Disturbing dreams are unsettling, especially when they’re frequent. You can learn all about nightmare disorder here and get tips to sleep better.
You can probably remember at least one vivid nightmare from your childhood.
While many adults may have the occasional nightmare, frequent nightmares are less likely.
If you find that your disturbing dreams start to become chronic, you may have a mental health condition known as nightmare disorder.
According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), nightmare disorder describes repeated instances of extended, profoundly unnerving, and well-remembered dreams.
These elaborate, unsettling dreams may involve life-or-death situations or scenarios that threaten an individual’s sense of security or wholeness.
Nightmares of this nature usually take place during rapid eye movement (REM) sleep, when dreams are longer and more vivid.
Upon waking, an individual is immediately alert and oriented. However, this type of sleep disturbance may cause a person significant unease and distract from daytime functioning. Over time, this can lead to a decrease in emotional and physical well-being.
The DSM-5 categorizes nightmare disorder by frequency:
- Acute. Nightmare occurrence is 1 month or less.
- Subacute. Nightmares occur for longer than 1 month but less than 6 months.
- Persistent. Nightmares persist for 6 months or longer.
And by severity:
- Mild. Less than one nightmare per week on average.
- Moderate. One or more nightmares per week, but not nightly.
- Severe. Nightmare episodes occur nightly.
Nightmares are common among those with post-traumatic stress disorder (PTSD).
Episodes of nightmare disorder aren’t usually caused by the effects of substances such as drugs or medications, either — though
Nightmare disorder can only be diagnosed when disturbing dreams are chronic and persistent. You may have nightmare disorder if you experience:
- daytime fatigue
- decreased emotional and physical well-being
- difficulty concentrating
- fixation on the nightmares during waking hours
- impaired functioning at work, school, or social situations
- increased anxiety and fear during waking hours
- fear of going to sleep at night
Nightmare disorder may also be associated with fear-based memories that lie dormant during waking hours and become aroused during sleep.
Possible contributing factors of nightmare disorder include:
- traumatic experiences in childhood
- sensitivity to negative stimuli
- inability to suppress unwanted thoughts and feelings
- sleep apnea, or other physiological factors that disrupt sleep
- withdrawal from medications that suppress REM sleep
- drugs that influence the chemical brain messengers (neurotransmitters) norepinephrine, serotonin, and dopamine — though quality evidence is lacking
In addition, the theoretical framework called the
The model explains that a “nightmare script” becomes activated in response to dream elements that resemble the original stressor and is perpetuated again and again.
Is there a cure for nightmare disorder?
An occasional nightmare episode doesn’t require treatment, but nightmare disorder and PTSD-associated nightmares can be treated in a number of ways to help reduce the occurrences of disturbing dreams.
IRT, a form of cognitive-behavioral therapy (CBT), theorizes that chronic nightmares are rooted in traumatic experiences. The approach is based on the belief that working with nightmare imagery during the day helps to influence dreams at night.
“IRT is my go-to for nightmare disorder,” says sleep psychologist Dan Ford of the Better Sleep Clinic in Auckland, New Zealand.
“It’s a gentle form of exposure therapy where clients will rescript the nightmares and rehearse the changed nightmares on a regular basis.”
A 2018 position paper from AASM states that the following techniques can be used to treat this condition:
- exposure, relaxation, and rescripting therapy (ERRT)
- lucid dreaming therapy
- progressive muscle relaxation (PMR)
- sleep dynamic therapy (SDT)
- self-exposure therapy
- systematic desensitization
- testimony method
If you know PTSD is the cause of your nightmare disorder, AASM suggests considering eye movement desensitization and reprocessing (EMDR) therapy.
How do doctors treat nightmare disorder?
You can speak with your doctor about being screened if you suspect this condition. To treat nightmare disorder, AASM recommends the following medications:
- prazosin (Minipress)
Any of these may be prescribed for the treatment of PTSD-associated nightmares:
There’s no guarantee that you can direct the content of your dreams.
But with the help of a qualified therapist, you can work through the imagery during your waking hours to cope with your symptoms and reduce the occurrences of nightmares.
For instance, research shows that targeted psychotherapy techniques such as IRT or ERRT combined with improved sleep hygiene practices may help reduce future instances of PTSD-associated nightmares.
Additionally, a 2015 study shows a link between nightmares, insomnia, sleep deprivation, and poor sleep quality.
You might try these tips to improve your sleep hygiene and get a better night’s rest:
- Establish to a regular bedtime routine.
- Commit to a regular sleep schedule.
- Set a no-screen rule at least 1 hour before bed.
- Charge your electronic devices in another room.
- Lower the thermostat to 65–70°F (18–21°C).
- Make your room as dark as possible.
- Diffuse calming essential oils like lavender.
- Invest in a quality pillow.
The occasional bad dream doesn’t usually require intervention, but chronic nightmare disorder just might.
In addition to working with a therapist who understands treatment for nightmare disorder, Ford recommends the IRT book, “Turning Nightmares Into Dreams” by sleep medicine specialist Dr. Barry Krakow.
“There is help available,” Ford says. “Remission or reduction of nightmares is possible.”