How to Treat Nightmare Disorder

Nearly everyone has nightmares from time to time. Nightmares usually involve dreams resulting in fear, anger, sadness, disgust, and other negative emotions.^{[1]XResearch sourceAmerican Academy of Sleep Medicine. International Classification of Sleep Disorders: Diagnostic and Doding Manual. 2nd ed. Westchester, Ill: American Academy of Sleep Medicine; 2005.} However, some nightmares can impact daily functioning or cause distress during your day. If you are in need of treatment for nightmare disorder, talk to a mental health or medical professional.

Method 1

Method 1 of 3:

Getting a Diagnosis for Nightmare Disorder

1
See your doctor and a mental health professional. If you are suffering from ongoing nightmares that are affecting you during the day, then seeking help from a mental health professional is a good first step.^{[2]XResearch source} You can start by seeing your doctor to discuss your nightmares and determine if the nightmares may be the result of medications or a physical condition.
- To receive a diagnosis of nightmare disorder, your nightmares cannot be explained by drug or alcohol use, medications, or another physical or mental health condition. If you have any of these factors, then see your doctor to find a way to correct the problem.
- For example, if you are taking a prescription drug that lists nightmares as a potential side effect, then your doctor may need to switch you to a different medication. If you have an existing mental health problem, then seeking treatment for that condition may help to alleviate your nightmares.
2
Consider how the nightmares make you feel. One of the criteria for nightmare disorder is that the dreams must be bad enough to cause you to wake up. The dreams may seem to threaten your life, safety, and self-esteem. For example, you might dream that you are being attacked by a person or a wild animal, or that you are being ridiculed by a group of your peers. After you wake up, you will feel alert and aware of your surroundings.^{[3]XResearch source}
- You may feel quite distressed upon waking as well. This feeling may last all day and interfere with your ability to engage with work, friends, family, and/or hobbies.
3
Explain how long the nightmares have been occurring. The length of time that you have been suffering from nightmares will affect how the clinician evaluating your condition will rate your disorder. The categories include:^{[4]XResearch source}
- Acute. Nightmares have been ongoing for one month or less.
- Subacute. Nightmares have been ongoing for one to six months.
- Persistent. Nightmares have been ongoing for six months or longer.
4
Specify the frequency of your nightmares. Your doctor or mental health practitioner will also assign a specifier to indicate the frequency of your nightmares. These specifiers include:^{[5]XResearch source}
- Mild. This means that you have no more than one nightmare per week.
- Moderate. This means that you have more than one nightmare per week, but that you do not have a nightmare every night.
- Severe. This means that you have nightmares every night.
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Method 2

Method 2 of 3:

Making Lifestyle Changes to Reduce Nightmares

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Use relaxation techniques to relieve stress. Some people notice changes in their dreams when faced with overwhelming stress and/or anxiety. Think about whether the nightmares started around a particular time in your life, and whether your ability to handle stress is affecting your dream state. If so, learning some relaxation techniques to help you cope with stress and anxiety may help to reduce the frequency of your nightmares.^{[6]XTrustworthy SourceMayo ClinicEducational website from one of the world's leading hospitalsGo to source}
- Exercising regularly is a great way to cope with stress.^{[7]XTrustworthy SourceHelpGuideNonprofit organization dedicated to providing free, evidence-based mental health and wellness resources.Go to source} Try to exercise for 30 minutes every day and do something that you enjoy. For example, you can try walking, swimming, biking, dancing, or playing a sport, such as basketball.
- Use breathing techniques, meditation, or yoga to help you cope with stress.
- Practice progressive muscle relaxation before bed. This is the process of tensing and releasing the muscles in your body moving from your toes to the top of your head Some participants who practiced progressive muscle relaxation saw a decrease in nightmares or an elimination of nightmares altogether.^{[8]XResearch source}
2
Avoid scary movies and TV shows. Watching a scary movie or TV show close to bedtime may also increase the chances that you will have a nightmare, so it is best to avoid these.^{[9]XTrustworthy SourceMayo ClinicEducational website from one of the world's leading hospitalsGo to source} Instead, try watching something funny or informative, such as a romantic comedy or a nature program.
- Keep the time before bed as calm as possible. Try reading a funny or romantic book, or just dedicate your evening to relaxing and preparing for a good night’s sleep.
To obtain a diagnosis of nightmare disorder, your dreams cannot be related to using alcohol or other substances.^{[10]XResearch source} However, some people do have nightmares as a result of drinking alcohol or using other substances too close to bedtime. To eliminate this risk factor, avoid drinking any alcoholic beverages or using any other substances before you go to bed.^{[11]XTrustworthy SourceMayo ClinicEducational website from one of the world's leading hospitalsGo to source}
4
Discuss your nightmares with a loved one. Sometimes it may not be possible to prevent a nightmare, but talking about it can help. Upon waking, describe your nightmare to a parent, friend, or to your significant other. Explain what happened, who was in the dream, and what made it so scary.^{[12]XTrustworthy SourceMayo ClinicEducational website from one of the world's leading hospitalsGo to source}
- You may also consider rewriting the ending of your dream. Try to imagine a happy ending for the nightmare.
- Journaling about your dream may also help you to understand it better and express the way that it made you feel.
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Method 3

