Understanding and Coping with Nightmares in Young People

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It’s normal for young children to have frequent nightmares. While they can be very distressing at the time, they usually go away as a child grows older.

Sometimes, however, frequent nightmares persist into adolescence and adulthood. Other young people may start getting more nightmares at a later point in their lives, after times of stress, trauma, or the start of an illness.

Adolescents and young adults who experience frequent nightmares may be living with a nightmare disorder. Nightmare disorders have a big impact on a young person’s daily life: they may cause disruptions to their sleep, daily distress, insomnia, and symptoms of anxiety or depression

The good news is that there is help and support available. Several types of therapy have been proven to reduce the severity and amount of nightmares that people face and make nights – and days – more manageable. 

This blog explores what nightmares are and why we have them. It also outlines some of the treatment options available for young people and how they can access the support they need.

What Are Nightmares?

Nightmares are vivid and usually frightening dreams. Sometimes, they may involve other intense emotions, like sadness or anger. Young people often wake up from their nightmares with detailed and clear memories of what happened.

Nightmares can involve many different types of stories. Children often dream about imaginary or scary creatures that may chase or threaten them in some way. Adolescents and young adults may have nightmares about events that are in some way distressing, involving violence, humiliation, or intense fear. Young people with PTSD often relive traumatic experiences during nightmares.

When a young person wakes up from a nightmare, they may be sweating and have a rapid heart rate. Feelings of fear can continue even when they are awake, as can disturbing memories of the dream.

Nightmares, Dreams, and REM Sleep

Dreams are autobiographical stories that our brains create by weaving recent experiences and current emotional states with past memories. Dreaming happens during REM sleep – a type of sleep that usually makes up about ⅕ of sleeping time, split into four or five different episodes through the night.

During REM sleep, people can experience rapid eye movement, an irregular heartbeat, and faster breathing. Parts of the brain’s network that become inactive in other stages of sleep stay functioning during REM, allowing us to experience the inner emotions, images, and stories that characterise dreams and nightmares.

Who Experiences Nightmares?

Nightmares are common in young children, especially between the ages of 3 and 6. They usually become less frequent as children grow older and many adults only have nightmares occasionally.

However, some adolescents and adults continue to suffer from nightmares. Research shows that about 2-6% of adults experience nightmares at least once a week. 

Scientists have found that among adolescents, young adults, and middle-aged adults, women and girls are more likely to report nightmares than men and boys. Younger boys and girls may experience more similar rates of nightmares.

Young people and adults are more likely to have nightmares if they have a mental health disorder or experience symptoms of anxiety, schizophrenia, and post-traumatic stress disorder.

Nightmares are particularly common among people with PTSD, with as many as 50% – 70% of people reporting frequent nightmares.

Studies have found that nightmares start to happen more often when someone goes through a time of more intense stress, such as relationship problems, exam anxiety, or moving schools.

One study showed that even among elementary children, those who experienced nightmares had higher levels of anxiety than those who did not – although it’s not clear whether the nightmares resulted from or caused their anxious feelings.

Why Are Nightmares More Common In Children?

Scientists aren’t sure exactly why nightmares are more common in children. Some people think that nightmares may reflect children’s vulnerability to external threats, perhaps constituting ‘rehearsals’ for threat avoidance in real life. Other people point to children’s more vivid imaginations or their greater difficulty in separating reality from fantasy.

What Causes Nightmares?

There are lots of different theories about why we have nightmares. Three of the most prominent models are image contextualisation, threat stimulation, and mood regulation.

These models are not mutually exclusive: instead, they offer different perspectives on nightmares that may work together to give a fuller explanation of how and why nightmares occur.

Image Contextualisation

The image contextualisation model suggests that during dreams and nightmares, our brains try to find a context for the emotions that we are experiencing.

The stories and images that we experience in dreams may not relate to the real-life cause of our emotions but something imaginary that could explain the emotions that we feel.

The image contextualisation model centres around our present emotions as the cause of nightmares. Nightmares happen when we experience fear, shame, sadness, or other feelings that fit with scary stories of threats, violence, humiliation, and other common nightmare themes.

People who have experienced trauma, live with mental health issues, or are struggling with intense stress are likely to have more of these emotions, causing them to have nightmares more often.

Threat Simulation

The threat simulation explanation of nightmares describes our bad dreams as rehearsals for facing and avoiding threats in real life. During nightmares, our virtual selves confront events that we find threatening.

By repeatedly responding to these threats in our dreams, we become more prepared and adept in the waking world. Threat stimulation theory pays particular attention to children’s dreams, which often involve threats like wolves or wild animals that our ancestors may have faced in their daily lives.

Mood Regulation

During REM sleep, we experience increased activity in the limbic system, the part of the brain involved with emotional and behavioural responses.

