Nightmares. Nightmarish dreams.- Causes, symptoms and treatment. MF.

Nightmares or frightening dreams with a threat to life or safety charge us with negative emotions for the whole day. It is estimated that about 4% of the adult population sees nightmares, among children and adolescents the percentage is much higher and is about 70%.

According to the definition of the international classification of diseases of the tenth revision, nightmares relate to sleep disorders of parasomnias( in the translation from Latin Somnus means "dream"), which are associated with a violation of the phase of fast sleep.

Causes of nightmares

Nightmares can have different origins and go hand in hand with mental disorders. Diseases that can cause nightmares: substance abuse, anxiety disorder, schizophrenia, borderline personality disorder and traumatic stress disorder.

There are several types of typical nightmares. Particular attention deserves nightmares associated with post-traumatic stress disorder .They appear in 80% of patients and this kind of nightmares is better susceptible to diagnosis, since the stress underlying the terrible dreams is derived from traumatic experiences, for example as a result of an accident, being in a war zone, rape or loss of a loved one. This kind of parasomnia can accompany the patient throughout life.

Recurring nightmares are based on real psycho-traumatic events of the past. Scientists suggest that recurring dreams are stored in memory in the form of a fixed model( fixed in memory of the experienced stress).A nightmare scenario, most often autobiographical. Unlike other memories, a terrible dream reproduces the events of the past in full, makes you experience not only at night, but throughout the day.

Severe stress can cause nightmares. Thus, a "vicious circle" is formed, stress causes a realistic nightmare, and a nightmare has a strong negative impact on a person's feelings after awakening. The mechanism is repeated again and again. The higher the level of stress, the stronger the nightmare. Attempts to avoid nightmarish dreams will lead, ultimately, to disturbances in the phase of fast sleep and to early awakenings. Such a person will feel not rested and not asleep.

Nightmares can be the result of exposure to psychoactive substances , which disrupt the functions of mediator systems in the brain( mainly associated with norepinephrine, serotonin and dopamine, as well as acetylcholine and gamma-aminobutyric acid, GABA).

What are the symptoms to consult a doctor?

To get rid of nightmares you need to be treated under the supervision of a specialist. The problem is that most patients do not recognize this sleep disorder as a disease. Addressing a graduate with experience is the best and most effective way to combat insomnia and nightmares.
Symptoms requiring a doctor to see a psychotherapist or somnologist:
- experiencing great difficulties when falling asleep.
- can not sleep for more than 30 minutes,
- wake up several times a night, and then again can not fall asleep,
- repeated awakening episodes from sleep accompanied by a feeling of intense anxiety, fear, anger, sadness, disgust and other negative emotions,
- awakening occurs in "full combat readiness", with a sense of confusion of thoughts, immediately very clearly comes the memory of the content of the dream,
- the presence of a real event of their past that carries a negativeemotions and echoes the dream content.

Treatment of conditions in which nightmares are dreamed of

Fortunately, there are many methods of treatment and ways to deal with nightmares. People who managed to defeat this disease have improved the quality of sleep, they wake up rested and are less stressed out at work, less sleep during the day. Getting rid of nightmarish dreams improves the overall physical condition. Each nightmare is unique and only the doctor can decide which type of treatment to use.

There are several ways to eliminate nightmares.

1. In the beginning, it's worth analyzing your habits associated with falling asleep, because in many cases their small modification can significantly improve the quality of sleep.

2. You can resort to drug therapy ( always used under the supervision of a doctor! !!).Sleeping pills are most often used in the treatment of sleep disorders. Their effectiveness, in general, depends on the cause of nightmares. Drug therapy is best proven in the treatment of parasomnias associated with substance abuse and nightmares with nightly awakenings.

Medicinal preparations.
Hypnotics: Bromizovalum, Bromisovalum, Diphenhydramin, Doxylaminum, Temazepamum, Phenobarbitalum, Flunitrazepamum, Flurazepamum, Estazolamum, Zaleplonum, ZolpidemZolpidemum), Zopiclonum, Clomethiazolum, Midazolamum, Nitrazepamum.
All drugs cause dependence when applied for more than 4 months, are strictly prescription. The hypnotic drugs of the diazepine group are best tolerated.

Hormone therapy.
A more safe drug in the treatment of parasomnia is melatonin( melatonin).Melatonin is a hormone produced by the pineal gland( located in the brain, refers to the photoendocrine system), but after thirty years it produces it too little. There are violations of circadian( cyclic) rhythms of sleep: increased fatigue, develops a depressive syndrome. You can make up for the lack of melatonin in the body with the help of synthetically synthesized. It is sold in the pharmacy network under the same name, only from different manufacturers( Italian, Indian and Russian).

