Nightmares, shift work & sleep problems

Most people have bad dreams sometimes. When frightening dreams happen often and cause a lot of distress, it’s worth getting support. Nightmares are much more common in people who have been through trauma.

Stress and anxiety can make nightmares more likely. A regular sleep schedule and a calm, relaxing routine before bed can help.

A therapy called imagery rehearsal therapy can help. While awake, you rewrite the ending of a nightmare so it’s no longer scary, then picture the new version. This can reduce how often nightmares happen and how upsetting they are.

Nightmares are much more common in people who have been through trauma. The U.S. National Center for PTSD says almost everyone who has PTSD also has trouble sleeping, and nightmares can replay what happened.

Some people put off going to bed because the night feels unsafe. Feeling on guard or easily startled makes deep rest hard.

CBT for insomnia can reduce how often nightmares happen and how upsetting they are, according to the VA.

Imagery rehearsal therapy is a talking therapy for nightmares. While you’re awake, you change the story of a recurring nightmare so it’s no longer frightening, then rehearse the new version in your mind. It can reduce how often nightmares happen and how upsetting they are.

The basic idea

1. Pick a milder recurring dream to start with.
2. Write a short outline, without lots of detail.
3. Change the story so it ends in a way that feels safe.
4. Picture the new version for a few minutes each day.

Nightmares are scary dreams that wake you up, tend to come later in the night, and are usually remembered. During a night terror, a person may scream or thrash but stays asleep, it usually happens early in the night, and they don’t remember it.

After a nightmare, a person needs comfort. During a night terror, it’s best to stay calm nearby and not try to wake them, unless they might hurt themselves.

Try this

1. Turn on a soft light.
2. Name 5 things you can see in the room.
3. Feel your feet on the floor or the weight of the blanket.
4. Breathe out slowly, a little longer than you breathe in.
5. Remind yourself: “It was a dream. I’m here, and I’m safe now.”

Stress and anxiety can make nightmares more likely. A regular sleep schedule and a calm, relaxing routine before bed can help.

Restless legs syndrome brings a strong urge to move your legs, often with tingling, throbbing, itching or aching. Some people feel it in their arms too. It usually gets worse in the evening and at night when you’re resting, which can make it hard to sleep.

Often there’s no clear cause, though it can run in families. It has been linked to low iron, kidney disease and pregnancy, when it often goes away after the baby is born.

Things that may help

• Exercise during the day
• A warm bath or a heat pad on your legs before bed
• Walking, stretching or massaging your legs when it starts
• Distraction, like a puzzle or a book
• No caffeine after midday, and no alcohol for at least 2 hours before bed
• Getting support to stop smoking

Sleepwalking usually happens in the first part of the night and lasts a few minutes. The person may have their eyes open but can’t respond normally, and usually won’t remember it. It’s common in children and often runs in families.

Common triggers

• Not getting enough sleep
• Stress
• A high temperature
• Alcohol
• Other sleep problems, like sleep apnea or restless legs

Keeping safe

• Keep doors and windows closed, and use stair gates for children
• Clear the floor of things to trip over
• Lock away knives and tools
• Don’t let a child who sleepwalks sleep on a top bunk
• Keep a regular routine and avoid caffeine and alcohol in the evening

During a night terror, a person may scream, thrash about or even get out of bed, yet stay asleep. It usually happens early in the night, can last up to 15 minutes, and they don’t remember it. Night terrors are most common in children aged 3 to 8.

Night terrors are different from nightmares. Nightmares are scary dreams that wake you up, tend to come later in the night, and are usually remembered.

What helps

• Stay calm and let them settle
• Don’t try to wake them or talk to them, unless they might hurt themselves
• Keep a calm bedtime routine and a sleep diary to spot triggers
• Help with any stress or worries during the day

If night terrors happen at about the same time each night, the NHS suggests gently waking the child about 15 minutes before they usually start, every night for 2 weeks. This may break the pattern.

Sleep paralysis is when you can’t move or speak as you’re falling asleep or waking up. Your brain is awake, but your muscles are still in the limp state of REM sleep. It can last up to a few minutes.

It can be frightening. Some people sense someone in the room or feel pressure on their chest. The NHS describes it as harmless. It’s been linked to broken sleep, shift work, jet lag, anxiety, PTSD and family history.

Things that may help

• A regular bed and wake time
• Enough sleep: the NHS suggests 7 to 9 hours for adults
• Avoid big meals, smoking, alcohol and caffeine close to bed
• Try not to sleep on your back

Most daytime sleepiness comes from not enough sleep. But if you feel sleepy all the time for no clear reason, or fall asleep suddenly during the day, it’s worth getting checked.

One rare cause is narcolepsy, a lifelong condition where the brain has trouble controlling sleep and waking. It usually starts in childhood or young adulthood. Signs can include sudden sleep, sudden muscle weakness set off by strong emotions or laughter, sleep paralysis and very vivid dreams.

