Nightmare Disorder

Diagnosis

There are no routine tests to diagnose nightmare disorder. Nightmares are considered a disorder only if disturbing dreams cause distress or interfere with sleep. Diagnosis usually involves a review of medical history and symptoms, and may include:

• Exam: A physical exam can identify underlying conditions contributing to nightmares. If anxiety or other mental health concerns are suspected, referral to a mental health professional may be made.

• Symptoms discussion: Diagnosis is often based on your description of experiences. Your doctor may ask about family history of sleep problems, sleep behaviors, and assess for other sleep disorders.

• Nocturnal sleep study (polysomnography): If sleep is severely disturbed, an overnight sleep study may be conducted. Sensors monitor brain waves, oxygen levels, heart rate, breathing, and eye and leg movements. Video recording may document behaviors during sleep cycles.

Treatment

Treatment is not usually needed unless nightmares cause distress, disrupt sleep, or interfere with daytime functioning. Treatment depends on the underlying cause and may include:

• Medical treatment: If nightmares are linked to a medical condition, treating that condition may improve sleep.

• Stress or anxiety management: Techniques such as counseling, therapy, or stress-reduction practices may be recommended if mental health issues contribute to nightmares.

• Imagery rehearsal therapy: Commonly used for PTSD-related nightmares, this therapy involves changing the ending of a remembered nightmare while awake and rehearsing the new ending to reduce nightmare frequency.

• Medication: Rarely used, but may be considered for severe nightmares associated with PTSD under a healthcare professional’s supervision.