Zaburzenie koszmarów sennych – Etiologia i przyczyny

Zaburzenie koszmarów sennych
Etiologia i przyczyny

Zaburzenie koszmarów sennych (Nightmare disorder) jest parasomnią manifestującą się niepożądanymi, intensywnymi koszmarami występującymi głównie w fazie REM snu. Patofizjologia opiera się na dwóch kluczowych mechanizmach: podwyższonym pobudzeniu (hyperarousal) utrzymującym się nocą oraz zaburzonym wygaszaniu lęku, co prowadzi do utrwalania lękowych wspomnień podczas snu. Czynniki ryzyka obejmują traumatyczne doświadczenia (szczególnie w PTSD, gdzie 80% pacjentów zgłasza koszmary), przeciwności losu we wczesnym dzieciństwie, stres, lęk, genetyczną predyspozycję (korelacje genetyczne z zaburzeniami lękowymi rg=0,671, depresyjnymi rg=0,562, PTSD rg=0,4083 oraz neurotyzmem rg=0,667), dezadaptacyjne przekonania, zaburzenia oddychania podczas snu (np. obturacyjny bezdech senny) oraz deprywację snu. Współwystępowanie z innymi zaburzeniami psychicznymi, takimi jak zaburzenia lękowe, depresyjne, BPD czy dysocjacyjne, jest częste i może wzmacniać objawy koszmarów. Ponadto, farmakoterapia (antydepresanty, beta-blokery) i nadużywanie substancji (alkohol, odstawienie leków GABA-ergicznych) mogą indukować lub nasilać koszmary.

Etiologia zaburzenia koszmarów sennych

Mechanizmy patofizjologiczne
Czynniki przyczyniające się do patogenezy
Współwystępowanie z innymi zaburzeniami
Czynniki farmakologiczne i substancje
Czynniki środowiskowe i styl życia

Modele teoretyczne tłumaczące zaburzenie koszmarów sennych
Etiologia koszmarów idiopatycznych vs. związanych z PTSD
Konsekwencje zaburzenia koszmarów sennych
Podsumowanie etiologii zaburzenia koszmarów sennych

Kolejne rozdziały

Etiologia zaburzenia koszmarów sennych

Zaburzenie koszmarów sennych (Nightmare disorder) jest klasyfikowane jako parasomnia, czyli rodzaj zaburzenia snu obejmujący niepożądane doświadczenia występujące podczas zasypiania, w trakcie snu lub w momencie wybudzania się. Koszmary zwykle pojawiają się podczas fazy snu o szybkich ruchach gałek ocznych (REM). Pomimo lat badań, dokładna etiologia zaburzenia koszmarów sennych pozostaje nie w pełni poznana, jednak badacze zidentyfikowali kilka potencjalnych czynników przyczyniających się do rozwoju tego schorzenia.¹²

Mechanizmy patofizjologiczne

Według aktualnych badań naukowych, dwa kluczowe mechanizmy odgrywają główną rolę w patofizjologii zaburzenia koszmarów sennych:¹²

Podwyższone pobudzenie (nadmierna aktywacja) – zgodnie z badaniami z 2019 roku, zaburzenie koszmarów sennych może być spowodowane podwyższonym poziomem pobudzenia (hyperarousal), które gromadzi się w ciągu dnia i utrzymuje w nocy. Podwyższone pobudzenie jest uważane za centralny czynnik patofizjologiczny zarówno w PTSD, jak i w bezsenności.¹²³
Zaburzone wygaszanie lęku – podczas gdy normalny sen i marzenia senne mogą umożliwiać wygaszanie lęku poprzez proces łączenia wspomnień wywołujących lęk z nowymi i oddzielonymi kontekstami, osoby z zaburzeniem koszmarów sennych nadal aktywują fragmenty pobudzających wspomnień podczas snu, wzmacniając wspomnienia lękowe. Zgodnie z teorią zaburzonego wygaszania lęku, osoby z zaburzeniem koszmarów sennych kontynuują aktywację wspomnień lękowych podczas snu.¹²³

Interakcja pomiędzy podwyższonym pobudzeniem a zaburzonym wygaszaniem lęku odgrywa kluczową rolę w rozwoju przewlekłych koszmarów sennych. Ta wzajemna zależność jest wzmacniana przez wrodzoną podatność na niepokój wywołany przez traumatyczne doświadczenia, przeciwności losu we wczesnym dzieciństwie oraz indywidualną podatność, a także przez podwyższone tłumienie myśli i potencjalnie zaburzenia oddychania podczas snu.¹

Czynniki przyczyniające się do patogenezy

Kilka czynników zostało zaproponowanych jako ułatwiające nadmierne pobudzenie i zaburzone wygaszanie lęku u pacjentów z zaburzeniem koszmarów sennych:¹²

Czynniki psychologiczne i traumatyczne

Doświadczenia traumatyczne – według modelu AND (Affect Network Dysfunction), zdolność wygaszania lęku jest zaburzona przez konsekwencje traumatycznych doświadczeń. Około 80% pacjentów z PTSD zgłasza koszmary senne, a nagłe przebudzenia w nocy są częstsze i dłuższe niż w przypadku idiopatycznych koszmarów.¹²³
Przeciwności losu we wczesnym dzieciństwie – stres rozwojowy, taki jak przeciwności losu we wczesnym dzieciństwie, może inicjować podobne mechanizmy jak traumatyczne doświadczenia. Zarówno dorośli, jak i dzieci, które doświadczyły wczesnych traum, mają historię zmienionej jakości snu i koszmarów.¹²
Stres i lęk – zwykły stres życia codziennego, jak problem w domu lub szkole, może wywołać koszmary. Duża zmiana, taka jak przeprowadzka lub śmierć bliskiej osoby, może mieć taki sam efekt. Doświadczanie lęku jest związane z większym ryzykiem koszmarów. Stres ma dwukierunkowy związek z koszmarami – większy stres zwiększa prawdopodobieństwo wystąpienia koszmaru, a koszmary są związane z większym stresem następnego dnia.¹²

