Nightmare Disorder: Symptoms, Causes, and Treatments

Nightmare Disorder

Nightmares are scary or disturbing dreams that can cause strong emotional reactions like fear, terror, anxiety or sadness. While occasional bad dreams are normal, frequent nightmares that disrupt sleep may indicate a condition called nightmare disorder.

What Is Nightmare Disorder?

Nightmare disorder, also known as dream anxiety disorder, is a sleep disorder characterized by frequent nightmares that cause repeated awakenings and difficulty going back to sleep. Disturbing dreams typically involve threats to survival or security.

People with nightmare disorder experience at least one nightmare per week over an extended period. The condition leads to fatigue, low mood, and impaired daytime functioning due to poor sleep quality and the intensity of the nightmares.

Symptoms of Nightmare Disorder

The key symptoms of nightmare disorder include:

  • Recurrent frightening or disturbing dreams with strong negative emotions like terror, anger or sadness
  • Typical nightmare themes involve physical danger, failure, helplessness, loss of control or threat to survival
  • Awakening during the night due to the disturbing dreams
  • Difficulty returning to sleep after a nightmare
  • Fear of going to sleep and anticipatory anxiety about having another disturbing dream
  • Daytime distress or impairment in social, occupational or other areas of functioning

Adults with this condition may avoid sleep or use alcohol to try to minimise nightmares. Children tend to become more clingy, afraid to sleep alone or of the dark due to frequent bad dreams.

In addition to causing daytime exhaustion, research indicates that nightmares increase suicide risk and risk of self-harm. They are also linked to conditions like depression, anxiety, PTSD, insomnia, substance abuse, hypertension and immune system dysfunction.

woman sleeping on couch having nightmare

Causes of Nightmare Disorder

The exact causes of nightmare disorder are unknown but various factors can increase risk:

  • Stress – Nightmares often become more severe, intense or frequent during periods of high stress or life changes. Any stressful event can trigger nightmares, whether it’s relationship conflicts, financial problems, traumatic events or grieving a loss.
  • Medications – Antidepressants, blood pressure medications, and Parkinson’s medications may precipitate nightmares in some individuals. Withdrawal from medications or recreational drugs can also spark bad dreams.
  • Sleep disorders – Conditions like sleep apnea may trigger more frightening dreams. The sleep deprivation of insomnia often makes nightmares worse.
  • Trauma – People who experience traumatic events often develop PTSD-related nightmares, reliving the trauma or dealing with related threats. Combat veterans and victims of violence frequently struggle with trauma-related night terrors.
  • Substance abuse – Withdrawal from alcohol, opioid pain medications or sedatives often causes rebounds of intensive nightmares and dreams as the brain rebounds out of the substance’s suppression of rapid eye movement (REM) sleep.
  • Medical conditions – Some illnesses like Parkinson’s disease, dementia, seizure disorders and fever can increase nightmare frequency.
  • Family history – Research suggests that frequent nightmares run in families. Having close relatives with psychiatric conditions like major depression also increases nightmare disorder risk.

picture of a man with lack of sleep

Treatments for Nightmare Disorder

If frequent nightmares interrupt sleep and impair your mental health or daily life, your doctor can provide both medical treatments and self-help tips to reduce traumatic dreams and improve sleep quality. Treatment options may include:

1. Imagery Rehearsal Therapy (IRT)

This specialized cognitive technique involves writing down nightmare details and then altering the disturbing storyline to create a new positive ending.

Rehearsing the rewritten dream scene helps minimize emotional intensity, so your brain essentially unlearns the association between poor sleep and nightmares. Studies indicate IRT successfully reduces nightmare frequency for 70% of people with PTSD.

2. Exposure, Relaxation and Re-scripting Therapy (ERRT)

Similar to imagery rehearsal, ERRT also involves rescripting nightmares. But it starts by describing the disturbing dream out loud, followed by muscle relaxation techniques.

