Recurring nightmares can have many causes, including daytime stress or anxiety, past trauma, and sleep disorders. We look at steps you can take to sleep better.
Most people have the occasional bad dream — but when nightmares are frequent they can be very disruptive.
Nightmares are defined as extremely disturbing, well-recalled dreams that usually involve threats to survival, your physical body, or your security. Upon waking from a nightmare you may feel immediately alert.
Nightmare disorder, a condition defined by recurring nightmares, affects about 4% of adults in the United States. This includes nightmares due to post-traumatic stress disorder (PTSD), other mental health conditions, and other causes.
Various treatments can help you manage and prevent nightmares, including talk therapy, medications, and good sleep hygiene.
There are many possible causes of nightmares. Some people experience nightmares or nightmare disorder due to an existing mental health condition.
The most studied cause of nightmares is PTSD, as up to 80% of people with this condition report having nightmares. Nightmares and insomnia are
While nightmares are common in PTSD, many people have nightmares without having PTSD.
The root causes of nightmares vary widely and include:
- Daytime stress. Experiencing stress in daily life can increase your risk of nightmares. For example, a
2021 studyof 392 nurses who kept a sleep diary for 2 weeks found that nightmares were more common after a stressful day. Having a nightmare also increased their stress the following day.
- Medications. Nightmares are a potential side effect of many medications. For example, bizarre and vivid dreams are a
knownside effect of some beta-blockers.
- Sleep disorders. Having another sleep condition can make it more likely you will experience nightmares. Sleep disorders include narcolepsy, insomnia, obstructive sleep apnea, and sleep-related movement disorders.
- Mental health conditions. Living with another mental health condition can lead to a greater risk of nightmares. Some examples include anxiety, PTSD, bipolar disorder, and schizophrenia.
Many people believe that eating certain foods before bed — such as cheese and other dairy products — can increase your risk of nightmares. A study from
Sometimes, it can be difficult to pinpoint exactly what’s causing nightmares. Even if you don’t know the cause, you can still take some steps to help relieve these distressing experiences.
Nightmares can cause problems in many areas of your life, leading to:
- daytime fatigue or sleepiness
- mood disturbances
- problems concentrating
- bedtime anxiety or a reluctance to go to sleep
Practicing some techniques at home may help some people to reduce the frequency and severity of nightmares. For example:
- Reduce stress. Consider steps to lower overall stress in life. Some people find exercise and relaxation techniques like meditation help to bring down stress levels.
- Talk it out. It may be helpful to express what’s going on, either by talking about disturbing dreams or journaling about them. Talking through life stressors may also reduce bad dreams.
- Practice good sleep hygiene. This is a group of practices to promote quality sleep. You can read good sleep hygiene tips here.
- Avoid drinking or eating right before bed. Nighttime beverages in particular can mean you need to get up to use the bathroom, leading to disturbed sleep.
If nightmares are linked to another condition, such as PTSD, getting help for the condition can also help reduce nightmares.
Although many people can improve sleep with home practices, some may want to consider speaking with a doctor about their nightmares. In particular, consider taking this step if your nightmares:
- are causing significant distress, affecting your sleep and daily life
- happen once a week or more
- coincide with starting a new medication
Your doctor may be able to discuss ways to alleviate nightmares while also managing other health conditions.
Treatment for nightmare disorder can often depend on the underlying cause. Options include medication and talk therapy.
Some forms of cognitive behavioral therapy (CBT) are specifically designed to help alleviate nightmares and reduce sleep disturbances, such as sleep therapy.
Types of therapy that might help with nightmares include:
- Image rehearsal therapy: With image rehearsal therapy you change the script of a nightmare while awake. You replace upsetting images with positive ones and rehearse the new scenario during waking hours.
- Eye Movement Desensitization and Reprocessing: EMDR focuses on helping you process traumatic memories using eye movements and tapping motions. It may help if your nightmares are related to PTSD.
- Exposure, relaxation, and rescripting therapy: This is an expanded form of image rehearsal therapy that also includes sleep hygiene techniques and progressive muscle relaxation.
- Hypnosis: Under the guidance of a trained practitioner, hypnosis involves entering a trance-like state and changing thoughts or behaviors.
- Lucid dreaming therapy: This technique helps someone to change the nightmare itself while they are experiencing it.
- Exposure and desensitization therapies. Other techniques involve exposing a person to the fear that may underlie their nightmares. Exposure in a controlled and safe environment may help reduce this fear over time.
A doctor may recommend one or a combination of these techniques in addition to medication.
Your doctor may prescribe medications depending on whether you also have a PTSD diagnosis, have nightmare disorder in isolation, or nightmares are the result of another cause.
Medications might include:
- anti-anxiety medication
Nightmares are more distressing than bad dreams. If they happen frequently, they can interfere with daytime functioning.
Many treatments can help people overcome nightmare disorder and manage other mental health conditions that may cause nightmares.
Want to learn more about starting therapy? Psych Central’s How to Find Mental Health Support resource can help.