Living well with it can include

• A regular bedtime and wake time
• Planned daytime naps
• Avoiding alcohol
• Regular exercise, but not late at night
• Talking therapies and support groups

Loud, frequent snoring, choking or gasping, and pauses in breathing during sleep can be signs of sleep apnea. In sleep apnea, breathing stops and starts many times during the night.

Other signs

• Feeling very sleepy or exhausted during the day
• Waking with a dry mouth or a headache
• Waking to use the bathroom often
• In children: hyperactivity, bedwetting or trouble focusing at school

Risk goes up with

• Alcohol, which relaxes the throat muscles
• Being male: it’s more common in men, though women have it too
• Family traits that shape the face and airway
• Getting older
• Some health conditions, like hormone changes or heart or kidney failure
• Smoking, which irritates the airway
• Weight: extra fat in the neck can narrow the airway

Large tonsils are one thing that can narrow the airway, and children can show signs too (see the first card). Babies born early have a higher risk of breathing problems during sleep.

Without enough quality sleep, it can be harder to concentrate, make decisions and remember things.

People who snored or often fell asleep in the day without meaning to were more likely to report falling asleep at the wheel in a large CDC survey.

If you or someone else notices snoring, gasping or pauses in your breathing, or you’re very sleepy in the day, talk to your clinical provider. They may suggest a sleep study.

It helps to bring notes from a bed partner about what they’ve seen and heard. The “Snoring and sleepiness notes” worksheet can help.

A common treatment is a breathing device such as a CPAP machine, which gently pushes air through a mask to keep the airway open while you sleep. Some people use a mouthpiece that holds the jaw or tongue forward.

Lifestyle changes that can help

• Limit alcohol and caffeine
• Quit smoking
• Regular physical activity and a healthy weight
• Sleep on your side rather than your back

Exercises for the mouth and face muscles, or surgery, are options in some cases. Getting used to a breathing device can take time, and side effects like a dry mouth or a stuffy nose are worth raising with your provider.

Your body clock expects you to be awake in daylight and asleep in darkness. Working nights or rotating shifts goes against this, which can make sleep shorter and lighter.

Shift work and jet lag are common causes of insomnia. Being awake for very long stretches also raises the risk of accidents.

When your work hours clash with your body clock, sleep needs extra protection. These tips come from NHLBI and NIOSH, the U.S. institute for worker safety.

Tips

• Keep lights bright at work, especially in the first half of the shift
• Have caffeine only early in your shift
• After a night shift, go to sleep as soon as you can
• Make your room very dark with blackout curtains or an eye mask, and block noise with earplugs or white noise
• Ask family and friends not to disturb you while you sleep
• Take a nap before your shift if you can
• Limit shift changes where possible so your body clock can adjust

Shift work disorder is a body-clock problem that affects people who work at night or on rotating schedules. Sleep can be shorter and lighter, and it can be hard to stay alert at work.

If you keep struggling to sleep after shifts, or feel very sleepy at work or on the drive home, talk to your clinical provider.

Light is the strongest signal for resetting your sleep-wake cycle. Some people use a light box that gives bright light similar to sunlight: in the morning to shift sleep earlier, or in the late afternoon or early evening to shift it later. Check with your provider first, especially if you have an eye condition.

Other helpful signals

• Avoid long naps, especially in the afternoon, but a short nap before a shift may help
• Keep a regular meal schedule, even on odd hours
• Limit caffeine, alcohol and nicotine, especially near bedtime
• Get regular exercise, but not close to bedtime

With delayed sleep-wake phase disorder, one of the most common body-clock disorders, sleep and wake times run much later than usual. With the advanced type, people struggle to stay awake in the early evening and wake very early.

Body-clock problems can be linked to aging, genes or a health condition. People with very little light exposure, including many people who are completely blind, can have a clock that drifts off a 24-hour day.

Jet lag can make it hard to sleep at bedtime and hard to wake in the morning. You may feel tired and struggle to stay awake in the day, with poor concentration and memory. Some people also get an upset stomach, appetite changes or mild anxiety.

Most people’s natural body clock runs slightly longer than 24 hours, so it’s easier to stay up later than to go to bed earlier. That’s why flying west is usually easier.

The CDC says people adjust by about 1.5 hours a day after flying west, and about 1 hour a day after flying east. So a 6-hour time change eastward can take close to a week to fully settle.

Get plenty of rest before you travel, so you don’t start the trip already short on sleep. For 2 to 3 days before, the CDC suggests moving your sleep by about 1 hour a day: earlier if you’re flying east, later if you’re flying west.

Try this

• Drink plenty of water
• Stretch and walk around when you can
• Sleep if it’s night-time where you’re going, with an eye mask or earplugs if they help
• Go easy on caffeine and alcohol, which can both dehydrate you and disturb sleep

Switch to the local schedule as soon as you can: stay awake in the local daytime and sleep at the local night. Set an alarm so you don’t oversleep, and spend time outdoors in daylight.

