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Nightmares

The term "nightmare" has been widely used for many years in the pediatric and adult literature to describe the condition REM sleep dreams. The reason that other terms, such as dream anxiety attack and REM nightmare have been suggested is to differentiate the phenomenon from sleep terrors (sometimes called stage 4 nightmares) on the assumption that nightmare was an overall lay term that covered the stage 4 as well as the REM sleep event. However, it is preferable to use the term "nightmares" for the REM phenomenon.

ESSENTIAL FEATURES

Nightmares are frightening dreams that usually awaken the sleeper.

The most obvious difference between night terror and dream anxiety attack is the timing of the episodes later in the nocturnal sleep cycle when REM rather than slow-wave sleep is prominent. The afflicted person vividly recalls a nightmarish dream, is oriented upon awakening, and shows fewer signs of sympathetic arousal than does the sleep terror victim, although a moderate degree of tachycardia.

The treatment of persistent nightmares involves an understanding of the underlying anxiety and the provision of reasonable support for the child. Night terrors are treated in the same fashion. Benzodiazepines (clonazepam) or tricyclic antidepressants (imipramine) may be effective because benzodiazepines and tricyclic antidepressants suppress stages 3 and 4 of the sleep cycle. Sleep laboratory studies and medical examinations are useful in assessing all sleep disorders.

Nonpharmacologic treatment such as psychotherapy, progressive relaxation, hypnosis, or anticipatory awakening is recommended for long-term management. Avoidance of potential triggering factors such as drugs, alcohol, and sleep deprivation.