Nightmares - Sleep Education (2024)

NightmaresJason Wilbanks2023-09-15T19:10:33+00:00

Home » Sleep Disorders » Nightmares

October 2020 | Reviewed by: Reeba Mathew, MD and Anne M. Morse, DO

What are nightmares?

Nightmares that occur frequently and keep you from getting restful sleep are considered a sleep disorder. Nightmare disorder is a parasomnia, a category of sleep disorders that involves unwanted events or experiences that occur while you are falling asleep or waking up or in your sleep.

If you have nightmare disorder, you may fear going to sleep or worry that each night you will have another nightmare. You may also feel anxious and scared when you wake up from a nightmare and be unable to go back to sleep. Sleep loss can cause you to have even more intense nightmares. As a result, you may experience daytime sleepiness.

Nightmares are usually coherent visual dreams that seem real and get more disturbing as they unfold and cause you to wake up. These most often happen towards the end of your sleep period. These dreams most often involve imminent physical danger. Nightmares may also focus on other distressing themes and provoke negative emotions such as:

  • Anxiety
  • Fear
  • Terror
  • Anger
  • Rage
  • Embarrassment
  • Disgust
  • Other negative feelings

In most instances after you wake up, you will be able to clearly remember the details of your nightmare. A disturbing dream that does not wake you up is not considered a nightmare. Instead, it is simply a bad dream. It is possible to have more than one nightmare, often with similar themes, during a night of sleep.

Nightmares tend to happen during REM sleep, the last stage in the sleep cycle. About 20% to 25% of your total sleep time is in REM sleep. The REM stage gets longer during each sleep cycle and your final period in REM may last up to an hour. As a result of this, nightmares are most likely to occur in the final third of the night. Nightmares that arise from trauma, such as in people with posttraumatic stress disorder (PTSD), may also occur in earlier sleep stages.

What are risk factors for nightmares?

Nightmares can happen to anyone, and in most cases the reasons why the nightmares occur are unclear. Stress, anxiety, an irregular sleep routine or being overtired can increase your risk for nightmares.

Some medications, such as antidepressants and medications for hypertension or Parkinson’s disease, may increase the frequency of nightmares. Nightmares that cause sleep problems may also be associated with factors such as:

  • Another sleep disorder
  • A medical condition
  • Medication use
  • A mental health disorder such as depression, anxiety or PTSD
  • Substance abuse

Having the same nightmare repeatedly over time can also be common after severe stress or a traumatic event. These nightmares are often a way of “reliving” the traumatic event.

How prevalent are nightmares?

Nightmares can happen to anyone, but nightmare disorder is relatively rare. The key difference in nightmare disorder is the inability to get sufficient sleep because of disturbing dreams. An estimated 2% to 8% of people have nightmares that cause sleep problems.

Children

Nightmares are especially typical in children aged 3-6 years. Up to 50% of young children have severe nightmares that cause them to wake up their parents. Nightmares in children tend to peak by ten years of age. After that time, nightmares usually decrease. Some children continue to have nightmares as teens and adults. This may be a lifelong problem for these individuals.

Adults

An estimated 50% to 85% of adults report having the occasional nightmare. Nightmares tend to become less frequent and intense as you age. Women tend to report nightmares more often than men but are also more open to discussing their dreams and nightmares.

What are parasomnias similar to nightmares?

Other sleep disorders also classified asparasomnias are sometimes mistaken for nightmares.

Night terrors

These episodes cause you to wake up disoriented from slow-wave sleep or deep sleep in intense fear with your heart racing. Night terrors may cause you to scream, kick, thrash or bolt out of bed. It’s usually difficult to remember what happened, though you may be able to recall brief segments of a terrifying dream. Night terrors tend to occur in the first third of the night.

REM sleep behavior disorder

A potentially dangerous sleep disorder that causes you to act out vivid dreams as you sleep. The dreams are usually filled with action and may even be violent. Because these actions may result in injury to yourself or your partner, REM sleep behavior disorder is considered a dangerous condition that requires medical attention. This disorder is most common in middle-aged men.

How to diagnose nightmares?

Self test

If you think you may have nightmare disorder, ask yourself the following questions:

  • Do you often wake up from sleep due to a disturbing dream?
  • Do these dreams evoke emotions of fear, anger, sadness or disgust?
  • Are you alert and able to think clearly as soon as you wake up?
  • Are you able to clearly recall details of these dreams?
  • Do these dreams often occur during the late portion of your sleep period, such as in the early morning part of your sleep?
  • Do you have difficulty falling back asleep after these dreams?

If you answered yes to these questions, you should talk to your doctor or see a sleep doctor. A sleep doctor is trained to accurately diagnose nightmare disorder and rule out any possible underlying causes or complications.

Diagnosis

The doctor will need to know when you first started having nightmares, how often they occur and the content of the nightmares. Your complete medical history, as well as any past or present drug and medication use, will help the doctor make a diagnosis. Tell the doctor if you have ever had any other sleep disorder, or if any of your family members have sleep problems.

You may be required to keep a sleep diary for two weeks. The sleep diary will help the doctor look at your sleep patterns. This data will give the doctor clues about what is causing your problem and how to correct it.

In most cases, you will not need any tests for nightmares. If your sleep is severely disturbed, or if the doctor suspects there are underlying problems, you may need to have a sleep study.

How to treat nightmares?

In most cases, treatment for nightmares is not necessary. For patients who have nightmare disorder and experience severe sleep disturbances and daytime sleepiness, treatment by abehavioral sleep medicine specialistis recommended.

Types of therapy

Counseling– A therapist can help you address some of the underlying causes of your nightmares. This will require processing your thoughts and feelings. More intensive counseling may be needed if the nightmares are caused by a traumatic event.