Czynniki genetyczne i indywidualne predyspozycje

Podatność konstytucyjna – teoria zróżnicowanej podatności jest zgodna z założeniami rozwojowymi modeli AND i SAH, które zakładają, że traumatyczne doświadczenia i przeciwności losu we wczesnym dzieciństwie zwiększają wrażliwość na bodźce u podatnych osób. Niektóre cechy osobowości, jak wysokie poszukiwanie nowości i predyspozycje genetyczne, mogą zwiększać szansę na występowanie uporczywych koszmarów.¹²
Genetyczne podłoże – w fińskim ogólnokrajowym badaniu bliźniąt, u bliźniąt monozygotycznych występowało większe podobieństwo częstości koszmarów niż u bliźniąt dizygotycznych, co sugeruje genetyczną skłonność do zaburzenia koszmarów sennych. Badania wykazały, że koszmary senne korelują genetycznie z zaburzeniami lękowymi (rg = 0,671), depresyjnymi (rg = 0,562) i zespołem stresu pourazowego (rg = 0,4083), a także cechą osobowości neurotyzmem (rg = 0,667).¹²

Czynniki poznawcze i dezadaptacyjne przekonania

Dezadaptacyjne przekonania – mogą odgrywać rolę w etiologii zaburzenia koszmarów sennych. Rozwój dezadaptacyjnych przekonań, takich jak tłumienie myśli (próba tłumienia niechcianych myśli i uczuć), zwiększa prawdopodobieństwo powrotu tych myśli w snach.¹²
Poznawczy model powtarzających się snów – zgodnie z tym teoretycznym modelem, koszmary są rodzajem wyuczonego zachowania, gdzie podświadomość reaguje negatywnie na wszelkie elementy snu, które przypominają początkowy stresor. Koszmary mogą zatem utrzymywać się długo po ustąpieniu początkowego stresora.¹²

Czynniki fizjologiczne i zaburzenia snu

Zaburzenia oddychania podczas snu – jednym z czynników fizjologicznych, który może wyjaśnić niektóre aspekty nadmiernego pobudzenia u pacjentów z koszmarami i który może utrudniać wygaszanie lęku, jest ciężka fragmentacja snu spowodowana obturacyjnym i centralnym bezdechem sennym. Zaburzenia oddychania związane ze snem mogą przyczyniać się do stresu psychologicznego, wywołując koszmary, i mogą powodować mniej regenerujące fazy snu, w których koszmary są częściej zapamiętywane.¹²
Deprywacja snu – zmiany w harmonogramie, które powodują nieregularne pory snu i czuwania lub które przerywają lub zmniejszają ilość snu, mogą zwiększyć ryzyko koszmarów. Bezsenność jest związana ze zwiększonym ryzykiem koszmarów. Badania randomizacji mendlowskiej sugerują przyczynowość od bezsenności do koszmarów (beta = 0,027, p=0,0002).¹²

Współwystępowanie z innymi zaburzeniami

Zaburzenie koszmarów sennych często współwystępuje z innymi zaburzeniami psychicznymi i medycznymi, co może sugerować wspólne mechanizmy patofizjologiczne lub wzajemne wzmacnianie symptomów:¹²

Zaburzenia psychiczne

Zespół stresu pourazowego (PTSD) – około 80% pacjentów z PTSD zgłasza koszmary. Koszmary są zwykle uważane za część objawów intruzywnych/ponownego przeżywania. Koszmary związane z PTSD są bardziej stresujące niż koszmary idiopatyczne.¹²
Zaburzenia lękowe i depresyjne – objawy lękowe i depresyjne są związane z doświadczaniem ciągłych koszmarów, szczególnie lęk. Istnieje silna korelacja między koszmarami a ryzykiem samobójstwa. Osoby z częstymi koszmarami są bardziej skłonne do prób samobójczych i zachowań autoagresywnych, prawdopodobnie za pośrednictwem trudności w regulacji emocji i negatywnych ocen poznawczych.¹²
Zaburzenie osobowości z pogranicza (BPD) – badanie analizujące związek między zaburzeniem osobowości z pogranicza a koszmarami wykazało, że koszmary, a także lęk związany ze snami i negatywna jakość snu, są bardziej powszechne u osób z BPD niż u osób bez tego zaburzenia.¹
Zaburzenia dysocjacyjne – zaburzenia dysocjacyjne, które są zaburzeniami psychicznymi, w których jednostka doświadcza odłączenia od rzeczywistości, myśli, uczuć i tożsamości, są również związane z zaburzeniem koszmarów sennych.¹

Schorzenia medyczne

Inne zaburzenia snu – istnienie innych zaburzeń snu, które zakłócają odpowiedni sen, może być związane z występowaniem koszmarów. Częste koszmary mogą pojawić się wraz z niektórymi schorzeniami medycznymi, takimi jak choroby serca lub nowotwory.¹
Przewlekłe choroby – zidentyfikowano kilka schorzeń medycznych jako czynniki ryzyka, w tym przewlekłe zaburzenia, takie jak migrena, zapalenie oskrzeli i astma.¹

Czynniki farmakologiczne i substancje

Farmakologiczne interwencje i używanie substancji mogą znacząco wpływać na występowanie koszmarów:¹²

Leki – niektóre leki, w tym niektóre antydepresanty, leki na ciśnienie krwi, beta-blokery oraz leki stosowane w leczeniu choroby Parkinsona lub pomagające rzucić palenie, mogą wywoływać koszmary. Leki, które wpływają na neuroprzekaźniki noradrenergiczne, serotoninowe i dopaminergiczne, również mogą przyczyniać się do występowania koszmarów.¹²
Nadużywanie substancji – alkohol i używanie narkotyków rekreacyjnych lub odstawienie mogą wywoływać koszmary. Koszmary często występują podczas odstawienia leków lub substancji GABA-ergicznych, takich jak alkohol, barbiturany i benzodiazepiny.¹²

