nachtmerries

Nachtmerries are distressing dreams that cause awakening with strong negative emotions such as fear, horror, or anxiety. The term is used mainly in Dutch-language contexts to denote nightmares; in German the closest standard term is Albträume. Nightmares typically occur during REM sleep and are usually remembered upon waking. When recurring and frequent enough to cause distress or impairment, they may be described in clinical terms as nightmare disorder.

Causes and risk factors include stress, anxiety, and trauma (including post-traumatic stress disorder), depression, sleep deprivation or irregular sleep schedules, illness or fever, and certain medications or substances (such as some antidepressants, caffeine, or alcohol). Nightmares can affect people of all ages, with children more likely to experience them frequently, though persistent nightmares can persist into adulthood for some individuals.

Nightmares must be differentiated from other parasomnias such as sleep terrors (pavor nocturnus), which typically occur during non-REM sleep in the first half of the night and may not be remembered. REM-based nightmares, by contrast, are usually vividly recalled upon waking and may disrupt subsequent sleep.

Diagnosis and treatment: Nightmares are considered problematic when they occur regularly and interfere with functioning. In such cases a clinician may consider nightmare disorder according to DSM-5 criteria. Treatments emphasize sleep hygiene, stress management, and psychological therapies. Imagery Rehearsal Therapy (IRT), a cognitive-behavioral technique that rewrites the dream while awake, has evidence of benefit. For nightmares linked to PTSD, targeted therapies and, in some cases, medication may be used under medical supervision.

Prognosis varies; many individuals improve with therapy, changes in sleep patterns, or time, while others may need ongoing management of underlying conditions.