Nightmares: why they happen & what helps

In a large Finnish study, just under half of adults had at least one nightmare in the past month. Bad dreams now and then are part of being human.

For some people nightmares come weekly or even nightly. Nightmare disorder is when repeated nightmares cause distress or make daily life harder. It affects about 4% of adults.

Frequent nightmares have been linked with exhaustion, headaches, low life satisfaction and finding it harder to work.

How they differ

• Night terror: screaming or thrashing while still asleep, early in the night, and usually not remembered
• Nightmare: a scary dream that wakes you fully, later in the night, and is remembered
• Sleep paralysis: being awake but unable to move for a short time while falling asleep or waking

Stress, anxiety and worry are common triggers. People who react strongly to stress, or find their feelings hard to settle, may be more prone to nightmares.

Being very tired or unwell can trigger nightmares. Very short or very long sleep has also been linked with them.

Seeing something frightening, like a scary film, can set off nightmares. A severe injury can also disturb sleep for 4 to 6 weeks afterwards.

Nicotine can cause nightmares, and so can cutting back on alcohol after heavy drinking. Some prescribed treatments can also cause vivid or frightening dreams.

Nightmares are more likely alongside other sleep conditions, such as sleep apnea, restless legs syndrome, narcolepsy and periodic limb movements.

Fear of nightmares can lead people to put off going to sleep. Feeling on alert makes restful sleep hard, and pushing memories away in the day can make them louder at night.

If dreams cause kicking and screaming, bed partners can be affected. Talking about it together in the daytime can ease worry and embarrassment.

Sleep experts recommend imagery rehearsal therapy for nightmares linked to PTSD. CBT, CBT for insomnia, EMDR and exposure, relaxation and rescripting therapy may also be used.

The National Center for PTSD says CBT for insomnia reduces how many nightmares people have and how upsetting they are.

How it can go

1. A nightmare wakes you and it’s hard to get back to sleep.
2. You feel drained and low the next day.
3. You start to dread bedtime.
4. Worry and short sleep make another nightmare more likely.

Insomnia and low mood both make frequent nightmares more likely, and nightmares in turn disturb sleep.

In Finland, adults with symptoms of seasonal low mood had higher odds of frequent nightmares and insomnia.

Untreated long-term nightmares have been linked with a higher risk of suicide attempts. That’s one reason recurring nightmares deserve care.

Lying awake in fear can link your bed with worry. Many people find it helps to get up, do something quiet and dull in low light, then return when sleepy.

Keeping a log of your sleep and how often and how strong your nightmares are is part of nightmare treatment. It can show patterns and triggers.

Ideas

• A calm, relaxing routine before bed
• Keeping a regular sleep schedule
• Less alcohol and nicotine, especially in the evening
• Something soothing to watch or read late at night instead of scary content
• Time to name and put down the day’s worries earlier in the evening

1. Learn about what nightmares are and why they keep coming back.
2. Pick one recurring nightmare. Start with a milder one, not the worst.
3. Write a short outline without lots of detail.
4. Change the story in any way you like, so it feels safer or calmer.
5. Picture the new version for a few minutes each day while awake.

You might

• Add a helper, friend or protector
• Change the place to somewhere you feel calm
• Give yourself a new ability, like flying or a shield
• Make the threat shrink, turn silly or walk away
• Stop the scene and step out of it

Pooled studies show imagery rehearsal and a related therapy can bring moderate to large drops in how often nightmares happen, and smaller gains in sleep.

A therapist can guide imagery rehearsal and help if it stirs up strong feelings. This matters most when nightmares come from trauma.

Cognitive behavioral therapy may be used for nightmare disorder and for nightmares linked to PTSD. The NHS says CBT can help children and adults with frequent nightmares.

CBT-I may be used for nightmares linked to PTSD. The National Center for PTSD says it reduces nightmares and the distress they cause.

Eye movement desensitization and reprocessing may be used for nightmares linked to PTSD.

ERRT is a CBT-based therapy related to imagery rehearsal. It may be used for both nightmare disorder and trauma nightmares.

Lucid dreaming therapy may be used for nightmare disorder. The idea is to learn to realise you are dreaming, which can give a sense of control.

Progressive deep muscle relaxation and systematic desensitization may be used for nightmare disorder. Both teach your body to stay calmer around frightening images.

Go to your child quickly, let them know you are there, and let them tell you about the dream if they want to. Remind them dreams aren’t real.

Check for things that might be frightening them, like shadows, and leave a light on if it helps.

Stress and worry are common triggers at any age. CBT can help children with frequent nightmares.

In adults, nightmares are often tied to stress, trauma, insomnia or low mood. In men they became more common with age, while in women they stayed steady.

Imagery rehearsal therapy is the recommended treatment for adults.

• Ask before touching: some people need space after a trauma nightmare
• Offer water and a soft light
• Remind them where they are and that they’re safe
• Speak slowly and quietly
• Stay until they feel settled, if they want you to

• Ask what helps them, and what doesn’t
• Encourage support if nightmares are frequent
• Don’t make them retell a dream they don’t want to share
• Help protect a calm evening routine

Veterans groups, trauma support groups and faith communities can help people feel less alone. Hearing that others have nightmares too can lift a lot of shame.