Afterwards, you create an alternative ending and review it while relaxed to associate the nightmare memory with the safety of the therapy room. Researchers have validated ERRT for treating PTSD nightmares.

3. Exposure, Relaxation and Rescription Therapy (ERRT)

ERRT is another specialized technique that also involves rewriting nightmares. But the initial step is describing the disturbing dreams aloud, followed by learning relaxation skills.

Afterwards, you create an alternative ending and review it while relaxed. This treatment links the nightmare to the safety of the therapy room. Studies confirm ERRT effectiveness for PTSD nightmares.

4. Lucid Dreaming Therapy (LDT)

This interesting technique leverages lucid dreams where you realize you’re dreaming. In LDT, patients learn how to induce self-awareness after a nightmare starts.

Being lucid empowers changing dream events so you can escape threats, turn bad guys into bunnies or summonprotective characters. Developing this degree of mental control while dreaming gives the confidence to transform nightmares and associated anxiety.

young man with therapist

5. Virtual Reality Exposure Therapy (VRE)

VRE leverages simulated dream settings viewed through VR goggles to gradually decrease trauma-related nightmare intensity through repeated exposure.

A therapist guides patients through customized virtual scenarios like combat zones, vehicle accidents or violence scenes from perspectives impossible in real life. This immersive treatment changes how the brain processes traumatic memories tied to disturbing dreams.

6. Eye Movement Desensitization and Reprocessing (EMDR)

EMDR incorporates bilateral eye movements as patients recall traumatic memories. Initially created for PTSD treatment, EMDR shows promising results for alleviating nightmares regardless of cause.

The rapid left-right eye movements are thought to accelerate the switching of traumatic memories into long-term storage. EMDR requires working extensively with a specially trained therapist.

7. Stress Management Techniques

Since stress commonly triggers nightmares, counselling in effective coping strategies can prevent bad dreams in some people. Stress management training may incorporate:

  • Relaxation skills like meditation, yoga, deep breathing, progressive muscle relaxation or mindfulness
  • Anger management strategies
  • Healthy lifestyles with regular exercise and balanced nutrition
  • Better sleep habits like consistent bedtimes, limited screen use before bed or bedtime routines

8. Medications

If self-help techniques and counselling don’t suppress frequent nightmares enough, physicians may prescribe appropriate medications. Commonly used drugs include:

  • Prazosin – This alpha-blocker successfully minimizes nightmares, especially treatment-resistant PTSD dreams unresponsive to other therapies.
  • Trazadone – Often prescribed off-label to treat PTSD-related nightmares, this older antidepressant dampens REM sleep. It may cause daytime drowsiness.
  • Clonidine – This blood pressure medicine likely decreases nightmares through effects on stress chemicals like norepinephrine. Side effects include low blood pressure, dizziness or weakness.
  • Topiramate – Used for preventing seizures and migraines, this anticonvulsant medication shows promise for alleviating nightmares. Side effects include numbness, memory problems and unusual eye movements. Talk to your doctor about possible medication risks or interactions if you have frequent frightening dreams with disturbed sleep.

When To Seek Medical Care

You should consult your physician or a sleep specialist if:

  • You have frequent nightmares with repeat nighttime awakenings
  • Disturbing dreams prevent falling back asleep
  • Impaired sleep reduces daytime energy levels
  • Ongoing intense nightmares increase anxiety, depression or thoughts of self-harm

Keeping a log tracking nightmare details, sleep quality changes and daytime functioning can help your healthcare provider pinpoint appropriate treatments for restoring healthy sleep.

Most primary doctors refer patients to psychologists or psychiatrists specially trained in medical nightmare therapies.

In Conclusion

Occasional unpleasant dreams are normal reactions to daily stressors. But when frequent frightening nightmares interrupt sleep and spark distress or health issues, seeking treatments becomes essential.

Visiting a doctor experienced in assessing and managing nightmare disorders allows for developing an effective plan mixing medications, therapy approaches and better sleep habits. Treating symptoms early leads to better outcomes with nightmare reduction and improved rest.