The mood regulation model proposes that when we dream, we regulate or contain these surges of emotion through the storylines that we experience throughout the night. Dreams are a kind of ‘emotional problem solving’ that can relieve us of the intensity of our feelings.

According to the mood regulation model, nightmares happen when we are unable to contain the emotions that we experience through our dreams, and emotions of fear, sadness, or shame stay strong, eventually waking us.

Some studies have found that the difference in a person’s mood at the beginning and end of the night is linked to the content of their dreams – and even the number of characters. Other research has noted that people whose dreams at the start of the night are more distressing than those at the end may cope with difficult events better in the long term.

This suggests that dreams may have a functional purpose of helping us to successfully contain emotions and make us more resilient to the challenges of waking life.

What Are the Risk Factors for Experiencing Nightmares?

Anyone can experience nightmares, regardless of age, gender, or life experiences. However, some factors make both children and adults more likely to have frequent nightmares and increase the risk of developing nightmare disorders.

A study among preschool-aged children found that children with difficult temperaments and anxiousness were more likely to experience nightmares. They also found that nightmares could be prevented or reduced if a child received attention and care from a parent when they woke up.

Among adolescents and adults, several factors can increase the risk of experiencing frequent nightmares or a nightmare disorder. Some of these include:

  • living with a mental health disorder
  • experiencing intense stress during waking life
  • living with PTSD
  • experiencing symptoms of anxiety or psychosis-like symptoms
  • sleep disturbances
  • heightened emotional and physical reactions to internal and external events
  • ineffective coping mechanisms

When Should You Seek Help?

If a child or young person finds that their nightmares affect their everyday life or cause them significant distress, it’s a good idea to seek help. Nightmares are treatable and young people don’t have to continue suffering: with the right support, they can start to enjoy calmer nights and easier days.

Psychologists, psychiatrists, therapists, sleep specialists, and other professionals can provide treatment for nightmares. If you’re worried about a young person, you can contact a doctor or another mental health professional for advice, referrals, and support.

What Treatments Are Available for Nightmares?

There are several different treatment approaches that may help to reduce nightmares in young people. While both medication and psychotherapy may effective in some cases, psychotherapy – particularly cognitive behavioural therapy – currently has the strongest and most consistent support from research.

Medication

In general, antidepressant drugs and most other medications seem to have little effect on the frequency or severity of nightmares.

The only clear exception is prazosin, which has successfully treated posttraumatic nightmares in a few small sample studies. Even then, the studies found that individuals had to keep taking the medication to maintain its positive effects and that nightmares typically returned if they stopped using the drug.

Cognitive Behavioural Therapy (CBT)

Cognitive behavioural therapy is usually the go-to treatment for nightmare disorders. Several different CBT techniques have been shown to effectively treat nightmares and alleviate associated symptoms. 

CBT techniques for nightmare disorder include:

  • recording nightmares
  • practising relaxation techniques
  • exposure techniques, when someone writes down their nightmares and relives them during the day
  • cognitive restructuring techniques, which involve writing down nightmares and then changing them to more positive versions

The most common cognitive restructuring technique is image rehearsal therapy (IRT). IRT involves reliving changed versions of nightmares during the day with less frightening endings, with the aim of experiencing a less scary form of the nightmare when it happens again.

Treating Underlying Conditions

Research shows that nightmares are more common in people who live with anxiety, depression, PTSD, and other mental health concerns. Addressing and treating these underlying issues can play an important role in reducing the frequency and severity of nightmares

Practising Self-Care

Practising good self-care alongside professional support can help young people to manage and reduce nightmares. They could try:

  • relaxing before bed
  • keeping regular sleep and wake hours
  • reducing overall stress and anxiety
  • avoiding alcohol

Even though they occur in our sleep, nightmares can be incredibly distressing and seriously affect the well-being of people of all ages.

They may also be a sign of another mental health concern, such as trauma or a mood disorder. If you’re worried about a young person, or they’ve come to you for help, it’s important to seek professional support so they can access the care they deserve.

The Wave Clinic: Transformative Recovery Journeys for Young People

The Wave Clinic is a specialist mental health treatment centre in Malaysia, dedicated to the needs of young people.

Our whole-person approach focuses on life advantage, giving young people the skills they need to plan and build better futures. We support young people to grow in self-esteem as they discover their incredible qualities, passions, and capacity to follow their dreams.

Founded by Fiona Yassin, The Wave Clinic is the only centre in the world that combines top-leading psychiatric and medical care with education, global citizenship, and a gap year experience. We’re here to set the global standard for teenage and adolescent mental health care, making a difference for the next generation.

If you want to find out more about what we have to offer, please reach out to us today. We can help.

Fiona - The Wave Clinic

Fiona Yassin is the founder and clinical director at The Wave Clinic. She is a U.K. and International registered Psychotherapist and Accredited Clinical Supervisor (U.K. and UNCG).

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