Are you waking up with nightmares regularly? Although nightmares themselves may be your problem, for many adults, it’s actually sleep apnea that is causing wakeful nights in terror. If you have trouble waking up regularly in a cold sweat with a sense of panic, have your primary care physician refer you for an in-lab sleep study to determine if any sleep apnea is present.
Night Terrors and Nightmares: What’s the Difference?
Night terrors and nightmares are distinct phenomena that can sometimes be confused. Night terrors, also called sleep terrors, are parasomnia, a certain kind of mental sleep disorder. You may awaken suddenly with a sensation of fear, but no real sense beyond that of why you are waking up.
Nightmares, on the other hand, are dreams that you experience vividly. The standard view of nightmares is a little different from the clinical definition. In the traditional view, you usually remember many of the details of nightmares, though they may not make sense to you. Even if you experience them, you usually won’t wake up because of them, but you can.
However, the clinical definition of nightmares is a little different. The clinical definition of a nightmare disorder includes three characteristics:
- Repeated long, bad dreams featuring threats of death, terror, or wounding that you remember well
- You orient quickly when you wake up
- Dreams and sleep disturbance disrupt your ability to function
Sleep apnea can contribute to nightmare disorder for some people, but for others, it might mean you are less likely to meet the clinical definition of nightmares. We’ll talk about this in more detail later.
Causes of Nightmares
Usually, nightmares can be traced back to specific causes. It’s rare to have nightmares without a clear cause. Eating late at night can cause nightmares because elevated blood sugar can increase brain activity.
Some medications have been linked to nightmares, including antidepressants, blood pressure medications, and narcotics. And ironically, medication withdrawal can lead to nightmares–if you take your medicines at about the same time each day and wake up with a nightmare at about the same time each night, this may be the cause. Alcohol consumption can also increase nightmares. And, of course, anxiety, stress, and PTSD are all associated with nightmares.
Whether sleep apnea causes nightmares or not is a lot less certain.
Sleep Apnea and Night Terrors
But it may be that nightmares are not your primary problem. Sleep apnea causes traumatic stress because your brain is low on oxygen and realizes your own throat is strangling you. It awakens partly to restore breathing. It also signals your heart to beat harder and faster to increase oxygen supply to the brain. The gasping breath and racing heart can make it easy to confuse this waking up with a nightmare, especially a night terror.
Studies of children have shown night terrors are associated with sleep apnea. Night terrors are much less common in adults. However, there are at least anecdotal reports that when adults have sleep terrors, they are associated with sleep apnea.
Sleep Apnea and Nightmares
Although associations between apnea and nightmares have been recorded for more than 1000 years, the relationship between sleep apnea and nightmares is much less clear. Some studies using a standard view definition of nightmares indicate that people with sleep apnea might experience nightmares twice as frequently as the general population. However, other studies suggest that people with sleep apnea don’t experience nightmares as often.
There are several potential explanations why sleep apnea might seem to increase nightmares in some cases or decrease it in others.
Nightmares occur during REM (rapid-eye movement) sleep when the brain is most active in creating dream visualizations. However, many people with sleep apnea experience reduced REM sleep. This means that they have less time to experience dreams of any sort, including nightmares.
However, some people with sleep apnea tend to have apneas during REM sleep. These people seem to have more nightmares than other individuals. Some studies looking at this phenomenon suggest that people experience more negative dreams with more complicated characteristics when they awaken from apneic sleep than when they awaken from healthy sleep. Some studies suggest that people who awaken with apneas incorporate choking or suffocating into their nightmares.
Does Sleep Apnea Treatment Help with Nightmares?
Although the association between sleep apnea and nightmares is not certain, a study indicates that when people have sleep apnea-related nightmares, treatment can help. Of course, the study used CPAP as the sleep apnea treatment, and it showed that when people complied with CPAP therapy, 91% of people who used CPAP saw nightmares disappear, compared to 36% of people who didn’t use their CPAP.
This means that sleep apnea treatment could help with nightmares–if people can get the effective treatment they will use. If you have sleep-apnea-related nightmares, but don’t want to use CPAP, oral appliance therapy could help. Repositioning your jaw helps your airway stay open, which means you can breathe easily at night without all the machinery, tubes, and straps related to CPAP.
If you’re waking up with nightmares, you should talk to a doctor or sleep dentist about sleep apnea. For an appointment with a Denver sleep dentist, please call (303) 691-0267 today for an appointment at the TMJ Therapy & Sleep Center of Colorado.