Czynniki środowiskowe i styl życia

Codzienne doświadczenia i wybory stylu życia mogą również wpływać na częstość i intensywność koszmarów:¹

Straszne książki i filmy – dla niektórych osób czytanie strasznych książek lub oglądanie przerażających filmów, szczególnie przed snem, może być związane z koszmarami.¹
Późne jedzenie – jedzenie zbyt blisko pory snu może zwiększyć ryzyko koszmarów. Późna przekąska zwiększa metabolizm, powodując większą aktywność mózgu, co prowadzi do dłuższego czasu marzeń sennych.¹

Modele teoretyczne tłumaczące zaburzenie koszmarów sennych

W badaniach nad zaburzeniem koszmarów sennych zaproponowano kilka modeli teoretycznych, które próbują wyjaśnić jego patofizjologię:¹

Model dysfunkcji sieci afektywnej (AND) – zakłada, że zdolność wygaszania lęku jest zaburzona przez konsekwencje traumatycznych doświadczeń i przeciwności losu we wczesnym dzieciństwie.¹
Model akceleracji stresu (SAH) – zakłada, że negatywne doświadczenia z dzieciństwa mają szkodliwy wpływ na przyszłe zdrowie fizyczne i psychiczne, zwiększając ryzyko problemów psychiatrycznych, zaburzeń snu i idiopatycznych koszmarów.¹²
Model dopaminergiczny – dodatkowa teoria dotyczy układu dopaminergicznego mezokortykalnego i mezolimbicznego, ponieważ uszkodzenia obejmujące ten obwód były związane z utratą marzeń sennych.¹
Skrypt koszmaru – wszystkie powyższe czynniki mogą przyczyniać się do kondensacji powtarzających się elementów koszmaru w „skrypt koszmaru”, gdzie elementy snu wywołują pojawienie się koszmaru.¹

Etiologia koszmarów idiopatycznych vs. związanych z PTSD

Istnieją pewne różnice między koszmarami idiopatycznymi a koszmarami związanymi z PTSD:¹

Wzorce snu – osoba z PTSD mająca koszmary budziłaby się w nocy częściej i na dłużej niż w przypadku koszmarów idiopatycznych. W konsekwencji osoby z PTSD miałyby gorszą jakość snu.¹
Poziom stresu – koszmary związane z PTSD byłyby bardziej stresujące niż koszmary idiopatyczne.¹
Treść koszmaru – koszmary związane z PTSD często odzwierciedlają traumatyczne wydarzenie lub są do niego podobne, podczas gdy koszmary idiopatyczne mają bardziej różnorodną treść.¹

Jednak konieczne są dalsze badania w tym obszarze, aby uzyskać bardziej wiarygodne wyniki.¹

Konsekwencje zaburzenia koszmarów sennych

Zaburzenie koszmarów sennych może prowadzić do różnych negatywnych konsekwencji dla zdrowia fizycznego i psychicznego:¹

Bezsenność – zaburzenie koszmarów sennych może powodować bezsenność z powodu strachu przed zaśnięciem wynikającego z obawy przed wystąpieniem koszmaru.¹²
Ryzyko samobójcze – badacze zaczynają uważać, że koszmary zwiększają ryzyko samobójstwa i zachowań samobójczych w ciągu całego życia. Istnieje silna korelacja między koszmarami a ryzykiem samobójstwa.¹²
Pogorszenie funkcjonowania – częste i intensywne koszmary mogą występować w związku z szerokim zakresem zaburzeń psychicznych, w tym depresją, zaburzeniami lękowymi i paniki, schizofrenią i zaburzeniem osobowości z pogranicza.¹

Podsumowanie etiologii zaburzenia koszmarów sennych

Etiologia zaburzenia koszmarów sennych jest złożona i wieloczynnikowa, obejmująca interakcję między podwyższonym pobudzeniem a zaburzonym wygaszaniem lęku. Czynniki ryzyka obejmują traumatyczne doświadczenia, przeciwności losu we wczesnym dzieciństwie, stres, lęk, genetyczną podatność, dezadaptacyjne przekonania, zaburzenia snu, leki i nadużywanie substancji. Lepsze zrozumienie tych czynników może prowadzić do bardziej ukierunkowanych i skutecznych interwencji terapeutycznych dla osób cierpiących na zaburzenie koszmarów sennych.¹²³

