About three-quarters of people experience the occasional nightmare, defined as a disturbing dream that causes the sleeper to wake up. Nightmares usually occur during rapid eye movement (REM) sleep in the later part of a sleep period.
Only a small percentage of adults have nightmares every week, but frequent nightmares are fairly common in childhood. They can start in children who are just a few years old, usually peak during school age Trusted Source Medscape Medscape is on online destination for healthcare professionals worldwide, offering expert perspectives, drug and disease information, and professional education. See Full Reference , and then often decrease in teenage years. Nightmares may be more common in girls, women, and people assigned female at birth.
Bothersome dreams can spark negative feelings such as fear and helplessness. They can also cause sweating, increased heart rate and blood pressure, and other hallmark symptoms of the fight-or-flight response.
In many cases, nightmares are infrequent or go away on their own. However, because recurring nightmares can negatively impact sleep, you might hope to try to prevent them from happening. We examine the factors that can contribute to bad dreams and how to stop having nightmares and get better sleep.
Common Causes of Nightmares
Nightmares do not have a single cause. Instead, many different triggers can induce troubling dreams.
- Stress: Stress and traumatic experiences are some of the main factors that can cause nightmares for both children and adults. In children, a break from or change in routine, like starting a new school or going on a trip, might be enough to trigger nightmares. Children can also have nightmares related to separation anxiety Trusted Source Medline Plus MedlinePlus is an online health information resource for patients and their families and friends. See Full Reference .
- Mental health conditions: Mental health conditions that are linked to nightmares include post-traumatic stress disorder (PTSD), depression, schizophrenia, anxiety and panic disorders, and borderline personality disorder.
- Medication: Certain beta blockers, stimulants, antidepressants, antibiotics, melatonin supplements, and other drugs can contribute to nightmares Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. See Full Reference . Nightmares may also occur after stopping the use of some medications including certain barbiturates, antidepressants, and benzodiazepines.
- Withdrawal: Nightmares can occur after decreasing or stopping the use of alcohol Trusted Source Medline Plus MedlinePlus is an online health information resource for patients and their families and friends. See Full Reference and nicotine Trusted Source Medline Plus MedlinePlus is an online health information resource for patients and their families and friends. See Full Reference . Withdrawal symptoms typically peak within one to three days but may persist longer for some people.
- Eating right before bed: It is believed that eating too close to bedtime may increase the chances of having nightmares.
- Illness: People with a fever are often more susceptible to nightmares.
- Pregnancy: Stress about the baby and upcoming life changes frequently Trusted Source Medline Plus MedlinePlus is an online health information resource for patients and their families and friends. See Full Reference cause vivid dreams and nightmares for pregnant people.
Therapy to Manage Nightmares
Therapy is one of the main ways to address nightmares. Many of the approaches for nightmares are based in cognitive behavioral therapy (CBT) Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. See Full Reference , which is intended to reframe the way a person feels, thinks, and acts to reduce symptoms and improve functioning.
A type of CBT that specifically focuses on sleep-related concerns is called CBT for insomnia (CBT-I). A CBT-I therapist may guide a person to restructure their sleep schedule and restrict negative stimuli in hopes of improving sleep and reducing nightmares.
Depending on the cause of a person’s nightmares, there are multiple methods for using therapy to decrease the chances of having bad dreams.
Psychotherapy For Nightmare Triggers
In nightmare-focused psychotherapy, a mental health professional helps a person work through sources of trauma or mental health issues that may be provoking nightmares. This includes empowering a person with techniques to recognize and address nightmare triggers Trusted Source UpToDate More than 2 million healthcare providers around the world choose UpToDate to help make appropriate care decisions and drive better health outcomes. UpToDate delivers evidence-based clinical decision support that is clear, actionable, and rich with real-world insights. See Full Reference .
Often, nightmares ease after treating accompanying mental health conditions like PTSD, anxiety, or depression. People who believe that they may have a mental health issue causing nightmares can ask their doctor for a referral to a mental health care provider.
