Understanding Nightmares: Symptoms, Causes, Impact On Sleep, Nightmare Disorder, And Strategies For Prevention

illustration of a nightmare

What are Nightmares?

Nightmares are disturbing and well-remembered dreams that typically occur during rapid eye movement (REM) sleep. They often incite anxiety and fear, causing a person to wake up abruptly.

Nightmares can involve various themes, including physical aggression, health issues, death, threats, sadness, confusion, guilt, and disgust. They can have a significant impact on emotional, physical, occupational, and social well-being, affecting relationships, productivity, and overall mental health.

Nightmare in Adults

Nightmares can have significant impacts on adults’ emotional, physical, and occupational well-being. As adults, we often experience nightmares that wake us up in the middle of the night, making it difficult to fall back asleep. This can lead to sleep deprivation, which has been linked to physical health problems such as an increased risk of depression and obesity.

On top of that, recurring nightmares can take a toll on our emotional well-being, causing feelings of fear, sadness, confusion, guilt, and disgust. These emotions can affect our daily lives, causing us to feel anxious and stressed, which can affect our productivity at work and interfere with our romantic relationships.

Nightmare in Children

Nightmares are common in children and can be triggered by various factors including stress, anxiety, trauma, and medications.

Children who experience frequent nightmares may wake up feeling scared, anxious, and overwhelmed. They may also experience sleep disturbances and may find it challenging to fall asleep or stay asleep. Nightmares can have a significant impact on a child’s emotional, physical, and social well-being.

They may experience daytime fatigue, irritability, and difficulty concentrating at school or during playtime. Frequent nightmares can also lead to sleep deprivation, which can affect their physical health and development.

What Causes Nightmares?

Stress is a common trigger in Nightmares, as it can lead to increased anxiety and disrupted sleep patterns. Physical factors such as medication use or withdrawal, sleep apnea, and restless leg syndrome can also contribute to the occurrence of nightmares.

Psychological factors such as trauma, PTSD, anxiety, and depression can play a role in the development of nightmares.

Physical Triggers of Nightmares

Nightmares can be triggered by physical factors. These include sleep deprivation, as nightmares tend to disrupt sleep and make it difficult to fall back asleep. Sleep deprivation has been linked to various physical health problems and emotional consequences, such as an increased risk of depression and obesity.

Certain medications and substances, such as sedatives, beta-blockers, amphetamines, and alcohol, can also interfere with brain chemicals and increase the likelihood of nightmares.

Psychological Triggers of Nightmares

Nightmares can also be triggered by psychological factors. These include unmet psychological needs, such as autonomy, competence, and relatedness. Some researchers believe that recurring nightmares may stem from these unmet needs and serve as an effort to process and integrate these experiences.

Additionally, individuals with post-traumatic stress disorder (PTSD) may experience nightmares as a result of their efforts to avoid threats to survival or physical integrity.

Can Stress Cause Nightmares?

Stress is indeed a contributing factor to nightmares. Studies show that individuals intensely coping with stress are more likely to have frequent nightmares compared to those facing similar stressors but coping less intensely. Nightmares, often marked by intense fear or terror, may serve as a way for people to process their stress.

Stressful events, daily stress, mental health disorders, and sleep reactivity can all contribute to the occurrence of nightmares.

What Do Nightmares Mean?

The meanings behind nightmares can be complex and unique to each individual. On a psychological level, they could represent unmet needs or latent fears.

Nightmares might also reflect unresolved emotions or trauma or serve as an outlet for processing difficult experiences.

The specific meaning of a nightmare depends on the unique factors and circumstances surrounding the person experiencing it.

Nightmare Disorder

Nightmare Disorder is a type of parasomnia, which is a sleep disorder. It is characterized by frequent nightmares that cause distress, disrupt sleep, interfere with daytime functioning, or generate a fear of going to sleep.

While nightmares are common in children and can occur at any age, the specific diagnostic criteria for Nightmare Disorder are relatively rare.

Nightmares are common in children and can occur at any age, but the disorder itself is relatively rare.

Nightmares are only considered a disorder if an individual experiences major distress or impairment during the day (like anxiety, persistent fear, or bedtime anxiety about having another nightmare), problems with concentration or memory, daytime sleepiness, fatigue, low energy, problems functioning at work or school or in social situations, and behavior problems related to bedtime or fear of the dark.

How to Stop Nightmares?

