Parasomnias
Nightmare Disorder
Frequent, vivid, distressing dreams that wake you and affect your sleep, mood or daytime functioning. Effective therapies are available.
Overview
Nightmares are vivid, disturbing dreams that usually involve threats to safety or survival and wake you up, after which you are quickly alert and can recall the dream. They occur during REM sleep, more often in the second half of the night.
Occasional nightmares are normal. Nightmare disorder is diagnosed when nightmares are frequent and cause significant distress, fear of going to sleep, daytime fatigue or problems at work, school or home.
Nightmares are especially common after trauma and in post-traumatic stress disorder. Imagery rehearsal therapy, a technique in which you rewrite and rehearse a new version of a recurring dream, is recommended by the American Academy of Sleep Medicine and helps many people.
Reviews estimate that about 2% to 8% of the general population experience frequent nightmares, with much higher rates in people with PTSD.
Common symptoms
- Recurrent, vivid, distressing dreams
- Waking quickly and fully alert, with clear memory of the dream
- Fear, anxiety or anger on waking
- Difficulty returning to sleep
- Fear of going to sleep
- Daytime fatigue, poor concentration or low mood
Causes and risk factors
- Trauma and post-traumatic stress disorder
- Stress and anxiety
- Depression and other mental health conditions
- Sleep deprivation
- Some medicines, such as certain antidepressants and blood pressure drugs, or withdrawal from medicines or alcohol
- Alcohol or substance use
How it is diagnosed
Nightmare disorder is diagnosed from your history: repeated, well-remembered, distressing dreams that cause significant distress or impairment and are not better explained by a substance or another condition. Clinicians also screen for PTSD, depression, anxiety and sleep apnea. A sleep study is not usually required.
Treatment options
Imagery rehearsal therapy
You change the storyline of a recurring nightmare while awake and rehearse the new version daily. AASM recommends it for nightmare disorder.
Cognitive behavioural therapy
Including CBT for insomnia and trauma-focused therapies, which can reduce nightmares.
Exposure, relaxation and rescripting therapy
Combines several techniques for trauma-related nightmares.
Medication
Prazosin and some other medicines are used for PTSD-related nightmares, though results have been mixed and decisions are individual.
Treating underlying conditions
Managing PTSD, depression or sleep apnea.
What you can do yourself
- Keep a regular sleep schedule and enough sleep
- Write down recurring dreams and practise a new, calmer ending
- Limit alcohol and avoid recreational drugs
- Use relaxation techniques before bed
- Avoid distressing media close to bedtime
When to see a doctor
- Nightmares happen often and leave you afraid to sleep
- Nightmares followed a traumatic event
- Nightmares began after starting or stopping a medicine
- You have thoughts of harming yourself (seek help immediately)
Frequently asked questions
What is imagery rehearsal therapy?
It is a technique in which you write down a recurring nightmare, change it in any way you like, and rehearse the new version for a few minutes each day. It is recommended by the AASM and helps many people reduce nightmare frequency.
Are nightmares a sign of PTSD?
Frequent trauma-related nightmares are a common symptom of PTSD, but nightmares have many causes. If nightmares followed a traumatic event, talk to a clinician.
Can medicines cause nightmares?
Yes. Some antidepressants, blood pressure medicines and other drugs, as well as stopping alcohol or certain medicines, can trigger vivid dreams or nightmares. Do not stop a medicine without talking to your prescriber.
How are nightmares different from night terrors?
Nightmares occur in REM sleep later in the night and you wake fully and remember them. Night terrors happen in deep sleep early in the night with little memory.
Sources
This page is general information, not a diagnosis or medical advice. Read our medical disclaimer.