Distressing dreams may occur in a number of settings.  When nightmares occur immediately following traumatic life events it is known as Acute Stress Disorder.  Vivid dreams and nightmares, often related to the traumatic events, may occur after a month or more of the event. This is part of Post-Traumatic Stress Disorder (PTSD). These conditions are usually considered under mental health problems.  In addition, distressing dreams may occur in two primary sleep disorders. These are nightmare disorder and REM Sleep Behaviour Disorder.

Nightmare Disorder

In nightmare disorder, there are repeated, well-remembered distressing dreams that usually involve threat to safety, security, integrity or survival of the person. The experience of the dream and sleep disturbance results in impairment of functioning on the following day.

REM Sleep Behaviour Disorder (RBD)

RBD is a parasomnia in which we ‘act out‘ our dreams.  This means that the sufferer will  perform the actions that he/she dreams. This potentially leads to injuries for the patient and the bed-partner.  It affects approximately 1% of those aged 50 or above.

Intense and vivid dreams usually occur  during Rapid Eye Movement Sleep (REM-Sleep).  Most of REM-Sleep occur in the early hours of the morning.  Therefore, RBD symptoms usually occur in the second half of the sleep period.  The dreams are often vivid with distressing or even violent content.  The degree to which the sufferer recalls the dreams varies but usually there is good recall. At other times there may be no recall.

In RBD, the sufferer performs whatever they are dreaming.  They may talk, shout or scream, flail their arms or legs, punch, kick out etc., and may injure themselves or their bed partners in the process.

RBD may occur as a side effect of certain antidepressant medications.  It may be associated with neurological disorders such as Parkinson’s disease.  In many cases however, it occurs as an isolated phenomenon when it is known as idiopathic or isolated RBD.  Such patients may develop neurodegenerative conditions later on in life.

The diagnosis of RBD is suspected on the basis of clinical history.  However it can be confirmed only with the help of full polysomnography.

Avoiding injuries to the patient and bed-partner is the first step in the management of RBD.  Unfortunately there is no curative treatment but RBD can usually be controlled with drugs such as melatonin and clonazepam.