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Materiały źródłowe

#1 Aetiology and treatment of nightmare disorder: State of the art and future perspectives
https://pmc.ncbi.nlm.nih.gov/articles/PMC6850667/
This consensus paper provides an overview of the state of the art in research on the aetiology and treatment of nightmare disorder and outlines further perspectives on these issues. […] Chronic nightmares develop through the interaction of elevated hyperarousal and impaired fear extinction. This interplay is assumed to be facilitated by trait affect distress elicited by traumatic experiences, early childhood adversity and trait susceptibility, as well as by elevated thought suppression and potentially sleep-disordered breathing. […] The aetiology of nightmare disorder may be influenced by increased hyperarousal that accumulates during the day and is maintained at night. Elevated hyperarousal is discussed as a central pathophysiological factor in PTSD, but also in insomnia disorder. […] Although normal sleep and dreaming may enable fear extinction through a process of recombining fearful memories with novel and dissociated contexts, individuals with nightmare disorder continue to activate arousing memory fragments during sleep, reinforcing fear memories.
#1 Aetiology and treatment of nightmare disorder: State of the art and future perspectives
https://pmc.ncbi.nlm.nih.gov/articles/PMC6850667/
Several factors have been proposed as facilitating hyperarousal and impaired fear extinction in patients diagnosed with nightmare disorder. […] According to the AND model, fear extinction capacity is impaired by the consequences of traumatic experiences, although developmental stress such as early childhood adversity may initiate some similar mechanisms. […] The theory of differential susceptibility is consistent with the developmental tenets of the AND and SAH models, which suppose that traumatic experiences and early childhood adversity augment trait sensitivity in susceptible individuals. […] Maladaptive beliefs may play a role in the aetiology of nightmare disorder. […] One physiological factor that may explain some aspects of hyperarousal in nightmare patients and which may impede fear extinction is the severe sleep fragmentation caused by obstructive and central sleep apnea. […] All the above factors may contribute to the condensing of recurrent nightmare elements into a nightmare script.
#1 Nightmare disorder | UM Health-Sparrow
https://www.uofmhealthsparrow.org/departments-conditions/conditions/nightmare-disorder
Nightmare disorder is referred to by doctors as a parasomnia a type of sleep disorder that involves undesirable experiences that occur while you’re falling asleep, during sleep or when you’re waking up. Nightmares usually occur during the stage of sleep known as rapid eye movement (REM) sleep. The exact cause of nightmares is not known. […] Nightmares can be triggered by many factors, including: […] Stress or anxiety. Sometimes the ordinary stresses of daily life, such as a problem at home or school, trigger nightmares. A major change, such as a move or the death of a loved one, can have the same effect. Experiencing anxiety is associated with a greater risk of nightmares. […] Trauma. Nightmares are common after an accident, injury, physical or sexual abuse, or other traumatic event. Nightmares are common in people who have post-traumatic stress disorder (PTSD).
#1 Nightmares and nightmare disorder in adults – UpToDate
https://www.uptodate.com/contents/nightmares-and-nightmare-disorder-in-adults/print
A wide range of medications have been implicated in generating nightmares. […] Nightmares commonly occur during withdrawal from GABA-ergic medications or substances such as alcohol, barbiturates, and benzodiazepines. […] Nightmares may occur with increased frequency during times of stress or emotional instability and may disturb the quality and continuity of sleep. Some have proposed that nightmares may initially be about the experience of a stressful event but very soon are replaced by the dominant emotion of the event as a repeating narrative. […] In a Finnish nationwide twin cohort study, monozygotic twins had more similar rates of nightmares than dizygotic twins, suggesting a genetic propensity.
#1 Nightmare Disorder: What Causes It and How Do You Manage It?
https://www.healthline.com/health/nightmare-disorder
Sleep-disordered breathing: Breathing disorders that affect sleep can contribute to psychological distress, triggering nightmares, and may cause less restorative sleep stages where nightmares are more likely to be remembered. […] Experts believe these factors come together in a variety of ways to create whats known as the cognitive model of recurrent dreams. Under this theoretical framework, nightmares are a type of learned behavior, where your subconscious reacts negatively to any elements in a dream that resemble an initial stressor.
#1 Nightmare disorder | UM Health-Sparrow
https://www.uofmhealthsparrow.org/departments-conditions/conditions/nightmare-disorder
Sleep deprivation. Changes in your schedule that cause irregular sleeping and waking times or that interrupt or reduce the amount of sleep you get can increase your risk of having nightmares. Insomnia is associated with an increased risk of nightmares. […] Medications. Some drugs including certain antidepressants, blood pressure medications, beta blockers, and drugs used to treat Parkinson’s disease or to help stop smoking can trigger nightmares. […] Substance misuse. Alcohol and recreational drug use or withdrawal can trigger nightmares. […] Other disorders. Depression and other mental health disorders may be linked to nightmares. Nightmares can happen along with some medical conditions, such as heart disease or cancer. Having other sleep disorders that interfere with adequate sleep can be associated with having nightmares. […] Scary books and movies. For some people, reading scary books or watching frightening movies, especially before bed, can be associated with nightmares.
#1 Nightmares and nightmare disorder in adults – UpToDate
https://www.uptodate.com/contents/nightmares-and-nightmare-disorder-in-adults/print
Nightmares are common beginning early in childhood and extending throughout the lifespan. The condition is strongly associated with stress, anxiety, and trauma. […] While nightmares are not by definition pathologic, those that are frequent or disabling and impair social, occupational, emotional, and physical wellbeing are considered a disorder and are often a sign of underlying and treatable psychopathology. Common causes include stress, negative life events, the experience of trauma as in posttraumatic stress disorder (PTSD), depression, other psychiatric disorders, and medication side effects. […] Nightmares are more prevalent during periods of stress. They can emerge in association with traumatic experiences, as in posttraumatic stress disorder (PTSD), and in association with other psychiatric diagnoses, including depression, dissociative disorders, and borderline personality disorder.
