DIAGNOSIS CHECKLIST
for Nightmares

Why: to determine if acute or chronic. Acute nightmares should make one think of the possibility of infectious disease, acute situational maladjustment (adjustment disorder) or a head injury. Chronic nightmares may be associated with drug or alcohol use, epilepsy, anxiety, depression, post-traumatic stress disorder, schizophrenia and bipolar disorder.

Why: Most people with normal sleep patterns have an occasional nightmare.

Why: There is full arousal and memory of the unpleasant dream with nightmares. In contrast, night terrors occur primarily in young children during the first few hours of sleep onset with the child suddenly screaming, sweating and breathing quickly. The child is difficult to arouse and rarely recalls the episode on awakening in the morning.

Why: Nightmaresare extremely frightening dreams that usually involve threats to survival, security, or self-esteem.

Why: Nightmares may follow physical trauma, either due to the anxiety associated with the trauma or actually to a head injury.

Why: questions specifically about relationship, family, children, social support, occupation, general physical health and financial stresses. Stressors are a common cause of nightmares such as a change of occupation, loss of a loved one, illness, anxiety over a deadline or examination.

Why: can help assess possibility of acute situational maladjustment (adjustment disorder) and assess levels of stress.

Why: can help assess possibility of acute situational maladjustment (adjustment disorder) and assess levels of stress.

Why: The regular use of sedatives or hypnotics will interfere with sleep patterns and lead to chronic insomnia. Often the dosage of these medications will have been increased in the past so as to maintain hypnotic effectiveness after tolerance begins to develop. In cases of withdrawal, individuals may sleep only 1-4 hours each night ("rebound insomnia") for several weeks and will also experience an increase in anxiety, nightmares and awakenings through the night.

Why: certain mental illnesses are known to be associated with nightmares such as depression, anxiety, post-traumatic stress syndrome, schizophrenia, mania.

Why: Some medications may be associated with nightmares including beta blocker blood pressure medication, reserpine, thioridazine, certain tricyclic antidepressants and benzodiazepines. Withdrawal of some medications such as benzodiazepine sleeping pills may also cause nightmares.

Why: The use of nicotine patches for smoking cessation may cause vivid dreams and an increased frequency of nightmares.

Why: Acute alcoholic intoxication can cause nightmares and hallucinations. Chronic alcoholism can lead to delirium tremens which can include nightmares.

Why: e.g. amphetamines may cause nightmares.

Why: e.g. epilepsy, narcolepsy, bipolar affective disorder, schizophrenia.

Why: may indicate ciguatera fish poisoning. Such fish contain ciguatoxins from plankton and may cause nightmares among other symptoms.

Why: fatigue and tiredness causes an increased risk of nightmares.

Why: may suggest an infectious process as the cause of acute nightmares.

Why: these findings suggest grand mal epilepsy. Nightmares may also result from complex partial seizures without tongue biting or incontinence.

Why: these type of hallucinations are called "hypnogogic" and are common in narcolepsy but may also be seen in normal people.

Why: e.g. delusions, hallucinations and disordered thinking - may suggest schizophrenia or bipolar disorder but these symptoms may also be present with delirium, dementia and severe depression. These disorders may be associated with an increased frequency of nightmares.

Why: e.g. missed menstrual periods, breast enlargement, breast tenderness, urinary frequency. Pregnant women are more likely to experience nightmares.

Why: e.g. depressed mood, crying spells, anhedonia (loss of interest or pleasure), increase or decrease in appetite (usually decreased), weight loss or gain, insomnia or increased sleeping, fatigue, loss of energy, feelings of worthlessness, feelings of excessive guilt, poor concentration, difficulty making decisions, low libido, thoughts of death or suicide attempt. The great majority of individuals who experience major depression will suffer form insomnia, usually early morning wakening (usually around 3am) with difficulty returning to sleep. There is also at increased risk of experiencing nightmares.

Why: e.g. nervousness, shakiness, tremor, restlessness, irritability, insomnia, poor concentration, heart palpitations, racing heart, sweating, dizziness, diarrhea, lump in throat and frequency of urination. Difficulty with getting to sleep (both at the beginning of the night and following night time awakenings) is a common feature of generalized anxiety disorder, due to increased autonomic arousal and worry. There is also at increased risk of experiencing nightmares.

Why: e.g. episodes of depression (often psychotic in intensity) and at other times episodes of psychotic excitement (mania or hypomania). Symptoms of psychotic excitement may include elevation of mood, increased activity, insomnia, decreased need for sleep, grandiose ideas, irritability, disinhibition (which affects social, sexual and financial behavior), rapid speech and racing thought, delusions (persecutory or grandiose) and sometimes hallucinations. There is also at increased risk of experiencing nightmares.

Why: e.g. symptoms follow exposure to an unusual stress such as a battle, being raped or a natural disaster. Symptoms include recurrent and intrusive recollections of the stress, recurrent distressing dreams of the event, acting or feeling as if the event was recurring, intense distress on exposure to resembling events, persistent avoidance of events that symbolize or resemble the trauma, increased arousal symptoms such as insomnia, exaggerated startle response, poor concentration and moodiness.

Why: e.g. excessive daytime sleepiness wit involuntary daytime sleep episodes, disturbed nocturnal sleep and cataplexy (sudden weakness or loss of muscle tome, often elicited by emotion).

Why: e.g. impaired conscious level with onset over hours or days, disorientation in time and/or place, unusually quite, drowsy, agitated, delusions, auditory hallucinations, visual hallucinations and nightmares. May be associated with infectious disease or drug intoxication.

Why: e.g. lip numbness, abdominal pain, nausea, vomiting, diarrhea, visual blurring, dislike of the eyes for light, metallic taste in the mouth and nightmares. Symptoms occur from a few minutes to 30 hours after ingestion of certain reef dwelling fish.