.

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