| C | The dream experience, or sleep disturbance produced by awakening from it, causes clinically significant distress or impairment in social, occupational, or other important areas of functioning as indicated by the report of at least one of the following: - Mood disturbance (eg, persistence of nightmare affect, anxiety, dysphoria)
- Sleep resistance (eg, bedtime anxiety, fear of sleep or subsequent nightmares)
- Cognitive impairments (eg, intrusive nightmare imagery, impaired concentration or memory)
- Negative impact on caregiver or family functioning (eg, nighttime disruption)
- Behavioral problems (eg, bedtime avoidance, fear of the dark)
- Daytime sleepiness
- Fatigue or low energy
- Impaired occupational or educational function
- Impaired interpersonal/social function
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