Phytotherapy.
Lavender flowers - a natural sedative, helps to improve sleep. It is used not only as a medicine for parasomnias, but also as a means for alleviating stress and irritability. Often lavender is added to the bath. Bouquets of flowers plants placed in the bedroom, can provide a healthy sleep.
Melissa grass - lemon balm infusion acts as a sedative. Treating sleep disorders. Especially recommended for the elderly.
Valerian root - the infusion of the plant helps to fall asleep, soothes, eliminates insomnia. Valerian is also used to combat stress.

Each medicine contains substances that interfere with the body's natural cycle. Therefore, care and moderation in the use of drugs for sleep should be observed. The constant use of herbs and other natural medicines can lead to psychological dependence. Swallowing tablets before going to bed becomes, in a way, a ritual that repeats itself every night. Natural falling asleep will become impossible, since the brain constantly sends out signals that prompt you to take the medicine.

3. Psychotherapy. The best choice of psychotherapeutic help will be cognitive-behavioral therapy. Various techniques of cognitive-behavioral therapy have proven effective in reducing the incidence of nightmares. Therapy is aimed at changing the mechanism of the nightmare scenario by influencing the cognitive model of dream formation.
The most widely used: the method of imagination or rehearsal therapy. The approach to treatment is based on the destruction of bad thoughts, emotions and behavior. The therapeutic procedure itself is very structured.
- The patient extracts from his memory his nightmares, writes them down.
- Then, under the guidance of the therapist, some elements and details of individual events change so that to replace all negative elements of sleep with positive ones.
- Later positive experience is fixed, which can affect the content of nightmares that arise in the future.

Prevention of nightmares

1. If you are lightly asleep, then eliminate all sounds in the bedroom that prevent you from falling asleep. Noise "paralyzes" the dream.
2. Remove the large dials of the clock from the bedroom, away from your field of vision. You can hang them over your head or put them on the ground next to the bed. If you look at the clock before going to bed, it seems that time flows more slowly, then stress and excitement are formed.
3. Very important lighting in the bedroom. Eyelids very easily pass light and just closing your eyes may not be enough to maintain an adequate level of darkness for a serene sleep. Good curtains or blinds should be protected from light, lights from the street in the evening and night, from the first rays of the sun in the morning. If you like to read a book before going to sleep, care should be taken to ensure that the light has a warm, natural color, preferably a low lamp power( but enough to not tire your eyes when reading the text).
4. If there are problems associated with awakening, try to expose yourself to sunlight or bright light. This will restore the biorhythms and, when twilight comes, it will be easier to cope with falling asleep.
5. Always take care of the timely change of bed linen. Ventilate the room a few minutes before going to bed.
6. Avoid foreign sharp smells in the bedroom( smell of food, air freshener).
7. Do not bring food into the bedroom, the smell of food can cause hunger at the wrong time. In addition, the presence of food in the bedroom can increase the likelihood of allergenic mold and fungus.
8. One hour before sleep, you can afford snacks containing carbohydrates, but do not exceed the caloric value to 100-200 calories( the number of calories is usually on the packaging of any food product).It is better to arrange a short snack in the evening, which will help prevent the desire to eat at night, starvation leads to a loss of sleep.
9. During the day, or for 3-4 hours before sleep, exercise should be done for at least 30 minutes. In addition, physical activity contributes to the prevention of stress, which is one of the main factors that break sleep.
10. The temperature in the room is very important for sleeping. The bedroom should be colder than the rest of the apartment. It is better to choose a room for a bedroom in an apartment with the fewest windows that are not located on the sunny side or simply equip the room with air conditioning.
11. Limit the consumption of alcoholic beverages in the evening. After 19 hours, it is better not to drink alcohol at all. Alcohol, at the beginning, will make it easy to fall asleep, but the dream will not be deep and intermittent. The more alcohol is drunk, the more time the body needs to process it. Sleep during this period will be of poor quality, in time there will not be a fast phase. As a result, the likelihood of nightmares will increase.
12. Do not drink coffee and strong tea more than two cups a day. After 15.00, you should not drink coffee at all. Caffeine remains in the body for a significant period of time, and its presence can cause disturbance and fragmentation( disruption of sleep).

Maintaining the basic principles of sleep hygiene will help eliminate many of the causes of parasomnias, but in some cases this may not be enough to solve all problems associated with nightmares. Proper sleep hygiene is a prerequisite for any planned treatment procedures to have the desired beneficial effect.

Doctor psychiatrist Kondratenko NA