Nightmares
A nightmare is a vivid, upsetting dream that wakes you up, and that you remember clearly once you’re awake. Most people have one now and then, often during stressful stretches. For some people they come often enough to change how they feel about going to sleep at all.
When nightmares become a problem
Nightmares are more likely after something frightening or painful has happened, during times of stress, with poor or broken sleep, and when starting or stopping some medicines. Alcohol can play a part too, especially as it wears off in the second half of the night.
They become a problem when they come often, upset you during the day, or make you dread bedtime. Then they can feed insomnia. Some people put off going to bed, lie awake bracing for a bad dream, or have trouble getting back to sleep after one. Over weeks, the bed starts to feel like an unsafe place, which is the opposite of what CBT-I works toward.
What helps
Imagery rehearsal. This is the best-studied treatment for nightmares that keep coming back. While awake, at a calm time that isn’t right before sleep, you choose a nightmare, change the story in any way you like, write down the new version, and then picture it for 5 to 20 minutes each day. The changed dream doesn’t have to be happy, only different. Over time, the nightmare tends to come less often or with less force. The American Academy of Sleep Medicine recommends it for frequent nightmares, with or without PTSD. “Rewrite a nightmare,” in the app’s “Quiet a busy mind,” walks you through it.
It’s best learned with a therapist, especially when nightmares are tied to trauma. A therapist can help you choose which dream to start with, often not the worst one, and help with any strong feelings that come up.
Steady sleep. Short or broken sleep makes nightmares more likely. That’s one more reason to keep regular sleep and wake times, which the diary and the sleep window are built around.
A plan for after you wake. When a nightmare wakes you:
- Remind yourself where you are. Look around, and name a few things you can see or feel, like the blanket or the floor under your feet.
- Breathe slowly, with the breath out a little longer than the breath in.
- If you don’t feel sleepy again within what seems like about 20 minutes, get up, go somewhere dim, and do something quiet until you are. “Up in the night” can keep you company.
- Keep lights low and skip the phone, so getting back to sleep stays easier.
When to talk with someone
Talk with a doctor or therapist if:
- Nightmares come once a week or more, or make you afraid to go to sleep
- They started after something traumatic, or come with other signs like flashbacks, feeling on edge, or avoiding reminders
- You act out your dreams, like shouting, punching, or kicking in your sleep, which can be a sign of a different sleep disorder
- They started with a new medicine
Nightmares and bad sleep can come along with low mood. If you’re thinking about suicide or about harming yourself, in the United States you can call or text 988 at any time. In an emergency, call 911.
References
- Morgenthaler, T. I., Auerbach, S., Casey, K. R., Kristo, D., Maganti, R., Ramar, K., Zak, R., & Kartje, R. (2018). Position paper for the treatment of nightmare disorder in adults: An American Academy of Sleep Medicine position paper. Journal of Clinical Sleep Medicine, 14(6), 1041–1055. doi.org/10.5664/jcsm.7178
- Krakow, B., Hollifield, M., Johnston, L., Koss, M., Schrader, R., Warner, T. D., Tandberg, D., Lauriello, J., McBride, L., Cutchen, L., Cheng, D., Emmons, S., Germain, A., Melendrez, D., Sandoval, D., & Prince, H. (2001). Imagery rehearsal therapy for chronic nightmares in sexual assault survivors with posttraumatic stress disorder: A randomized controlled trial. JAMA, 286(5), 537–545. doi.org/10.1001/jama.286.5.537
Helpful links
- American Academy of Sleep Medicine: Treating nightmare disorder in adults
- 988 Suicide and Crisis Lifeline
Everyday Insight’s tools are for education and personal reflection. They are not therapy or medical care, and they are not for emergencies. In an emergency, call 911. If you are in crisis in the United States, call or text 988.
The exercises are in the app, under “Quiet a busy mind.” See them all