Blood pressure medication, levodopa and medications for Parkinsons disease have also been known to cause nightmares.The nightmares may be idiopathic or could be associated with psychiatric disorders like post-traumatic stress disorder, schizophrenia, and borderline personality disorder. Nightmares can also be triggered by stress and anxiety and substance abuse, such as drugs that affect the neurotransmitters norepinephrine and dopamine and serotonin. Nevertheless, causality between drugs such as beta-blockers or alpha-agonists and nightmares is still unclear and further research needs to be done to investigate the biochemical mechanisms of nightmares.Eighty percent of patients who have PTSD report nightmares. Patients with PTSD have symptoms that are classified into three clusters: intrusive/re-experiencing, numbing, and hyperarousal. Nightmares are usually considered to be part of the intrusive/re-experiencing symptom.Some differences are existing between idiopathic and PTSD related nightmares. A PTSD person having nightmares would wake up during the night more frequently and for a longer time than with idiopathic nightmares. Consequently, people with PTSD would have a poorer sleep quality. Furthermore, nightmares related to PTSD would be more stressful than idiopathic ones. However, further studies have to be conducted in this area to obtain more reliable results. Assessment
Polysomnography records physiological parameters, such as electroencephalography (EEG), electromyography (EMG) and electrooculography (EOG) in a sleep laboratory. However, the frequency of posttraumatic nightmares tends to decrease in an artificial lab setting, which would impact the content of nightmares.
Nightmares can also have negative impact on the bed partners life. Content of idiopathic nightmares
Physical aggression is the main theme of nightmares. Other fields, such as interpersonal conflict, failure, helplessness, apprehension, being chased, accidents, evil forces, disasters, insects and environmental abnormalities may also feature in nightmares. Fear is the most frequent emotion associated with nightmares, even if other emotions such as sadness, anger, and confusion can also be present. Criteria
According to the International Classification of Sleep Disorders, the criteria needed to diagnose a nightmare disorder are the following. First, the presence of frequent nightmares that imply danger for the person and impact mood in a negative way is needed. Second, when waking up from nightmares, the person behaves in an alert way. Finally, the disorder has to have a significant impact on the patients personal, social or professional functioning, in areas like mood, sleep, cognition, behaviour, fatigue, family and occupation. Causes
Nightmares can be caused by extreme pressure or irritation if no other mental disorder is discovered. The death of a loved one or a stressful life event can be enough to cause a nightmare but conditions such as post-traumatic stress disorder and other psychiatric disorders have been known to cause nightmares as well. If the individual is on medication, the nightmares may be attributed to some side effects of the drug. Amphetamines, antidepressants, and stimulants like cocaine and caffeine can cause nightmares.