Imagery Rehearsal Therapy for Nightmares
The American Academy of Sleep Medicine recommends using imagery rehearsal therapy as a treatment for nightmare disorder, including nightmares related to PTSD. Image rehearsal therapy aims to reformulate the plot of a recurring dream to make it less disturbing.
Working with a therapist, the sleeper writes down the new and changed plot of the dream and rehearses it during the day. The goal is that the nightmare, if it recurs, will automatically follow the new, more agreeable form.
A related technique called exposure, relaxation, and rescripting therapy (ERRT) builds on image rehearsal therapy by adding progressive muscle relaxation, refinement of sleep habits, and other techniques to complement imagery rehearsal therapy.
Other Types of Therapy for Nightmares
There are many more therapeutic approaches that have been proposed to treat nightmares, but in general these have not been as extensively studied.
- Eye movement desensitization and reprocessing: This therapy is intended to help a person process harmful memories while awake by stimulating the areas in the brain that are active during REM sleep.
- Lucid dreaming therapy: During a lucid dream, the sleeper is aware they are dreaming. Therapists hope that invoking this awareness might help a person change a dream’s storyline when they realize they are having a nightmare.
- Hypnosis: In hypnosis, the therapist induces a state of intense concentration in which a person can try to work through their nightmare trigger.
- Progressive deep muscle relaxation: Working one muscle group at a time, progressive deep muscle relaxation asks the user to tense and then relax successive parts of the body to induce a state of calmness.
- Self-exposure therapy: In a subset of CBT called self-exposure therapy or systematic desensitization, the person intentionally faces the situations that make them anxious, building up from the least to most intense, in hopes of reducing the anxiety they generate.
These therapy techniques involve specific protocols for addressing trauma or anxiety in a controlled way. It is important to always work closely with a mental health professional before starting these therapies and throughout the protocol.
Improving Sleep Hygiene
Sleep hygiene refers to both daytime and nighttime habits that affect sleep. Improving sleep hygiene can promote better sleep and may reduce nightmares. Good habits to adopt include:
- Going to bed and waking up at more or less the same time every day
- Arranging a comfortable bedroom environment
- Using the bedroom only for sleep and being intimate
- Engaging in enjoyable and affirming social interactions
- Getting regular exercise, preferably earlier in the day
- Avoiding heavy meals before bed
- Cutting out alcohol, nicotine, and caffeine in the evening
- Going to the bathroom before bed to reduce the need to wake up to urinate
- Implementing a relaxing bedtime routine
- Turning off or putting away electronic devices while getting ready for bed
Seeking Out Stress Relief
Stress relief may help address a common trigger for nightmares. What works best can vary from person to person but may involve reaching out to trusted friends and family members and making time for self-care activities like exercise, hobbies, and occasional rest periods. Some people find that relaxation techniques, such as yoga, meditation, or listening to music, can reduce stress.
Medication to Reduce Nightmares
In some cases, a doctor may prescribe medication to treat nightmares, including those linked to PTSD. However, the effectiveness of medications for nightmares remains unclear.
Some drugs work by dampening the fight-or-flight response, and research on other types of medication is ongoing.
People interested in medications for nightmares should consult a doctor. Experts generally do not recommend using medication to treat nightmares in children.
In addition, anyone who suspects that a medication that they currently take is contributing to nightmares should talk with a doctor before stopping the drug or decreasing its dosage.
Using Technology to Stop Nightmares When They Happen
Nightware is a smartwatch that tracks heart rate and body movements and vibrates when it detects that the sleeper is having a nightmare. In 2020 the Food and Drug Administration (FDA) granted approval Trusted Source U.S. Food and Drug Administration (FDA) The FDA is responsible for protecting the public health by ensuring the safety, efficacy, and security of human and veterinary drugs, biological products, and medical devices; and by ensuring the safety of our nation's food supply, cosmetics, and products that emit radiation. See Full Reference for the manufacturer to market Nightware for adults with nightmare disorder or PTSD. The device is only available by prescription.