Method 3 of 3:

Seeking Help for Nightmares

1
Treat any underlying medical conditions. To receive a diagnosis of nightmare disorder, your nightmares cannot be explained by another medical or mental health condition.^{[13]XResearch source} However, an underlying condition may be responsible for your nightmares and treating it may eliminate the nightmares. Talk to your medical doctor about any medical conditions you may have that may underlie the nightmares. Your doctor may run some tests and rule out causes for your nightmares. If a medical cause is found, treat the underlying medical cause.^{[14]XTrustworthy SourceMayo ClinicEducational website from one of the world's leading hospitalsGo to source}
- Your doctor can also prescribe new medications, or adjust your current medications if he or she suspects that these medications may be causing your nightmares.^{[15]XResearch source}
- Repeated nightmares may be an indication of a breathing disorder such as sleep apnea. Sleep apnea occurs when the body stops breathing while sleeping, then gasps for air. A telltale sign of sleep apnea is loud snoring, followed by a pause, then a snort or gasp. This pattern repeats throughout the night. You may wake up feeling unrefreshed or grumpy in the morning, feel drowsy throughout the day, or have untreatable headaches.^{[16]XResearch source}
- Although it is not related to nightmare disorder, PTSD is a common cause of nightmares. Post-traumatic stress disorder (PTSD) affects some people after a stressful or traumatic event. 71 to 96% of people who experience trauma and resulting PTSD experience nightmares. The nightmares may recount major scenes of the trauma.^{[17]XResearch source} Go to a therapist and get assessed for symptoms of PTSD and the resulting nightmares.
2
Use behavior approaches in therapy. Using therapy and behavior approaches can be effective in both children and adults. Effects of behavior therapy can have both short-term and long-term effects on nightmare disorders. Therapy can be brief, with just a few sessions in a group or individually.^{[18]XTrustworthy SourceAmerican Academy of Family PhysiciansOrganization devoted to improving the health of patients, families, and communitiesGo to source}
- Many kinds of behavior therapy exists. You may practice Exposure, Relaxation, and Rescripting Therapy (ERRT), Lucid Dreaming Therapy, and Eye Movement Desensitization and Reprocessing (EMDR).
- You may learn ways to cope with nightmares, ways to help your mind and body relax before bed, and ways to handle stress better.
3
Try Imagery Rehearsal Therapy (IRT). IRT is a practice performed while the individual is awake. While engaged with the nightmare, the person changes the ending of the nightmare so that it no longer is upsetting. Once the ending has been changed, the person replays the nightmare and the resulting ending over and over in the mind. This type of treatment can reduce the frequency of the nightmares.
- For example, if you constantly dream about driving off a cliff, imagine yourself driving the same road, anticipating the cliff, and the car or bus driving past the location. Then, see the destination up ahead. You may imagine a nice forest or beach where you can have a picnic.
4
Go to hypnosis.^{[19]XResearch sourceHauri PJ, Silber MH, Boeve BF. The treatment of parasomnias with hypnosis: a 5-year follow-up study. J Clin Sleep Med. 2007 Jun 15. 3(4):369-73.} Hypnosis helps relax the mind and the body to focus on one particular thought, memory, or feeling. It’s used to help change or reflect certain thoughts or behaviors. In some samples, many treated with hypnosis were symptom-free following treatment.^{[20]XResearch source}
- You may experience a recurring scary dream from a natural disaster. Work with the dream while in a hypnotic state and notice how the recurring dream lessens or stops.
- For more information, check out How to Find a Hypnotherapist.
5
Consider medication. Medication is generally only used when treating nightmares associated with PTSD. Some medications can be helpful when treating symptoms of PTSD, particularly when nightmares are present. Some considerations in medication include trazodone, atypical antipsychotic medications, topiramate, low dose cortisol, fluvoxamine, triazolam and nitrazepam, phenelzine, gabapentin, cyproheptadine, and tricyclic antidepressants.^{[21]XResearch source}
- Keep in mind that many medications have side effects and it may take a while to find one that works well for you.
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