Nightmares: Symptoms, Causes, & Treatments

What Is a Nightmare?

Nightmares and bad dreams have a lot of overlap; nightmares are considered to be more terrifying than bad dreams, which are thought of as being unpleasant, but not necessarily frightening. In nightmares, the dreamer has a clear vision of things that are anxiety-provoking and distressing to see or think about. It can happen at any point in the sleep cycle; however, it happens more during rapid eye movement (REM) sleep. In this stage of sleep, the dreamer tends to have intense dreams. These dreams can feel so realistic that when the dreamer wakes up, it can feel like the dream is real and physically feel that way. ¹

Nightmares Vs. Night Terrors

Nightmares and night terrors have some overlap, but they are distinctly different. Nightmares are a normal part of the sleep experience, while night terrors are a type of parasomnia that makes the sleep experience distressing. Parasomnias are sleep disorders that include unusual and disturbing physical movements and experiences that make sleep feel restless. People may open their eyes and act out during night terrors, such as yelling or flailing their arms.

What Causes Nightmares?

Nightmares are still not well understood and often have no known cause, but things that happen when you are awake can contribute to the likelihood of having nightmares. Dreams may help with processing emotions and memories, with nightmares processing trauma and fear. But there is no consensus from the experts as to why we dream. Nightmares are normal and usually not symptoms of a medical or mental health issue, except in cases of post-traumatic stress disorder (PTSD), depression, or anxiety.²

Triggers for nightmares include:

• Stress and anxiety: The stress in your wake time can seep into your sleep, subconsciously and emerge in nightmares. ³
• Mental health conditions: Nightmares are a symptom of PTSD as a trauma response. PTSD is one of many mental health conditions linked to nightmares. Other mental health issues include depression, anxiety, and bipolar disorder. ³
• Medical conditions: Medical conditions such as Parkinson’s disease or sleep apnea can impact sleep and cause sleep deprivation or disruption in sleep cycles. ⁴
• Medications: Nightmares can be a side effect of certain medications. ⁵
• Sleep deprivation: REM rebound, which occurs when a person is temporarily compensating for a lack of sufficient REM sleep.
• History of recurring nightmares: A person with a family history of recurring nightmares has a higher likelihood of nightmares themselves
• Sleep disorders: Sleep disorders are also linked to nightmares as they disrupt the typical sleep processes.

6 Tips for Reducing Nightmares

Nightmares are a common occurrence that people experience from time to time. There are no medical treatment options. However, there are ways to manage this at home.

6 practical tips for coping with nightmares include:

1. Keep a regular sleep schedule: Having a routine at bedtime help your mind and body know what to expect and relax as you prepare for sleep.
2. Check medications: Make sure you are logging side effects to medications and speaking with your doctor if it is impacting your sleep.
3. Reduce screen time before bed: Many screens emit a blue light that disrupts your sleep, so limit screens before bed.
4. Exercise and yoga: The mental health benefits of exercise and yoga include helping you fall asleep more easily. Do these activities regularly to help your mind and body relax at bedtime.
5. Practice mindfulness: Mindfulness and meditation can help you become more mentally grounded and calm, helping you fall asleep more easily.
6. Avoid caffeine and alcohol: Alcohol and caffeine can interfere with your body’s ability to fall and stay asleep, especially close to bedtime. Limiting them may help you get more restorative sleep.

When to Seek Professional Help

Occasional nightmares can happen to anyone, but having nightmares every night is not normal and could be a sign of nightmare disorder. Sometimes chronic nightmares can be related to an untreated mental health condition such as PTSD or anxiety, and therapy may help. If you are experiencing this multiple times a week and are struggling to focus during the day or your mood is impacted, it may be time to seek professional help. It can feel hard to know whether you are struggling if you have always had issues with sleep, but know there are ways and options available to improve your sleep quality.⁶

Treatment Options When You Have Nightmares

If you’ve tried the home remedy and tips explained above and keep having chronic nightmares, there are treatment options available. If your sleep is impacting your health, it is important to connect with your physician, and possibly a therapist as well. Searching an online therapist directory is a good way to choose a therapist for your specific needs, or consider online therapy services as an option if you are not able to find a therapist near you. Together, you and your medical team can come up with a plan to improve your sleep and work through anything that may be impacting your sleep in a negative way.⁷

Final Thoughts

What you are dealing with is unique to you, but you are not alone. Nightmares can be difficult to cope with, but there are ways to move forward. Working on home remedies and collaborating with a therapist can be an effective way to learn to manage your triggers and symptoms.