Although there is limited research on its effectiveness, Nightware provides a low-risk option for managing nightmares that can be used in conjunction with therapy and medications.
In preliminary studies, the smartwatch did not appear to disrupt sleep or cause daytime sleepiness. However, sleepers should always consult a doctor before using Nightware, which may not be appropriate for all people who have nightmares.
How to Help Your Child With Nightmares
If a child is experiencing nightmares, first try soothing them by reminding them that it was just a dream. Children may also find it helpful to describe or draw Trusted Source UpToDate More than 2 million healthcare providers around the world choose UpToDate to help make appropriate care decisions and drive better health outcomes. UpToDate delivers evidence-based clinical decision support that is clear, actionable, and rich with real-world insights. See Full Reference what they saw in the nightmare so they can talk about it with a trusted adult. As in adults, rescripting or imagery rehearsal therapy while awake may help change the ending of the nightmare so it is less frightening.
It is natural for children to occasionally experience nightmares, but if they happen regularly or cause notable distress, then caregivers should seek advice from a pediatrician.
Children often respond well to having a quiet and dark bedroom, a consistent bedtime, and a screen-free evening routine. To help a child feel safe, spend time with them before bed and offer them a soft toy for comfort. These steps may help reduce stress at night and facilitate nightmare-free sleep.
When to Talk to a Doctor
Consult with a doctor if nightmares occur more than a few times a month or if nightmares are interfering with sleep or other aspects of everyday life. A doctor may be able to identify factors that are contributing to nightmares, such as medications or an untreated mental health condition.
A sleep study is not usually needed for nightmares, but a doctor may suggest a sleep study if a person also has signs of a sleep disorder. For example, if nightmares are related to breathing problems during sleep, a sleep study can diagnose or rule out a sleep-related breathing disorder.
In evaluating any person who experiences nightmares, a health professional often needs to consider whether nightmare disorder or PTSD may be present.
Nightmares vs. Nightmare Disorder
Nightmare disorder involves more than just nightmares that occur every once in a while. Instead, it occurs when frequent nightmares interfere with sleep quality, the ability to fall asleep, or daily life. While occasional nightmares are common, only about 4% of people have nightmare disorder.
Only a health professional can formally diagnose nightmare disorder after carefully reviewing a person’s symptoms. Treating nightmare disorder can help take away the fear of falling asleep and make sleep more refreshing.
Nightmares are a central feature of PTSD, a condition involving ongoing symptoms associated with a traumatic event. It is estimated that as many as 80% of people with PTSD have nightmares. Many people with PTSD revisit the traumatic event in their dreams or have nightmares based on the feelings surrounding the event.
Although nightmares typically occur during REM sleep, people with PTSD may experience nightmares when they first fall asleep. As a result, nightmares often cause insomnia and impaired sleep for people who live with PTSD.
Children can also have PTSD with nightmares Trusted Source UpToDate More than 2 million healthcare providers around the world choose UpToDate to help make appropriate care decisions and drive better health outcomes. UpToDate delivers evidence-based clinical decision support that is clear, actionable, and rich with real-world insights. See Full Reference . Whereas adults tend to dream about the trauma itself, children with PTSD may have nightmares about seemingly unrelated events. Still, these ongoing nightmares can make it difficult for children to sleep if they wake up frightened or are scared to fall asleep.
Caregivers of children who have experienced traumatic events can take steps to help the child feel safer. Establishing a daily routine, communicating about the event in an age-appropriate way, limiting exposure to disturbing news broadcasts, and being present with the child may help them recover Trusted Source Medline Plus MedlinePlus is an online health information resource for patients and their families and friends. See Full Reference from the experience. If they are still having trouble coping, a mental health professional can provide additional strategies to help them work through their feelings.
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