#1 Nightmare disorder – Wikipedia
https://en.wikipedia.org/wiki/Nightmare_disorder
Nightmares can be caused by extreme pressure or irritation if no other mental disorder is discovered. The death of a loved one or a stressful life event can be enough to cause a nightmare, but conditions such as post-traumatic stress disorder and other psychiatric disorders have been known to cause nightmares as well. […] The nightmares may be idiopathic or could be associated with psychiatric disorders like post-traumatic stress disorder, schizophrenia, and borderline personality disorder. Nightmares can also be triggered by stress and anxiety and substance abuse, such as drugs that affect the neurotransmitters norepinephrine and dopamine and serotonin. […] Eighty percent of patients who have PTSD report nightmares. Patients with PTSD have symptoms that are classified into three clusters: intrusive/re-experiencing, numbing, and hyperarousal. Nightmares are usually considered to be part of the intrusive/re-experiencing symptom.
#1 Nightmare Disorder: Symptoms, Causes, Treatment
https://www.verywellmind.com/nightmare-disorder-definition-symptoms-causes-treatment-5220095
Nightmare disorder (ND) is a sleep disorder in which a person consistently experiences frightening, vivid or disturbing dreams, defined as nightmares, that suddenly wakes them. […] Nightmare disorder is considered a parasomnia, a type of sleep disorder that interferes with a persons sleep by creating abnormal or undesirable experiences. […] The following are possible causes of nightmare disorder or conditions that coexist with nightmare disorder: PTSD, Stress, Trauma, Anxiety, Depression, Suicidality, BPD. […] Post-traumatic stress disorder (PTSD) has been shown to be greatly connected to nightmare disorder. […] Anxiety and depressive symptoms are associated with the experience of constant nightmares, especially anxiety. […] Researchers are beginning to believe that nightmares increase ones risk of suicidality and suicidal behavior across the lifespan.
#1 Nightmare Disorder: Symptoms, Causes, Treatment
https://www.verywellmind.com/nightmare-disorder-definition-symptoms-causes-treatment-5220095
A study examining the association between borderline personality disorder (BPD) and nightmares, found nightmares, as well as dream anxiety, and negative quality of sleep, to be more prevalent in those with BPD, than in those without. […] Both adults and children who have experienced early trauma have a history of altered sleep quality and nightmares. […] Dissociative disorders, which are mental disorders in which an individual experience disconnects from reality, thoughts, feelings, and identity, is also associated with nightmare disorder.
#1 Nightmare Disorder and Isolated Sleep Paralysis
https://pmc.ncbi.nlm.nih.gov/articles/PMC8116464/
Nightmare disorder can cause insomnia due to fear of falling asleep through dread of nightmare occurrence. […] Hyperarousal and impaired fear extinction are involved in nightmare generation, as well as brain areas involved in emotion regulation. […] Nightmare disorder is particularly frequent in psychiatric disorders and posttraumatic stress disorder. […] Several medical conditions have been identified as being risk factors, including chronic disorders such as migraine, bronchitis, and asthma. […] Nightmare disorder might also involve disturbance of fear extinction, which should be enabled by normal sleep and dreaming in patients with nightmare disorders. […] Both hyperarousal and impaired fear extinction, possibly facilitated by traumatic experiences, childhood adversity, and other trait susceptibilities, as well as physical and cognitive factors, contribute to the formation of a nightmare script, which is then thought to be replayed over and over and to generate the nightmare distress.
#1 What Causes Nightmares?
https://sleepdoctor.com/pages/health/nightmares
Nightmares are more common in women, children, and people diagnosed with a range of mental health conditions. […] There is no consensus regarding why people have nightmares. Researchers suggest that these distressing dreams occur as the body attempts to integrate memories, regulate mood, and process waking experiences. […] Although many nightmares are idiopathic, meaning they have no known cause, research has identified several nightmare triggers. […] Nightmares are associated with a variety of mental health conditions, including depression, general anxiety disorder, bipolar disorder, schizophrenia, and post-traumatic stress disorder (PTSD). […] Certain medications are associated with an increased risk of nightmares. […] Several sleep disorders are associated with an increased risk of nightmares, including insomnia, obstructive sleep apnea, sleep related movement disorders, and narcolepsy. […] When recurrent nightmares interfere with a personâs ability to function during the day, they may be diagnosed as nightmare disorder. […] Eating too close to bedtime may increase the risk of nightmares. […] Understanding the cause of nightmares is an important step to reducing their frequency.
#1 Nightmare Disorder and Isolated Sleep Paralysis
https://pmc.ncbi.nlm.nih.gov/articles/PMC8116464/
Several factors have been suggested to facilitate hyperarousal and impaired fear extinction, including trait susceptibility and maladaptive beliefs. […] Additional theories have been advanced, one of which involves the mesocortical and mesolimbic dopamine system, as lesions involving this circuit have been associated with loss of dreaming. […] Several models have been developed to explain the pathophysiology of nightmare disorder. […] The REM parasomnias nightmare disorder and recurrent isolated sleep paralysis can be a cause of significant distress. […] Insomnia is a frequent consequence of nightmare disorder, as patients are frightened of nightmare occurrence and, therefore, fear falling asleep. […] Brain areas responsible for emotion regulation are involved in nightmare generation, as well as hyperarousal and impaired fear extinction. […] Conditions in which nightmare disorder is particularly frequent include psychiatric disorders and posttraumatic stress disorder.
#1 Nightmares | MedLink Neurology
https://www.medlink.com/articles/nightmares
Genetic and environmental factors are involved in the pathogenesis of nightmares. […] There is a strong relationship between nightmare frequency and psychiatric disorders. […] Nightmares as symptoms of PTSD are critical because sleep disruption may lead to maintenance of PTSD in a vicious circle. […] Nightmares may occur as side effects of medications. […] Various studies suggest that some genetic factors, in addition to unrelated environmental effects, are involved in the pathogenesis of nightmares. […] Pathophysiology of nightmares is not clear but several hypotheses to account for nightmares have been proposed in the past. […] According to the stress acceleration hypothesis, adverse childhood experiences have a deleterious impact on future physical and mental health, increasing risk for psychiatric problems, sleep disorders, and idiopathic nightmares.
