Nightmares

What Are Nightmares?

Nightmares are distressing dreams involving fear, guilt, or anxiety that can wake you from sleep. Unlike bad dreams, nightmares often leave you awake, remembering vivid details and feeling unsettled.

Occasional nightmares are common — about 85% of adults report having at least one each year — but frequent nightmares are less so, affecting roughly 2% to 6% of people weekly. They are more common in women, children, and people with certain mental health conditions.

Nightmare Disorder

When recurrent nightmares interfere with a person’s ability to function during the day, they may be diagnosed as nightmare disorder. Nightmare disorder is a type of sleep disorder called a parasomnia. 

Nightmares vs. Night Terrors

Though these terms are sometimes confused, nightmares and night terrors are quite different. From a physiological standpoint, nightmares usually happen during REM sleep later in the sleep cycle, while night terrors happen during non-REM sleep earlier in the night.

While people usually remember nightmares in vivid detail, with night terrors, they can’t recall the dream itself but they awaken with intense fear and disorientation. If you ever see someone in the midst of a night terror, they might scream or thrash around but may not remember doing so when they wake up.

The biggest difference between nightmares and night terrors is that the latter mostly affects children under 12 (more so during the preschool years) and is rare in adulthood.

What Causes Nightmares?

Researchers aren’t certain why nightmares occur, but they may be linked to how the brain processes emotions, memories, and daily experiences. While many nightmares have no clear cause, identifying potential triggers and related health conditions can help reduce how often they happen.

Stress and Anxiety

Nightmares are more frequent during periods of stress and major life transitions. Research has shown that the content of dreams often reflect sources of daytime stress. While this might be unsettling at first, some researchers suggest that nightmares may actually help to alleviate stress. These researchers suggest that many nightmares represent the body’s attempt to positively cope with daytime stressors.

Research also reveals a correlation between anxiety and nightmares. In fact, the former clinical name for nightmare disorder was “dream anxiety disorder.” However, it’s hard to say which one is the cause and which is the effect. Some research finds that frequent nightmares can lead to or contribute to anxiety disorders, while other studies show that anxiety can be a stimulus of frequent nightmares. 

Mental Health Conditions

Nightmares are associated with a variety of mental health conditions, including depression, general anxiety disorder, bipolar disorder, schizophrenia, and post-traumatic stress disorder (PTSD). 

In particular, nightmares are a characteristic symptom of PTSD, affecting as many as 72% of people with this condition. For many people with PTSD, nightmares involve painfully reliving traumatic experiences and often contain themes of helplessness and lack of control.

Medications and Supplements

Certain medications are associated with an increased risk of nightmares. Medications linked to nightmares include antidepressants, narcotics, and barbiturates. Stopping or withdrawing from some medications can also lead to nightmares.

Numerous medications, including barbiturates and benzodiazepines, reduce the amount of deep REM sleep a person gets each night. When someone stops taking these medications, the body may experience what’s called a “REM rebound.” During a REM rebound, the body attempts to catch up on lost REM sleep. Because most nightmares occur during REM sleep, people experiencing REM rebound are at an increased risk of vivid dreams and nightmares.

Melatonin is a sleep-promoting hormone naturally produced by the body. Many people also take melatonin as an over-the-counter sleep aid. While some individuals have reported nightmares after taking melatonin supplements, there is little research that discusses this potential side effect. One potential explanation is that melatonin supplements have been shown to increase REM sleep, which means there are more opportunities each night for nightmares and other vivid dreams.

Sleep Disorders

Several sleep disorders are associated with an increased risk of nightmares, including insomnia, obstructive sleep apnea, sleep-related movement disorders, and narcolepsy. Nightmares are reported in about 17% of people with chronic insomnia and 33% of people diagnosed with narcolepsy.

Substance Use and Withdrawal

Trying to reduce dependency on certain types of substances like alcohol or drugs can have an impact on general sleep quality, which in turn can cause more frequent nightmares. 

For example, one study found that during the first four weeks of alcohol withdrawal, patients report more REM sleep, which leads to more vivid and intense dreams. Other research shows a connection between cocaine withdrawal and bad dreams.

Fever and Illness

The term “fever dream” exists for a reason. As your body’s temperature rises, it can have an effect on your brain activity, including the way you dream. Research has found that when people have a fever, dreams tend to be more bizarre or negative in nature, and in some instances, they can be classified as nightmares. 

In extreme cases, patients with high fevers may also have hypnopompic hallucinations, which is when you see, hear, or feel something that isn’t real right as you’re waking up.

Eating Before Bed

Eating too close to bedtime may increase the risk of nightmares. In one study, 9.5% of people reported that eating late affects the contents of their dreams. It’s unclear if the meal itself leads to nightmares or if there’s something else that explains this relationship.

