This is an occasional problem I have been experiencing, and wanted to see if others were having something similar.
I have noticed the difficulty changing ingame. At times when when my character dies and I reload, the enemy is softer than before. Meaning, if set on nightmare and it takes 20-30 hits to kill an enemy, upon reload that same enemy dies in only 3-4 hits. This seems to affect all the enemies in the area as well and not just tied to that one in particular.
This has prompted me to adjust my settings to casual, save settings and return to gameplay. Then pausing and changing the settings back to nightmare. By doing this, it returned to nightmare but the healthbars of the enemies in the current area are all at 50%. As these enemies are cleared and I move into another area, (eg The Bandits in front of the Bandit Camp entrance to the Black Ring around the Quarry) the new enemies are at 100% health.
This happend once AFAIK in my first playthrough, but have noticed it to happen on several occasions in my current.