#1 Nightmare disorder – Wikipedia
https://en.wikipedia.org/wiki/Nightmare_disorder
Some differences exist between idiopathic and PTSD related nightmares. A person with PTSD having nightmares would wake up during the night more frequently and for a longer time than with idiopathic nightmares. Consequently, people with PTSD would have a poorer sleep quality. Furthermore, nightmares related to PTSD would be more stressful than idiopathic ones. However, further studies have to be conducted in this area to obtain more reliable results.
#1 What Are the Causes of PTSD Nightmares | High Focus Centers
https://www.highfocuscenters.com/what-causes-ptsd-nightmares/
PTSD and nightmares are closely linked, with sleep disturbances being a significant challenge for those suffering from the disorder. […] Nightmares in PTSD are not just occasional bad dreams; they are often intense and recurring. The content of the nightmares may or may not be directly related to the traumatic event. […] Nightmares are a manifestation of the brain trying to process and make sense of the traumatic event. […] PTSD can cause changes in brain structures involved in fear and memory processing, such as the amygdala and hippocampus. […] Stress hormones like cortisol can remain elevated in individuals with PTSD, affecting sleep patterns and increasing the likelihood of nightmares.
#1 Nightmares and nightmare disorder in adults – UpToDate
https://www.uptodate.com/contents/nightmares-and-nightmare-disorder-in-adults/print
Patients with a history of physical or emotional trauma are at increased risk for nightmares and related symptoms of intrusion, negative mood, dissociation, avoidance, and arousal. […] Frequent and intense nightmares may occur in association with a wide range of psychiatric disorders, including depression, anxiety and panic disorders, schizophrenia, and borderline personality disorder. […] Stress has a bidirectional association with nightmares, with greater stress increasing the likelihood of having a nightmare and nightmares associated with greater next-day stress. […] There is a strong correlation between nightmares and suicide risk. Individuals with frequent nightmares are more likely to attempt suicide and self-harming behaviors, possibly mediated through emotional regulation difficulties and negative cognitive appraisals.
#2 Nightmare disorder | UM Health-Sparrow
https://www.uofmhealthsparrow.org/departments-conditions/conditions/nightmare-disorder
Nightmare disorder is referred to by doctors as a parasomnia a type of sleep disorder that involves undesirable experiences that occur while you’re falling asleep, during sleep or when you’re waking up. Nightmares usually occur during the stage of sleep known as rapid eye movement (REM) sleep. The exact cause of nightmares is not known. […] Nightmares can be triggered by many factors, including: […] Stress or anxiety. Sometimes the ordinary stresses of daily life, such as a problem at home or school, trigger nightmares. A major change, such as a move or the death of a loved one, can have the same effect. Experiencing anxiety is associated with a greater risk of nightmares. […] Trauma. Nightmares are common after an accident, injury, physical or sexual abuse, or other traumatic event. Nightmares are common in people who have post-traumatic stress disorder (PTSD).
#2 Nightmare Disorder: What It Is, Symptoms & Treatment
https://my.clevelandclinic.org/health/diseases/24464-nightmare-disorder
Nightmare disorder is a pattern of repeated frightening and vivid dreams that cause significant distress or impaired functioning. […] Researchers donât know what exactly causes nightmares and nightmare disorder, but they have multiple theories. […] One theory is that nightmare disorder may be influenced by increased hyperarousal that builds during the day and remains at night. […] Another theory involves a concept called fear extinction. […] According to the impaired fear extinction theory, people with nightmare disorder continue to activate fear memories during sleep.
#2 Nightmare Disorder: Symptoms, Causes, Treatment, and Prevention
https://psychcentral.com/disorders/nightmare-disorder-symptoms
Nightmare disorder may also be associated with fear-based memories that lie dormant during waking hours and become aroused during sleep. […] Research from 2019 suggests nightmare disorder may be influenced by hyperarousal that builds during the day and continues throughout the night. […] Possible contributing factors of nightmare disorder include: traumatic experiences in childhood, sensitivity to negative stimuli, inability to suppress unwanted thoughts and feelings, sleep apnea, or other physiological factors that disrupt sleep, withdrawal from medications that suppress REM sleep, drugs that influence the chemical brain messengers (neurotransmitters) norepinephrine, serotonin, and dopamine though quality evidence is lacking. […] In addition, the theoretical framework called the cognitive model of recurrent dreams poses that persistent nightmares are caused by loops or scripts of replaying patterns, even when stress from the original event has faded from regular waking consciousness.
#2 Nightmare Disorder: What Causes It and How Do You Manage It?
https://www.healthline.com/health/nightmare-disorder
The exact causes of nightmare disorder arent fully understood. Experts theorize several factors may be involved, including: […] Hyperarousal: Elevated levels of stress, tension, and anxiety during the day may contribute to sleep challenges and the intensity of nightmares. […] Impaired fear extinction: Intense fear that doesnt naturally resolve with time, such as that from trauma, can keep the brain in an aroused memory state where it recombines fearful experiences into dream scenarios. […] Trait susceptibility: Certain personality factors, like high novelty-seeking and genetic predispositions, may increase the chance of having persistent nightmares. […] Maladaptive coping (thought suppression): Internal habits to cope with stress that involve the suppression of negative thoughts and emotions may cause them to manifest in nightmares.
#2 Nightmare disorder – Wikipedia
https://en.wikipedia.org/wiki/Nightmare_disorder
Nightmares can be caused by extreme pressure or irritation if no other mental disorder is discovered. The death of a loved one or a stressful life event can be enough to cause a nightmare, but conditions such as post-traumatic stress disorder and other psychiatric disorders have been known to cause nightmares as well. […] The nightmares may be idiopathic or could be associated with psychiatric disorders like post-traumatic stress disorder, schizophrenia, and borderline personality disorder. Nightmares can also be triggered by stress and anxiety and substance abuse, such as drugs that affect the neurotransmitters norepinephrine and dopamine and serotonin. […] Eighty percent of patients who have PTSD report nightmares. Patients with PTSD have symptoms that are classified into three clusters: intrusive/re-experiencing, numbing, and hyperarousal. Nightmares are usually considered to be part of the intrusive/re-experiencing symptom.
