Thursday, April 23, 2015

N-Night mare disorder

Nightmares can be defined as vivid and terrifying dreams which awaken the dreamer from sleep. Typically, the dreamer wakes from the rapid eye movement (REM) stage of sleep and can remember a detailed, perhaps bizarre dream plot. There is evidence that frequent nightmares are associated with insomnia and poor-quality sleep.
ICD-10 classification defines..A sleep disorder characterised by the repeated occurrence of frightening dreams which precipitate awakenings from sleep; on awakening, the individual becomes fully alert and oriented and has detailed recall of the nightmare, which usually involves imminent danger or extreme embarrassment to the individual

 Diagnosis:The diagnostic criteria as DSM-IV-TR--
A) The essential feature of Nightmare disorder is the repeated occurrences of frightening dreams that lead to awakening from sleep usually involving threats to survival,security or self esteem. (Criterion A),the awakening generally occurs on the second half of the sleep period.
B) awakening from the frightening dreams the individual becomes fully alert and rapidly becomes oriented on awakening (Criterion B)in contrast to the confusion and disorientation seen in Sleep Terror Disorder and some forms of sleep epilepsy. 
C) The dream experience or the sleep disturbance resulting from the awakening causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. (Criterion C)
D) The nightmares do not occur exclusively during the course of another mental disorder (eg post traumatic stress disorder) and are not due to the direct physiological effect of substance (eg.drug abuse,medication) or a general medical condition..
Prevalence: The prevalence is between 10%-50% of children aged 3-5 years having nightmares of sufficient intensity that disturb their parents. In adult population as many as 50% of individuals may report at least one occasional night mare. In young adults at least 3% reports having nightmares frequently or always,however the actual prevalence is unknown.A cross-sectional study of 4- to 12-year-olds suggests a peak prevalence between 7 and 9 years, with 87% and 95.7% of children retrospectively reporting bad dreams often or sometimes
Causes: Nightmares disorder is most likely to appear in children exposed to severe psychosocial stressors.Females report having nightmares more than do men, at a ratio 2:1 to 4:1
Identification:  A clinician will add specifiers to the diagnosis according to its duration and severity.
  • Acute: Duration of period of nightmares is 1 month or less.
  • Subacute: Duration of period of nightmares is greater than 1 month but less than 6 months.
  • Persistent: Duration of period of nightmares is 6 months or greater.
Severity is rated by the frequency with which the nightmares occur:
  • Mild: Less than one episode per week on average.
  • Moderate: One or more episodes per week but less than nightly.
  • Severe: Episodes nightly
Children:  Reassurance of the patient or child and parents is all that is usually required.
    It may help to develop a relaxing bedtime routine that does not vary. Attention to causes of stress and upheaval within the home may help reduce the propensity to nightmares.
    Use of night lights and other strategies that may reduce  anxiety levels at night can help.
    If the nightmare is recurrent then it may help for the parents to talk through the nightmare and imagine a less scary ending.If the problem is occurring, say, on a more than twice-weekly basis persistently, then it may be worth referring for psychological or child-psychiatric input.
Adult :If your nightmares aren't illness- or medication-related, don't despair. Behavioral changes have proven effective for 70% of adults who suffer from nightmares, including those caused by anxiety, depression, and Post Traumatic Stress Disorder. Imagery rehearsal treatment is a promising cognitive behavioral therapy for recurrent nightmares and nightmares caused by PTSD
Keeping a regular wake-sleep schedule is important, maintaining sleep hygiene. So is engaging in regular exercise, which will help alleviate nightmare-causing anxiety and stress. You may find that yoga and meditation are also helpful.For further help one can contact a medical profession.

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