Scary Media or Emotional Content Before Bed

Have you ever noticed that some of your dreams can be tied to something you read about, watched, or thought about before bed? There is science to back up the notion that visual media, especially consumed right before bedtime, could influence what you dream about. 

If you’re falling asleep watching a violent or scary TV show or scrolling negative or upsetting content on social media in bed, those images could resurface in your dreams. For example, some researchers have found that adolescents who use social media right before bed have poorer sleep quality including nightmares.

How to Stop Nightmares

Understanding the cause of nightmares is an important step to reducing their frequency. While occasional bad dreams are unavoidable, several strategies may be helpful in reducing more frequent nightmares.

Lifestyle Changes

• Reduce stress: Decreasing stress and worry may be the most effective way to reduce nightmares. Finding ways to cope with stress, like regular exercise, pursuing hobbies, and taking time to relax may be helpful places to start.
• Express yourself: Although it may be tempting to ignore stress, research suggests that suppressing thoughts may actually increase the frequency of nightmares. Instead of ignoring worrisome thoughts or dreams, try to find a way to express them. Consider starting by talking to a friend or creating a piece of art that allows your brain opportunities to process your experience.
• Keep a regular sleep schedule: Routine and quality sleep go hand-in-hand. Improve your sleep hygiene by creating a sleep-promoting routine. One of the most important aspects of good sleep hygiene is going to sleep at the same time every day, even on the weekends. You may even consider making some bedroom upgrades to get better sleep.
• Get support for PTSD: If you experience regular nightmares related to trauma, or if you’ve been diagnosed with PTSD, it’s vital to get support. Treatment for veterans and civilians can help PTSD symptoms and reduce nightmares.
• Avoid large meals before bed: Although the science studying food and sleep is far from certain, many professionals suggest avoiding large meals before bedtime. Instead, have dinner a few hours before getting into bed.

Most importantly, don’t be afraid to ask for help if you’re experiencing nightmares. It’s important to talk to a health professional if nightmares are happening more than once a week or if they’re affecting your mood and daytime activities. There are several treatments available for recurrent nightmares, so don’t suffer in silence.

Imagery Rehearsal Therapy (IRT)

Also referred to as nightmare rescripting, IRT is a kind of cognitive behavior therapy and the treatment of choice to help patients with PTSD reduce their nightmares. It involves sessions in which the patients describe the content of their nightmares in detail. From there, a clinician helps the patients practice forming positive images and coping mechanisms to rescript now the specific nightmares play out.

With repeated practice, the new script can actually begin to appear in the patients’ dreams. Nearly two thirds of patients using IRT in one study saw improvement in their overall PTSD sleep symptoms.

Sleep Coaching With Sleep Doctor

If frequent nightmares have gotten to the point where you’re anxious about what each night might bring and it’s impacting your sleep quality, you might benefit from a personalized consultation to get to the root of the issue. Sleep Doctor’s Sleep Consult is a one-to-one session with a sleep expert who can help guide you through healthy sleep habits.

You can also seek ongoing help via the Sleep Doctor Sleep Coaching program. This can help support you as you seek to improve sleep hygiene and build a healthy sleep routine to not only reduce nightmares but optimize your rest overall.

When to Talk to a Doctor

If you recognize that your nightmares are not simply one-off occurrences, and they start to wake you in the middle of the night and cause daytime worries, a call to your doctor may be in order. In some cases, it could be a sign of an underlying physical or mental health condition that shouldn’t go untreated. 

Some of the key signs that you may want to connect with your doctor regarding nightmares:

• Nightmares are happening more than once per week for a few weeks.
• You feel excessive fatigue during the day because the nightmares are interfering with sleep.
• You’re taking a new medication that might be the cause.
• You’re having other potential sleep disorder symptoms like snoring.
• You’ve had a recent trauma or something that triggered PTSD for a past trauma.
• You are anxious about going to sleep or fixated on upsetting images from your nightmares.

Frequently Asked Questions

Can dogs have nightmares?

According to pet experts, dogs have a similar sleep cycle to humans, including having dreams and the occasional nightmare. Dog nightmares can also be the result of a traumatic past or from having a stressful experience like going to the vet. 

Can babies have nightmares?

There’s some debate about whether babies can have nightmares or even have the cognitive ability to process the concepts of “scary” and “frightening.” Some studies indicate that babies don’t actually dream at all until around age two.

Does melatonin cause nightmares?

There’s no definitive research that finds melatonin is a direct cause of nightmares, however there could be a connection. Melatonin increases the amount of REM sleep that a person has. Because this is the stage in which vivid dreaming occurs, additional REM sleep means a person is more likely to remember their dreams — including bad ones — when they awake.