These are REM related events and typically occur in the second half of the night. There is typically a recollection of the nightmare or scary event unlike sleep terrors. The age of onset of nightmares is typically around 3-6 years and can last into adulthood. Certain medications can induce an increase in nightmares as well as a condition in which there is REM rebound with very vivid dreams and nightmares when the medication is withdrawn. Most patients will awaken at termination of the nightmare and can typically remember the events in the morning and recollect the event and its content.
Predisposing factors for parasomnias
Genetic factors, insufficient sleep, stress, anxiety and affective disorders.
Take a good history and physical examination. Obtain a good medication and drug use history. Does not typically require overnight sleep study although in cases of REM it may be helpful in clearly defining the condition.
Safety is paramount especially in cases of nightmare. Maintaining an uncluttered environment is helpful.
Psychotherapy may be necessary in some patients with nightmares
Review of drug management, and consideration of different drug options if such medications are inducing the nightmares.
Benzodiazepines can be used to ameliorate the nightmares. Tricyclic antidepressants and Selective serotonin reuptake inhibitors can also be used to reduce nightmares but withdrawal can result can result in REM rebound.