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1Modern physiological methods of sleep research (REM-EEG) have shown that awakenings with anxiety occur during all stages of sleep. The most severe type of nightmare (pavor nocturnus or night terror) of children and adults arises out of the deepest stage of nondreaming sleep, Stage IV; the more severe posttraumatic nightmares are evidently of this type also. Although initiated out of Stage IV sleep, this type of severe nightmare is in some sense a "disorder of arousal" (Broughton). It is characterized by (a) a sudden, cataclysmic breakthrough of uncontrolled anxiety; (b) a sudden loud scream of blood-curdling intensity or cry for help; (c) the passing into an arousal reaction—subject is dissociated, confused, unresponsive, hallucinating; (d) a waking EEG pattern, but subject is not fully alert; (e) the subject frequently being propelled out of bed and moving through the house as though in flight; (f) intense autonomic discharge, heart rate doubling or nearly tripling in 15 to 30 seconds, and respiratory rate and amplitude increasing; (g) difficulty in retrieving content and rapid onset of amnesia for the attack.
2Stage IV nightmare appears to arise out of a physiological void because there is no evidence of autonomic activation just prior to its violent onset, but rather the opposite, respiration, for example, slowing and the intensity of the nightmare being proportional to the duration of the Stage IV preceding it. This suggests that the deeper the sleep, the more intense the nightmare arising from it. These nightmares take place in the first few hours of sleep when most Stage IV is present, about two thirds of them during the first NREM period.