From Kimberly Read & Marcia Purse,
Your Guide to Bipolar Disorder.
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About.com Health's Disease and Condition content is reviewed by Steven Gans, MD

by Marcia Purse

Nightmares also occur frequently in bipolar disorder. In The Reinterpretation of Dreams, the authors write:

Bipolar patients report bizarre dreams with death and injury themes before their shift to mania (Beauchemin and Hays, 1995). Beauchemin and Hays (1996) found that dreams of bipolar depressed patients have more anxiety than those of unipolar patients. Dreams of bipolar patients, particularly those with rapid cycling, may show evidence of the subsequent shift prior to noticeable affective and behavioral changes (Frayn, 1991).

Bipolar children particularly suffer from nightmares. The July 2000 issue of "The Bipolar Child Newsletter" notes that for these children, dreams of explicit violence, gore and death are a common symptom. In the January 2000 issue of the same newsletter, authors Papolos and Papolos wrote, "Many of these children suffer night terrors and fears of abandonment and annihilation. Whereas most children sleep and dream and have a nightmare or bad dream once in a while, many children with bipolar disorder are trapped through the night in hour after hour of night terrors (parents may not even realize it because often the children do not truly wake up but seem in anesthetized states)."

Night terrors and such conditions as sleepwalking, restless leg syndrome, bruxism (teeth grinding) make up a group of arousal disorders called parasomnias. Night terrors do not occur during REM sleep and are not dreams, although they have nightmarish elements. They occur instead either during deep sleep or in a transitional state between deep and dreaming sleep and are a form of confusional arousal disorder.

When a child is experiencing a night terror and actually remembers it, he or she later reports dreams that are extremely threatening. The content has to do with some predatory person or animal chasing them, or terrible fears of abandonment such as their parents being killed. Some adults who suffer them and seem to have greater recall speak of ceilings and walls pushing down on them, and others report snakes and spiders slithering and crawling all over the bed or room" (Bipolar Child Newsletter, January 2000).

Night terrors are rare in adults, yet Papolos and Papolos cited a 1999 study by Dr. Maurice Ohayon which found that bipolar disorders and depression with anxiety were the most common factors associated with adults who reported night terrors.

In these episodes, people are known to appear to awaken, recognize no one, and exhibit symptoms of extreme fear, even screaming, thrashing around or running from the bedroom. In her article comparing nightmares with night terrors, Sleep Disorders Guide Florence Cardinal gives tips on how to help prevent and treat these conditions. Dr. Alan Greene suggests an interesting theory and treatment for a child with night terrors who is at potty-training age.

I do not have nightmares often; but in the morning, my last dream before waking might be so involved and detailed that it could take three or four full pages if I tried to write it all down. I could describe the colors and textures of a dinosaur-like creature's scales; I could tell you today 15 minutes of details about a dream I had five years ago where Bill Cosby was standing on our front lawn (I won't, though). The effect of bipolar disorder on dreams can be interesting and entertaining - or utterly terrifying.

More Resources:

• Bipolar report of unusually vivid dreams coupled with fatigue even after long sleep
• Bipolar report of long-term vivid dreams
• Night Terrors Basics

Page 1 - Bipolar, Sleep Disorders and Vivid Dreams