Light timing matters. Morning light moves your clock earlier, and evening light moves it later. After flying east, get bright light in the morning and avoid it in the evening. After flying west, get daylight at your destination and avoid very bright light early in the morning.

Also helpful

• If you must nap, keep it to about 20 to 30 minutes
• Use caffeine in the local daytime if you need it, and stop about 6 hours before bed
• After flying west, try to stay up until local bedtime

For short trips of 2 to 3 days, the NHS and CDC suggest you can keep eating and sleeping on your home time where possible. That way you don’t have to readjust when you get back.

Pull over if you notice

• Yawning or blinking a lot
• Not remembering the last few miles
• Missing your exit
• Drifting out of your lane
• Hitting the rumble strip

In the CDC survey, falling asleep at the wheel was more common in men (5.3%) than women (3.2%), and in younger adults than older ones (1.7% of those 65 and older). It was more common in people who usually slept 6 hours or less (6.7%) than in those who slept 7 to 9 hours (2.6%).

People who snored, or who often fell asleep in the day without meaning to, were also more likely to report it. Snoring and daytime sleepiness can be signs of sleep apnea.

People driving home after night or long shifts are at extra risk too.

NIOSH says most drowsy-driving crashes or near misses happen between 4 and 6 a.m. Other peak times are midnight to 2 a.m. and 2 to 4 p.m.

These line up with natural dips in your body clock, which is why the drive home after a night shift and the mid-afternoon slump can be so dangerous.

Turning up the radio, opening the window or blasting the air conditioning have not been found to work. They may make you feel more awake for a moment, but your brain can still slip into sleep.

The only safe choice is to get off the road and rest until you’re fully alert, or let someone else drive.

Before you drive

• Get enough sleep: 7 to 9 hours for adults
• Avoid alcohol before driving
• Get snoring or daytime sleepiness checked by your clinical provider
• On long trips, share the driving and plan rest stops
• After a night shift, consider a ride, public transport or a rest before driving

During puberty, the body clock shifts later. Teens’ bodies start sending the natural "time to sleep" signal later in the evening, so they often don’t feel sleepy until later at night, and need to wake later in the morning.

But school often starts early. That’s why many teens are short on sleep. The American Academy of Pediatrics recommends that middle and high schools start no earlier than 8:30 a.m.

What helps teens

• Keep bed and wake times similar on school nights and weekends
• Get bright light, ideally outdoors, in the morning
• Put phones and screens away at least 30 minutes before bed, ideally outside the bedroom
• Avoid energy drinks, soda and coffee in the afternoon and evening

Children do best with a set bedtime and a bedtime routine. Teens whose parents set bedtimes are more likely to get enough sleep.

Family tips

• Keep bedtimes and wake times the same on school nights and weekends
• Set a family “media curfew” and keep devices out of bedrooms
• Build a calm routine: bath, teeth, story, lights out
• Model good sleep habits yourself

Parents need sleep too. When you can, share night-time duties with a partner or family member, and rest when you get the chance.

As we get older, the body clock shifts earlier. Older adults tend to go to bed and wake up earlier, and get less deep sleep. The CDC recommends 7–8 hours for adults 65 and older.

Trouble staying asleep is more common later in life. In 2020, about 1 in 5 U.S. adults aged 65 and older (20.3%) had trouble staying asleep most days.

What helps

• Get daylight and gentle activity every day
• Keep naps short and early
• Limit drinks in the evening
• Calming routines like massage, meditation or gentle yoga may help
• Talk to your clinical provider about pain, bathroom trips or snoring that disturb sleep

People with sleep apnea often don’t know they snore, gasp or stop breathing. A bed partner is often the one who notices. Loud snoring is not just annoying: it can be a key sign of sleep apnea, which can affect heart health if it isn’t treated.

How to raise it gently

• Choose a calm moment, not 3 a.m.
• Describe what you noticed: “I heard you stop breathing for a few seconds”
• Share how it affects you both without blame
• Offer to go with them to see their clinical provider

After a nightmare, a child is awake, scared and remembers the dream. They need comfort: a hug, a calm voice, and reassurance they’re safe. During a night terror, the child is still asleep. It’s best to stay calm nearby and not try to wake them, unless they might hurt themselves.

Talk to your child’s provider if

• Nightmares continue after age 6, happen often, or started after something upsetting
• Night terrors continue after age 12, or start after age 5

After trauma, nights can feel unsafe. Some people dislike silence and prefer a TV or light on. Feeling on guard and easily startled can make it hard to settle.

Ways to help

• Ask what helps them feel safe at night, like a night light or a door left open
• If you need to wake them, say their name softly from a distance rather than shaking them
• After a nightmare, help them ground: name things in the room, breathe slowly together
• Gently encourage support: CBT for insomnia can reduce nightmares

Shift workers often need to sleep while the rest of the household is awake. NIOSH suggests asking family and friends not to disturb them while they sleep.

Ways to help

• Agree on quiet hours while they sleep
• Help make their room very dark and quiet
• Offer a ride after a long or night shift
• Plan family time around their schedule, not against it