If you are experiencing recurring nightmares and would like to stop having them, there are several strategies that may be helpful:

  • Seek therapy: Talking to a therapist can be beneficial in addressing the underlying causes of your nightmares. Therapists may use techniques such as exposure therapy or cognitive behavioral therapy to help you cope with and reduce the frequency of nightmares.
  • Make lifestyle changes: Certain lifestyle factors can contribute to nightmares. It may be helpful to establish a regular sleep routine, create a relaxing bedtime environment, and avoid stimulating activities or substances before bed, such as caffeine or electronic devices.
  • Address underlying mental health issues: Nightmares can be associated with mood disturbances, anxiety, and depression. Seeking treatment for these underlying mental health conditions may help reduce the occurrence of nightmares.
  • ┬áConsider medication changes: In some cases, medication changes may be necessary to decrease nightmares. Consulting with a physician or psychiatrist can help determine if adjusting or changing medications could be beneficial.
  • Practice stress management techniques: Stress and anxiety can contribute to nightmares. Engaging in stress-reducing activities such as exercise, mindfulness, or relaxation techniques may help alleviate nightmares.

Remember, it is important to consult with a healthcare professional or therapist to determine the best course of action for your specific situation.

Do Nightmares Affect Sleep Quality?

Yes, Having nightmares can significantly affect sleep quality. Nightmares tend to wake people up, making it difficult to fall back asleep and leading to sleep deprivation.

Sleep deprivation has been linked to various physical health problems and emotional consequences, such as an increased risk of depression and obesity. Additionally, recurring nightmares can interfere with romantic relationships and cause difficulties in managing emotions and appetite when sleep-deprived.

However, it is important to note that the relationship between nightmares and sleep quality may be influenced by other factors, such as lucid dreaming and individual traits.

How Is Nightmare Disorder Treated?

People suffering from Nightmare Disorder should seek treatment under the guidance of a healthcare professional who can suggest the most suitable therapy based on the individual’s overall health and the root cause of their nightmares.

The two main approaches to treating nightmare disorder are psychotherapy and medication.


Psychotherapy, commonly referred to as talk therapy, is a treatment method aimed at understanding and reframing negative thought patterns. It is a widely used approach for addressing mental health disorders and sleep problems, including insomnia.

  • Cognitive-behavioral therapy (CBT) is a primary type of psychotherapy, with a specific form, CBT for insomnia (CBT-I), employed to treat nightmares. CBT focuses on reorienting negative thoughts and feelings and modifying harmful behavioral patterns. There are various forms of talk therapy and CBT that may help alleviate nightmares:
  • Image Rehearsal Therapy: This method involves rewriting a recurring nightmare’s script and rehearsing it while awake to alter its progression and impact on the person.
  • Lucid Dreaming Therapy: This therapy takes advantage of a person’s awareness during a lucid dream to help them actively modify a nightmare’s content while experiencing it.
  • Exposure and Desensitization Therapies: These approaches employ controlled exposure to fears to lessen emotional reactions to them, often using techniques like self-exposure therapy and systematic desensitization.
  • Hypnosis: By inducing a relaxed, trance-like mental state, this method helps individuals more effectively absorb positive thoughts to combat stress.
  • Progressive Deep Muscle Relaxation:While not a direct form of talk therapy, this technique helps calm both the mind and body through deep breathing and sequential muscle tension and releases throughout the body.

In many cases, a combination of these therapies is employed, such as CBT-I, Sleep Dynamic Therapy, and Exposure, Relaxation, and Rescripting Therapy (ERRT). Professionals can adapt talk therapy for nightmares to suit individual needs and take into account any coexisting mental health disorders.


Several prescription medications that affect the nervous system, such as anti-anxiety, antidepressant, or antipsychotic drugs, may be used to address Nightmare Disorder. Certain medications are specifically used for individuals experiencing nightmares related to PTSD.

Although medications can be beneficial for some patients, they may also exhibit side effects. It’s essential to consult a doctor who can discuss the potential advantages and risks associated with prescription drugs for Nightmare Disorder.

Can Nightmares Cause Health Issues?

Yes, nightmares can potentially lead to physical health problems. As they often result in sleep deprivation, people experiencing nightmares are at a higher risk of developing health issues like depression and obesity.

Furthermore, recurring nightmares have been associated with non-suicidal self-injury and even suicide in certain populations, like war veterans. While more research is required to fully understand the relationship between nightmares and physical health problems, it’s clear that nightmares can negatively impact overall well-being.

Nightmares vs Night Terrors

Nightmares and night terrors are both types of sleep disturbances, but they have distinct differences. Nightmares are scary and unsettling dreams that occur during REM sleep and are often triggered by upsetting experiences or stimuli. People who have nightmares usually remember the content of the dream and may recall it upon waking.

Night terrors are a type of parasomnia that occurs during non-REM sleep, specifically during a state between dreaming and waking. Unlike nightmares, people who experience night terrors are not fully conscious during the episode and typically have no memory of it happening.

Night terrors often involve sudden wake-ups accompanied by yelling, screaming, and violent movements. They can also cause physiological symptoms like increased heart rate, sweating, and hyperventilation.