- Distressing dreams occurring during sleep, with awakenings typically during REM sleep.
- Interchangeable usage of the term with other sleep disturbances linked to post-traumatic stress disorder, psychiatric conditions, drugs, neurological disorders, REM behavior disorder, status dissociatus, or vivid dreams.
Detailed criteria for diagnosing nightmares include:
- Repeated occurrences of extended, extremely distressing dreams, vividly remembered upon waking.
- Dreams often involve threats to safety, survival, or physical well-being.
- Awakening with full alertness and orientation.
- Significant impairment in social, occupational, or other important life aspects due to these dreams.
- Differentiating between nightmares and sleep terrors can be challenging.
- Nightmares occur during REM sleep and entail distressing content but exhibit greater functional impairment compared to sleep terrors.
- Patients with nightmares lack significant autonomic changes seen in sleep terrors and avoid vocalization or motor behaviors.
- Sleep terrors involve consistent distressing dream content, increased heart rate, and attempts to escape.
- Variations in dream content can aid in differentiating conditions like narcolepsy, Parkinson’s disease, Lewy body dementia, REM parasomnias, status dissociatus, hypnagogic, and hypnopompic hallucinations.
A list of medications known to worsen vivid dreams, including antidepressants, antihypertensives, smoking cessation drugs, and certain cholinesterase inhibitors.