#2 Nightmare Disorder: Symptoms, Causes, Treatment
https://www.verywellmind.com/nightmare-disorder-definition-symptoms-causes-treatment-5220095
A study examining the association between borderline personality disorder (BPD) and nightmares, found nightmares, as well as dream anxiety, and negative quality of sleep, to be more prevalent in those with BPD, than in those without. […] Both adults and children who have experienced early trauma have a history of altered sleep quality and nightmares. […] Dissociative disorders, which are mental disorders in which an individual experience disconnects from reality, thoughts, feelings, and identity, is also associated with nightmare disorder.
#2 Nightmares and nightmare disorder in adults – UpToDate
https://www.uptodate.com/contents/nightmares-and-nightmare-disorder-in-adults/print
Patients with a history of physical or emotional trauma are at increased risk for nightmares and related symptoms of intrusion, negative mood, dissociation, avoidance, and arousal. […] Frequent and intense nightmares may occur in association with a wide range of psychiatric disorders, including depression, anxiety and panic disorders, schizophrenia, and borderline personality disorder. […] Stress has a bidirectional association with nightmares, with greater stress increasing the likelihood of having a nightmare and nightmares associated with greater next-day stress. […] There is a strong correlation between nightmares and suicide risk. Individuals with frequent nightmares are more likely to attempt suicide and self-harming behaviors, possibly mediated through emotional regulation difficulties and negative cognitive appraisals.
#2 Nightmares share genetic risk factors with sleep and psychiatric traits | Translational Psychiatry
https://www.nature.com/articles/s41398-023-02637-6
Nightmares are vivid, extended, and emotionally negative or negative dreams that awaken the dreamer. […] frequent nightmares often reflect underlying pathologies of emotional regulation. […] insomnia, depression, anxiety, or alcohol use have been associated with nightmares in epidemiological and clinical studies. […] the connection between nightmares and their comorbidities are poorly understood. […] our goal was to examine the genetic risk factors for nightmares and estimate correlation or causality between nightmares and comorbidities. […] the genetic correlation analysis showed a robust correlation (rg 0.4) of nightmares with anxiety (rg = 0.671, p=7.507e06), depressive (rg = 0.562, p=1.282e07) and posttraumatic stress disorders (rg = 0.4083, p=0.0152), and personality trait neuroticism (rg = 0.667, p=4.516e07).
#2 Nightmare Disorder: Symptoms, Causes, and Treatment | Doctor
https://patient.info/doctor/nightmare-disorder
The development of maladaptive beliefs, such as thought suppression (attempting to suppress unwanted thoughts and feelings), which increases the likelihood of those thoughts recurring in dreams. […] Sleep fragmentation due to obstructive sleep apnoea and other sleep-related hypoventilation syndromes. […] Medications that influence neurotransmitter activity and function. […] It is theorised that recurrent nightmare elements may then become condensed into a 'nightmare script’, where dream elements trigger the nightmare to occur. Nightmares may, therefore, persist long after the initial stressor has subsided.
#2 Nightmare Disorder: What Causes It and How Do You Manage It?
https://www.healthline.com/health/nightmare-disorder
Sleep-disordered breathing: Breathing disorders that affect sleep can contribute to psychological distress, triggering nightmares, and may cause less restorative sleep stages where nightmares are more likely to be remembered. […] Experts believe these factors come together in a variety of ways to create whats known as the cognitive model of recurrent dreams. Under this theoretical framework, nightmares are a type of learned behavior, where your subconscious reacts negatively to any elements in a dream that resemble an initial stressor.
#2 Nightmares share genetic risk factors with sleep and psychiatric traits | Translational Psychiatry
https://www.nature.com/articles/s41398-023-02637-6
Mendelian randomization suggested causality from insomnia to nightmares (beta = 0.027, p=0.0002). […] our findings suggest that nightmares share genetic background with psychiatric traits and that insomnia may increase an individual’s liability to experience frequent nightmares. […] the biological basis behind nightmares and the causality between nightmares and psychiatric traits have not been thoroughly established. […] our findings suggest not only an association but also a causal relationship between insomnia and the incidence of nightmares. […] our finding of shared genetic risk between nightmares and symptoms of insomnia would support this hypothesis. […] heavy alcohol consumption may modify the genetic correlations between nightmares and psychiatric traits.
#2 Nightmare Disorder – PsychDB
https://www.psychdb.com/sleep/parasomnias/nightmare-disorder
Nightmare disorder is a sleep disorder characterized by typically lengthy, elaborate, story-like sequences of dream imagery that seem real and that incite anxiety, fear, or other dysphoric emotions. […] Individuals who experience nightmares report more frequent past adverse events, but not necessarily trauma, and often display personality disturbances or psychiatric diagnosis. Sleep deprivation or fragmentation, and irregular sleep-wake schedules that alter the timing, intensity, or quantity of REM sleep, can put individuals at risk for nightmares. […] Nightmares may be comorbid with several medical conditions, including coronary heart disease, cancer, parkinsonism, and pain, and can accompany medical treatments, such as hemodialysis, or withdrawal from medications or substances of abuse. Nightmares frequently are comorbid with other mental disorders, including PTSD; insomnia disorder; schizophrenia; psychosis; mood, anxiety, adjustment, and personality disorders; and grief during bereavement.
#2 Nightmare disorder – Wikipedia
https://en.wikipedia.org/wiki/Nightmare_disorder
Some differences exist between idiopathic and PTSD related nightmares. A person with PTSD having nightmares would wake up during the night more frequently and for a longer time than with idiopathic nightmares. Consequently, people with PTSD would have a poorer sleep quality. Furthermore, nightmares related to PTSD would be more stressful than idiopathic ones. However, further studies have to be conducted in this area to obtain more reliable results.
#2 Nightmares and nightmare disorder in adults – UpToDate
https://www.uptodate.com/contents/nightmares-and-nightmare-disorder-in-adults/print
