Nightmares A Narrative Review
Tiffany Field
The prevalence of nightmares appears to be highly variable in this current literature on nightmares, ranging from low in healthy populations (6% to 11%), to slightly higher in those with medical problems (12% to 13%), significantly higher in individuals with neurological conditions (24% to 30%) and again significantly higher in those with psychiatric diagnoses (27% to 62%). Medical comorbidities of nightmares include cardiocerebrovascular disease and cardiometabolic disease. Neurological comorbidities include functional neurological diseases and dementia. Psychiatric comorbidities Include anxiety/ depression, PTSD, and REM sleep behavior disorder. Several negative effects of nightmares have been noted in this literature including poor sleep quality, stress, anxiety and depression, suicidal ideation, and suicide attempts. Several risks for nightmares have been addressed including childhood trauma, stress, arousal, and anxiety. Potential underlying biological mechanisms for nightmares include a surprisingly small effect for heritability and parasympathetic dysregulation and increased beta waves suggesting hyper- arousal. Despite the severity of the negative effects of nightmares, only three interventions have appeared in this literature including imagery rescripting, cognitive behavioral therapy for nightmares and telehealth cognitive behavioral therapy.
