Can Nightmares Kill You?
Nightmares, although being a very disturbing disorder, is non-fatal in most of the cases and do not produce mortality. Only a few numbers of cases can be attributed to it because of the conversion of nightmare disorder into night terrors and these are usually associated with chronic organic brain disorders or severe functional disorders like depression, paranoia, schizophrenia, etc.
Although the prognosis is very good at it it can significantly affect the quality of life of the individual. The patient remains suspicious, find difficulty in daily routine work and occupation, increased daytime sleepiness due to ineffective and less night sleep, etc. The content of the dream remains wandering and roaming in mind of the patient because it can be recalled in nightmare disorder as compared to night terror disorder where it cannot be recalled and it is much more severe.
Is Nightmare A Mental Disorder?
Nightmares or parasomnias also are known as dream anxiety disorder are a group of sleep disorders which are a part of mental (psychological) disorders described as neurotic disorders in the psychiatry. Neurotic disorders are the group of diseases associated with intact reality contact and no loss of insight with the environment. It has to be differentiated from psychotic disorders which comprise of loss of insight and reality contact with the environment. Most of the nightmare disorders occur in the younger age group ranging between 2 to 18 years of age and the prevalence is about 30 to 40% as derived by many studies. The exact data collection is not visible because of the subjective nature of this disorder.[1]
Most of the nightmare disorder cases are attributed to the immaturity of neural circuits belonging to various cortical neurological pathways in the brain. As the age progresses, these pathways get matured and the nightmare disorder resolves till adolescence. Only of few cases do not get enough matured in neural circuits and goes till the age of adulthood. Other causes are also found like organic brain disorders, functional abnormalities in the mental aspect, substance abuse, drug-induced, etc.
It is thoroughly described in diagnostic and statistical manual of mental disorders, 5th edition along with its diagnostic criteria. It is defined as the awakening episodes from the sleep which are recurrent in nature due to intense dream mentation of disturbing nature usually associated with the fear and anxiety jeopardizing the personal safety and threat to life and are the commonly experienced feelings during the dreams. Sometimes other emotions include sadness, anger, disgust, guilt, etc. which are extremely dysphoric in nature can also be felt in the nightmares.[2]
Along with the emotional symptoms, sometimes patients can also observe physical symptoms like increase in heart rate, excessive sweating or diaphoresis, flushing of the skin, wetting of palms, etc. The patient may find it difficult to fall asleep again after the nightmare due to recalling of events and the fear generated by them. Sleep deprivation can be an end result of this disorder leading to various other systemic symptoms indirectly.
Conclusion
Nightmare disorder is usually not associated with morbidity and has very good prognosis. The immature neural pathways which are thought to be the cause of nightmares get easily mature with age and nightmares disappear. If the disorder persists for the period of time or the symptoms become severe enough to disrupt the daily routine life of the person, then a psychiatrist must be consulted as soon as possible for proper guidance and treatment of the disorder. Conservative management with the psychotherapies and cognitive improvement is done so as to make the patient bearable to the nightmares. Medical treatment is neither indicated nor required in most of the cases but it can be used in severe cases. Selective serotonin reuptake inhibitors are the drugs of choice used for this disorder like fluoxetine, fluvoxamine, etc. The patient should be dealt cordially and reassurance should be given.
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