Nightmares

Night terrors are a sleep disorder related to parasomnia, in which a person quickly wakes up from sleep in a terrified state, combined with a high level of autonomic nervous system activity and mobility. Often occurs in combination with another type of parasomnia - Somnabulzim. This sleep disorder most often occurs in childhood. Sleep terrors affect approximately 6.5% of children   and <1% of adults.  No sex difference is reported. 

Night terrors are characterized by an instant awakening from the deep sleep phase, within one to four hours after falling asleep, when the deep sleep phase dominates and dreams are almost non-existent. This is what distinguishes night terrors from "nightmares" (dreams that everyone has) and which usually leave an unpleasant feeling after waking up (in such cases, people usually say that they had a "bad dream").

The following are common characteristics of a night terror:

• Sudden awakening from sleep
• Persistent fear or terror that occurs at night
• Screaming
• Sweating
• Confusion
• Rapid heart rate
• No recall of bad dreams or nightmares
• Unable to fully wake up
• Difficult to comfort 

The specific DSM-5 criteria for nightmare disorder are as follows:

• Recurrent episodes of extended, extremely dysphoric, and well-remembered dreams that usually involve efforts to avoid threats to survival or security or physical integrity. The nightmares generally occur in the second half of a major sleep episode.
• On waking from the nightmare, the individual rapidly becomes oriented and alert.
• The episodes cause significant distress or impairment in social, occupational or other areas of functioning.
• The symptoms cannot be explained by the effects of a drug of abuse or medication.
• The nightmares cannot be attributed to another mental disorder (i.e., posttraumatic stress disorder, delirium) or medical condition. 

Most common causes nightmare disorders

Nightmare disorder is strongly associated with chronic or acute stress and psychiatric disorders, particularly post-traumatic stress disorder, anxiety, bipolar disorder, and depression. 
Certain medicines and pharmacological agents are strongly associated with particular disorders: venlafaxine and mirtazapine with RBD; noradrenaline, serotonin, and dopamine with nightmares and other sleep disturbances.

The assessment of sleep terrors and nightmares must include:

• When the episode occurs during the sleep period
• Age of onset
• How often these episodes occur (frequency) and how long they last for (duration)
• Description of the episode, including behavior, emotions, and thoughts during and after the event
• How responsive the patient is to external stimuli during the episode
• How conscious or aware the patient is, when awakened from an episode
• If the episode is remembered afterwards
• The triggers or precipitating factors
• Sleep–wake pattern and sleep environment
• Daytime sleepiness
• Other sleep disorders that might be present
• Medical, psychiatric, and neurological history
• Medication and substance use history
• Overnight polysomnography, EEG 

Treatment tactics:

• Safety modifications and correction of predisposing factors
• Psychotherapy
• Medications (benzodiazepins, tricyclic antidepressants)

How to help during a night terror and nightmare

• Try to help return to normal sleep. Do not try to awaken your bed partner\child. 
• Make soothing comments. Hold your bed partner/child if it seems to help him or her feel better. Shaking or shouting may cause  to become more upset.
• Protect your child /bed partner against injury. During a night terror, a person can fall down a stairway, run into a wall, or break a window. Try to gently direct your person to bed.
• Try to prevent night terrors. A night terror can be triggered if you becomesoverly-tired. Be sure you go to bed at a regular time, and early enough to give you enough sleep.   

How to prevent night terror or nightmares?

• Establish a regular, relaxing routine before bedtime.  Do quiet, calming activities — such as reading books, doing puzzles or soaking in a warm bath — before bed. Meditation, deep breathing or relaxation exercises may help, too. 
• Use a night light. Also, make the bedroom comfortable and quiet for sleep.
• Talk about the dream. Ask your child or partner to describe the nightmare. Rewrite the ending. Imagine a happy ending for the nightmare. Sometimes a little creativity can help.
• Put stress in its place. If stress or anxiety is an issue, talk about it. Practice some simple stress-relief activities, such as deep breathing or relaxation.
• Provide comfort measures. As for children - your child can feel safe if he sleeps with a favorite toy, blanket or other comfortable object. Leave the child's door open for the night so that she does not feel lonely. Also, keep the door open if your child needs your help overnight. 

Sourses:

• https://bestpractice.bmj.com/topics/en-gb/573/epidemiology 
• https://www.hopkinsmedicine.org/health/conditions-and-diseases/nightmares-and-night-terrors 
• https://emedicine.medscape.com/article/914428-overview 
• https://www.mayoclinic.org/diseases-conditions/nightmare-disorder/diagnosis-treatment/drc-20353520