Hello,
Thanks for your query.
I appreciate your efforts for medical consultation in so much distress.

Fearful dreams are called nightmares. Nightmares are vividly realistic, disturbing dreams that awake person from a XXXXXXX sleep. They often set your heart pounding from fear. Nightmares tend to occur most often during rapid eye movement (REM) sleep, when most dreaming takes place. Because periods of REM sleep become progressively longer as the night progresses, you may find you experience nightmares most often in the early morning hours.


When you wake up terrified from a disturbing nightmare, you might think you're the only adult who has them. But nightmares are very common condition and between 2% and 8% of the adult population is plagued by nightmares.

When nightmares cause significant distress, interrupt your sleep on a regular basis then it become important to determine what's causing your nightmares. Then you can make changes to reduce their occurrence.

Causes of nightmares in her case (in order of preference):
-Stress, anxiety and depression. Like exam stress in her case.
-Sleep deprivation may contribute to adult nightmares. In exam student used to sleep less number of hours.
-Some people have nightmares after having a late-night snack, which can increase metabolism and signal the brain to be more active.
-Excessive use of caffeine and nicotine (smoking) during exam time.


Following steps will help her:

-There are a number of other steps you can take on your own that may help reduce your nightmare frequency. Keeping a regular wake-sleep schedule is important. So is engaging in regular exercise, which will help alleviate nightmare-causing anxiety and stress.

-You may find that yoga and meditation (from physician) are also helpful.

-Remember to practice good sleep hygiene, which will help prevent the sleep deprivation that can bring on nightmares in adults. Make your bedroom a relaxing, tranquil place that is reserved for sleep, so that you don't associate it with stressful activities.

-Also, be cautious about the use of caffeine, and nicotine, which can remain in your system for more than 12 hours and often disrupt sleep patterns.

I hope this information has been both informative and helpful for you. In case of any doubt, I will be available for follow ups.

Wish you good health.
Regards,

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Hello again,
Thanks for follow up.

Solution depend more on the cause. As you report restlessness and increase frequency of these symptoms during exam, then evaluation of anxiety is required in your case.

Other symptoms of anxiety which may or may not be present in your case: nervousness, restlessness, mild irritability, excessive worry regarding own health, tremor, muscle spasm, heaviness in body, easy fatigability, headache, sleep disturbance, palpitation and dry mouth. Let me know, if these symptoms present in her case.

Irrespective of cause, above steps, as mentioned in primary reply will help her.



Also follow these detailed steps of sleep hygiene for relief:

•     Fix a bedtime and an awakening time. Do not be one of those people who allows bedtime and awakening time to drift. The body "gets used" to falling asleep at a certain time, but only if this is relatively fixed. Even if you are retired or not working, this is an essential component of good sleeping habits.
•     Avoid napping during the day
•     Avoid caffeine 4-6 hours before bedtime. This includes caffeinated beverages such as coffee, tea and many sodas, as well as chocolate, so be careful.
•     Avoid heavy, spicy, or sugary foods 4-6 hours before bedtime
•     Exercise regularly, but not right before bed. Regular exercise, particularly in the afternoon, can help deepen sleep.
•     Use comfortable bedding.
•     Find a comfortable temperature setting for sleeping and keep the room well ventilated.
•     Block out all distracting noise, and eliminate as much light as possible.
•     Reserve the bed for sleep. Don't use the bed as an office, workroom or recreation room. Let your body "know" that the bed is associated with sleeping.
•     Practice relaxation techniques before bed. Relaxation techniques such as yoga, XXXXXXX breathing and others may help relieve anxiety and reduce muscle tension.
•     Don't take your worries to bed. Leave your worries about job, school, daily life, etc., behind when you go to bed. Some people find it useful to assign a "worry period" during the evening or late afternoon to deal with these issues.
•     Establish a pre-sleep ritual. Pre-sleep rituals, such as a warm bath or a few minutes of reading, can help you sleep.
•     Getting Up in the Middle of the Night :Most people wake up one or two times a night for various reasons. If you find that you get up in the middle of night and cannot get back to sleep within 15-20 minutes, then do not remain in the bed "trying hard" to sleep. Get out of bed. Leave the bedroom. Read, have a light snack, do some quiet activity, or take a bath. You will generally find that you can get back to sleep 20 minutes or so later. Do not perform challenging or engaging activity such as office work, housework, etc. Do not watch television.
•     A Word About Television: Many people fall asleep with the television on in their room. Watching television before bedtime is often a bad idea. Television is a very engaging medium that tends to keep people up. We generally recommend that the television not be in the bedroom. At the appropriate bedtime, the TV should be turned off and the patient should go to bed. Some people find that the radio helps them go to sleep. Since radio is a less engaging medium than TV, this is probably a good idea.

Wish you good health.
Regards.

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