Intense nightmares are often the result of normal things like garden-variety stress — or they could be a signal of a physical health issue.

What causes nightmares?

All dreams occur during REM (rapid eye movement) sleep, which is essential to mental health. “You need REM sleep to integrate current emotional material into long-term memory,” explains Patrick McNamara, Ph.D., associate professor of neurology, Boston University School of Medicine.

This means your brain uses dreams to make sense of what you experience every day. “If you disrupt REM sleep, whether through respiratory problems, intense hormonal changes or stress, that emotional content just sits there and irritates the brain. You get nightmares as a result.” These dark dreams usually occur later in the night, and women get them more often than men.

In general, you shouldn’t worry about the content of your nightmares, says Dr. McNamara. Lots of people have bizarre dreams. But if you experience nightmares often, talk to your doctor. Most times they are a result of stress, anxiety, certain medications, family history, and hormonal changes. However, other more serious issues could be the cause:

Serious health conditions related to intense nightmares

Intense nightmares in the elderly can result in some unfortunate medical side effects and health conditions.

Bad dreams cannot only disrupt sleep but can play a direct role in high blood pressure, sleep deprivation, and can even lead to the following more serious health conditions.

  • Heart disease
  • Parkinson’s disease and other neurodegenerative diseases
  • Psychotic episodes
  • Sleep apnea

Heart Disease

A 2003 Swedish study discovered that in elderly men and women, increased nightmares were associated with an increase in irregular heartbeats, as well as in spasmodic chest pain. That same study also found that the occurrence of chest pain and irregular heart beats increased in 40- to 64-year-old women with frequent nightmares and poor sleep. The occurrence of spasmodic chest pain was further increased after menopause.

Most heart attacks occur in the early morning when REM is occurring, because REM places stress on the body.

“When we switch into REM sleep, our breathing becomes more rapid, irregular, and shallow, our eyes jerk rapidly in various directions, and our limb muscles become temporarily paralyzed,” says the National Institute of Neurological Disorders and Stroke. “Heart rate increases, blood pressure rises, and males develop penile erections. When people awaken during REM sleep, they often describe bizarre and illogical tales.”

So it’s not the nightmares that are causing physical stress but rather the REM sleep, which in turn causes the nightmares.

REM sleep is a stressor…Combine this overactive amygdala with poor cardiac health, and you are much more vulnerable to having a heart attack.
Dr. Patrick McNamara
Boston University School of Medicine

“REM sleep is a stressor because it is stimulating your amygdala, the part of your brain responsible for emotions. Combine this overactive amygdala with poor cardiac health, and you are much more vulnerable to having a heart attack. It’s as if a person with cardiac problems is riding up a hill. It makes the autonomic nervous system overreact,” says Dr. McNamara. (Except in this one instance, nightmares cannot physically harm you.)

Parkinson’s and other neurodegenerative diseases

Three recent studies published in The Lancet Neurology have shown that people with REM sleep disorders who experience intense nightmares that manifest physically during sleep (ie: screaming, crying, punching, and kicking) are at risk for developing Parkinson’s Disease and other neurodegenerative diseases. Healthy people experience a paralysis during REM sleep. People with Parkinson’s, and related neurodegenerative disorders, however, lose the ability to maintain paralysis in REM sleep. This allows them to act out their dreams, which people who don’t have neurodegenerative disorders generally cannot do.

Psychotic Episodes

A new English study found that children who suffer from frequent nightmares or bouts of night terrors may be at an increased risk of psychotic experiences in adolescence.

“Our recent research that looked at being bullied and nightmares indicate that experiences during the day are still processed at night and this alters stress responses physiologically. Both of these have been related to increased risk of developing mental health problems,” says Dieter Wolke, Ph.D., lead author of the study, Professor of Developmental Psychology and Individual Differences, The University of Warwick Department of Psychology.

However, we’re not talking about the occasional nightmare: Parents should be concerned when the nightmares occur regularly – over months and even years, adds Wolke.

Sleep Apnea

Nightmares not only warn of possible conditions in your future; it can also alert you to health issues you currently have and may not be aware of. If your nightmares are increasing and the content is often about not being able to breath, have your healthcare professional check you for sleep apnea.

Sleep apnea is a chronic condition that occurs when you have pauses in your breathing or shallow breaths while asleep. Sleep apnea wreaks havoc with your REM sleep due to lack of oxygen.

William Kohler, MD, medical director of the Florida Sleep Institute, Spring Hill, explains, “Patients have had terrifying dreams of drowning or suffocation.  In reality, their airway is blocked off.” A recent study published in Sleep Medicine found that the nightmares disappeared in 91% of patients with sleep apnea were treated with continuous positive airway pressure (CPAP) therapy.

Want to get rid of run-of-the mill nightmares?

If your nightmares are not a symptom of illness, there are therapies and treatments to stop disturbing dreams. Treatments for nightmares include:

  • Hypnosis
  • Imagery Reversal Therapy (IRT)
  • Medication

Hypnosis

Hypnosis is lead by a trained therapist that attempts to reframe your nightmares using suggestions to your subconscious. You’ll be instructed to tell yourself when you have a nightmare, “I’ve had nightmares before and nothing bad has ever happened, nothing ever will happen.”

Imagery Reversal Therapy (IRT)

IRT asks patients to confront the images of their nightmares in a safe place, such as a therapist’s office. You draw, describe or write about the scary thing, and then confront it. Look at it, talk directly to it, challenge it.

Then you draw/describe/ write about it again, and make it less scary by rewriting the script. That person stalking you is really trying to give you a present, for example. “This does work but it takes time. You have to do it for many weeks,” says Dr. McNamara.

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Medication

Medication can also help improve sleep quality. A study published in the American Journal of Psychiatry showed that the drug prazosin could decrease nightmares caused by post-traumatic stress disorders. In patients with severe nightmares caused by a traumatic event, the drug has been shown to be effective in diminishing frequency and severity of nightmares.

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