I have been experiencing nightmares and what I think of as anxiety attacks for some time now. They have been increasing in frequency over the last couple of months. In the nightmares, I am dreaming that I am asleep and that something is "stealing" my dreams so I can't wake up. I try to yell or move my body so I can wake up. Sometimes it works, and I wake up screaming. Sometimes when I do wake up I am still not sure I am REALLY awake, so I spend 15-20 minutes convincing myself that I am awake, by turning on lights or taking a shower. I am growing increasingly afraid to go to sleep at night for fear that I may feel (and stay) in that dream state of trying to wake up. Any ideas?

-- Anton

You may be experiencing symptoms of a sleep disorder. I can't say for sure, of course, but I think it's worth checking out. I'd recommend you contact a sleep disorders center for an evaluation. Your local hospital may have such a center, or the hospital or your primary care physician may be able to refer you to one.

A sleep disorders evaluation will probably involve your spending the night at the facility while your brainwaves and other functions are monitored through noninvasive procedures. There are several different kinds of sleep disorders besides sleep apnea and narcolepsy, which are two of the most well-known ones. Others include nightmare disorder and sleep terror disorder.

You might also want to consider the role of any medication in your experiences. Some people who are withdrawing from benzodiazepines, a class of antianxiety drugs that includes Xanax, Ativan, Valium and Klonopin, experience an increase in nightmares and sleep terrors. (Warning: Antianxiety medication should NEVER be decreased without a physician's guidance, because severe withdrawal reactions to benzodiazepines can include convulsions and even death.) And speaking of medication, let me add that it's generally not a good idea to regularly use prescription medicine to aid sleep, because of the tendency of your body to get used to the medication and experience "rebound" sleep problems when you discontinue it.

Sometimes psychological factors such as anxiety and stress can play a role in sleep disorders and nightmares. People who have posttraumatic stress disorder or dissociative disorders also may experience chronic nightmares, sleep disturbance and occasional difficulty discerning whether they're actually asleep or awake. It might be helpful to make sure any sleep disorders evaluation also includes assessment by a clinical psychologist to examine any pertinent psychological factors. The psychologist and the sleep disorders center can then make recommendations as to the best treatment approaches. Good luck.