Imagery Rehearsal Therapy – This approach helps you reimagine your nightmares with different less frightening outcomes with the goal being to “reprogram” your nightmares to be less disturbing if they recur.

Systematic desensitization– This approach involves gradual exposure to the disturbing or frightening dream content to lessen your emotional response. Systematic desensitization is most useful when recurrent nightmares appear after severe trauma.

Stress management– Managing stress in your life can help you manage your nightmares. This may include relaxation training so that you are able to reduce the anxiety or tension that keeps you from falling asleep and so you can go back to sleep after a nightmare.

Tips for parents

Most children have nightmares. These tips may help if your child has problems with nightmares:

  • Let your child sleep with a special blanket or stuffed animal for security.
  • Plug in a dim nightlight so your child’s bedroom feels safe.
  • Respond quickly to comfort your child when he or she wakes up from a nightmare.
  • Discuss nightmares openly with your child during the day.
  • Assure your child that it is normal for children and even adults to have nightmares.
  • Talk to your child’s pediatrician if recurring nightmares greatly disturb your child.
Nightmares - Sleep Education (2024)

FAQs

Nightmares - Sleep Education? ›

Sleep loss can cause you to have even more intense nightmares. As a result, you may experience daytime sleepiness. Nightmares are usually coherent visual dreams that seem real and get more disturbing as they unfold and cause you to wake up. These most often happen towards the end of your sleep period.

How do you help someone with nightmares? ›

Meditation, deep breathing or relaxation exercises may help, too. Also, make the bedroom comfortable and quiet for sleep. Offer reassurances. If your child is struggling with nightmares, be patient, calm and reassuring.

What are coping skills for nightmares? ›

Practice relaxation, pleasant imagery, and coping skills first, to be sure you are ready to work on changing your nightmares. Do progressive relaxation, paced breathing, and/or Wise Mind exercises; listen to music or guided imagery; review the distress tolerance crisis survival skills.

Why am I having nightmares every night? ›

Depression and other mental health disorders may be linked to nightmares. Nightmares can happen along with some medical conditions, such as heart disease or cancer. Having other sleep disorders that interfere with adequate sleep can be associated with having nightmares.

How to stop trauma nightmares? ›

The Role of Therapy in Nightmare Management

Evidence-based therapies, such as Eye Movement Desensitization and Reprocessing (EMDR) and Cognitive-Behavioral Therapy for PTSD (CBT-PTSD), can help individuals process traumatic experiences, reduce nightmares, and improve overall well-being.

How do I stop my child from having nightmares? ›

Here are some tips you can try to get nightmares under control.
  1. Get into a healthy sleep routine. Try to go to bed about the same time and wake up at the same time every day. ...
  2. Sleep with a stuffed toy or favorite blanket. This helps some kids feel more secure.
  3. Use a nightlight. ...
  4. Keep your door open.

Can you take anything to stop nightmares? ›

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.

What are nightmares trying to tell you? ›

Indeed, studies suggest that nightmares are often linked to unmet psychological needs and/or frustration with life experiences. Yet those links aren't always easy to make—except in cases of trauma (discussed below), our nightmares tend to reflect our troubles through metaphor rather than literal representation.

How to calm down from a bad dream? ›

Exhale, relaxing your chest. Relax your legs, thighs, and calves. Clear your mind for 10 seconds by imagining a relaxing scene. If this doesn't work, try saying the words, “Don't think,” over and over for 10 seconds.

What to say when someone has nightmares? ›

You might say something like, "You had a bad dream, but now you're awake and everything is OK." Reassure your child that the scary stuff in the nightmare didn't happen in the real world. Offer comfort. Show that you understand that your child feels afraid and it's OK.

What is the treatment goal for nightmares? ›

In IRT treatment, you're helped to reimagine your nightmares with different, less frightening outcomes. 1 The goal is to "reprogram" your nightmares to be less terrifying if and when they occur again.

What vitamins help with nightmares? ›

You may also benefit from vitamin supplements or foods that are high in these vitamins and minerals:
  • Omega-3.
  • Tryptophan.
  • Magnesium.
  • Vitamin D.

How to stop repetitive nightmares? ›

For example:
  1. Reduce stress. Consider steps to lower overall stress in life. ...
  2. Talk it out. It may be helpful to express what's going on, either by talking about disturbing dreams or journaling about them. ...
  3. Practice good sleep hygiene. ...
  4. Avoid drinking or eating right before bed.
Nov 16, 2022

How to stop getting bad dreams? ›

Try to eliminate bad dreams by:
  1. Setting a regular sleep schedule. ...
  2. Cutting out caffeine, alcohol, and cigarettes (especially late in the day).
  3. Getting regular exercise during the day — but don't work out right before going to bed.
  4. Relaxing before falling asleep.

How to comfort someone in a nightmare? ›

Start with a brief dose of empathy. Use some soothing words, “I'm sorry you got scared,” or a hug, and then return your child to his/her bed. Next, re-focus your child away from the memory of the nightmare, and on to something else.

What to tell someone who is having bad dreams? ›

Tell her that you would have been afraid, too, but then explain to her that bad dreams are just our imagination making things up while we sleep, and sometimes the things can be crazy.

How do you respond to nightmares? ›

One potentially helpful approach is to try and spend time going through the whole story – not just up to the worst point – but also what also happened after up to a point where you were safe. It can be useful to write out the whole story and read it a number of times a day – including just before going to sleep.

Is nightmare disorder a mental disorder? ›

While nightmares are associated with certain mental health conditions, such as PTSD, anxiety and depression, nightmares aren't considered a psychiatric illness. They're a type of parasomnias, which are behavioral sleep abnormalities.

References

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