A wide range of medications have been implicated in generating nightmares. […] Nightmares commonly occur during withdrawal from GABA-ergic medications or substances such as alcohol, barbiturates, and benzodiazepines. […] Nightmares may occur with increased frequency during times of stress or emotional instability and may disturb the quality and continuity of sleep. Some have proposed that nightmares may initially be about the experience of a stressful event but very soon are replaced by the dominant emotion of the event as a repeating narrative. […] In a Finnish nationwide twin cohort study, monozygotic twins had more similar rates of nightmares than dizygotic twins, suggesting a genetic propensity.
#2 Nightmares | MedLink Neurology
https://www.medlink.com/articles/nightmares
The proposed mechanisms are disruption of normal infantile amnesia, which enables early childhood memories to influence later emotions including the expression of threats in nightmares, and alterations of regulation of fear extinction during REM sleep leading to nightmares. […] Findings of a sleep-lab study on participants with frequent nightmares indicate that they had increased high-frequency spectral power during NREM and pre-REM periods, as well as relatively reduced slow frequency and increased fast frequency spectral power across pre- and post-REM periods as compared with healthy controls. […] This combination of reduced sleep-protective activity and increased hyperarousal suggests an imbalance between sleep regulatory and wake-promoting systems in participants with frequent nightmares.
#2 Nightmare Disorder and Isolated Sleep Paralysis
https://pmc.ncbi.nlm.nih.gov/articles/PMC8116464/
Several factors have been suggested to facilitate hyperarousal and impaired fear extinction, including trait susceptibility and maladaptive beliefs. […] Additional theories have been advanced, one of which involves the mesocortical and mesolimbic dopamine system, as lesions involving this circuit have been associated with loss of dreaming. […] Several models have been developed to explain the pathophysiology of nightmare disorder. […] The REM parasomnias nightmare disorder and recurrent isolated sleep paralysis can be a cause of significant distress. […] Insomnia is a frequent consequence of nightmare disorder, as patients are frightened of nightmare occurrence and, therefore, fear falling asleep. […] Brain areas responsible for emotion regulation are involved in nightmare generation, as well as hyperarousal and impaired fear extinction. […] Conditions in which nightmare disorder is particularly frequent include psychiatric disorders and posttraumatic stress disorder.
#2 Nightmare Disorder: Symptoms, Causes, and Treatment | Doctor
https://patient.info/doctor/nightmare-disorder
Several research groups have proposed that nightmare disorders result from increased hyperarousal and impaired fear extinction. […] Hyperarousal may develop during the day and be maintained at night. Hyperarousal is central to the pathophysiology of PTSD and insomnia. […] Normal sleep and dreaming may lead to fear extinction by recombining fear-inducing memories with novel and dissociated contexts. However, people with nightmare disorder continue to activate distressing and arousing memory fragments during sleep, reinforcing memories of fear. […] Factors hypothesised to lead to hyperarousal and impaired fear extinction include traumatic experiences and childhood adversity (disrupting emotional regulation). […] Differential susceptibility: some individuals are more sensitive to both positive and negative stimuli, leading to an increased likelihood of emotional and affective distress and nightmare disorder.
#3 Nightmare Disorder: What Causes It and How Do You Manage It?
https://www.healthline.com/health/nightmare-disorder
The exact causes of nightmare disorder arent fully understood. Experts theorize several factors may be involved, including: […] Hyperarousal: Elevated levels of stress, tension, and anxiety during the day may contribute to sleep challenges and the intensity of nightmares. […] Impaired fear extinction: Intense fear that doesnt naturally resolve with time, such as that from trauma, can keep the brain in an aroused memory state where it recombines fearful experiences into dream scenarios. […] Trait susceptibility: Certain personality factors, like high novelty-seeking and genetic predispositions, may increase the chance of having persistent nightmares. […] Maladaptive coping (thought suppression): Internal habits to cope with stress that involve the suppression of negative thoughts and emotions may cause them to manifest in nightmares.
#3 Nightmare Disorder: Symptoms, Causes, and Treatment | Doctor
https://patient.info/doctor/nightmare-disorder
Several research groups have proposed that nightmare disorders result from increased hyperarousal and impaired fear extinction. […] Hyperarousal may develop during the day and be maintained at night. Hyperarousal is central to the pathophysiology of PTSD and insomnia. […] Normal sleep and dreaming may lead to fear extinction by recombining fear-inducing memories with novel and dissociated contexts. However, people with nightmare disorder continue to activate distressing and arousing memory fragments during sleep, reinforcing memories of fear. […] Factors hypothesised to lead to hyperarousal and impaired fear extinction include traumatic experiences and childhood adversity (disrupting emotional regulation). […] Differential susceptibility: some individuals are more sensitive to both positive and negative stimuli, leading to an increased likelihood of emotional and affective distress and nightmare disorder.
#3 Nightmare disorder – Wikipedia
https://en.wikipedia.org/wiki/Nightmare_disorder
Some differences exist between idiopathic and PTSD related nightmares. A person with PTSD having nightmares would wake up during the night more frequently and for a longer time than with idiopathic nightmares. Consequently, people with PTSD would have a poorer sleep quality. Furthermore, nightmares related to PTSD would be more stressful than idiopathic ones. However, further studies have to be conducted in this area to obtain more reliable results.
#3 Nightmare Disorder and Isolated Sleep Paralysis
https://pmc.ncbi.nlm.nih.gov/articles/PMC8116464/
Several factors have been suggested to facilitate hyperarousal and impaired fear extinction, including trait susceptibility and maladaptive beliefs. […] Additional theories have been advanced, one of which involves the mesocortical and mesolimbic dopamine system, as lesions involving this circuit have been associated with loss of dreaming. […] Several models have been developed to explain the pathophysiology of nightmare disorder. […] The REM parasomnias nightmare disorder and recurrent isolated sleep paralysis can be a cause of significant distress. […] Insomnia is a frequent consequence of nightmare disorder, as patients are frightened of nightmare occurrence and, therefore, fear falling asleep. […] Brain areas responsible for emotion regulation are involved in nightmare generation, as well as hyperarousal and impaired fear extinction. […] Conditions in which nightmare disorder is particularly frequent include psychiatric disorders and posttraumatic stress disorder.