Nightmare disorder

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Kiran Singh, M.D. [2]


Nightmare disorder is a sleep disorder characterized by frequent awakening from nightmares with a vivid remembrance of the dream. It is often caused by a major stressful event or from the use of SSRIs. Most cases reported begin at the age of 10 after a stressful life event. The frequency of the episodes is varied form person to person; generally one will suffer from three or four episodes every week.

Differential Diagnosis

  • Bereavement
  • Breathing-related sleep disorders
  • Medication or substance use

Epidemiology and Demographics

The prevalence of nightmare disorder is:

  • 6,000 per 100,000 (6%) monthly among adults
  • 1,000-2,000 per 100,000 (1%-2%) frequently among adults[1]

Risk Factors

  • Genetic predisposition
  • Irregular sleep-wake schedules
  • Past adverse events
  • Sleep deprivation
  • Sleep fragmentation[1]

Diagnostic Criteria

DSM-V Diagnostic Criteria for Nightmare disorder [1]

  • A. Repeated occurrences of extended, extremely dysphoric, and well-remembered dreams that usually involve efforts to avoid threats to survival, security, or physical integrity

and that generally occur during the second half of the major sleep episode.


  • B.On awakening from the dysphoric dreams, the individual rapidly becomes oriented and alert.


  • C.The sleep disturbance causes clinically significant distress or impairment in social, occupational,or other important areas of functioning.


  • D.The nightmare symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication).


  • E.Coexisting mental and medical disorders do not adequately explain the predominant complaint of dysphoric dreams.

Specify if:

  • During sleep onset

Specify if:

  • With associated non-sleep disorder, including substance use disorders
  • With associated other medical condition
  • With associated other sleep disorder

Specify if:

  • Acute: Duration of period of nightmares is 1 month or less.
  • Subacute: Duration of period of nightmares is greater than 1 month but less than 6 months.
  • Persistent: Duration of period of nightmares is 6 months or greater.

Specify current severity:

Severity can be rated by the frequency with which the nightmares occur:

  • Mild: Less than one episode per week on average.
  • Moderate: One or more episodes per week but less than nightly.
  • Severe: Episodes nightly.


  1. 1.0 1.1 1.2 1.3 Diagnostic and statistical manual of mental disorders : DSM-5. Washington, D.C: American Psychiatric Association. 2013. ISBN 0890425558.

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