Nightmare Disorder: Symptoms, Causes, and Treatment

Table of ContentsView AllTable of ContentsPrevelance of Nightmare DisorderCauses of Nightmare DisorderComorbidityImpact on Quality of LifeTreatment

Table of ContentsView All

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Table of Contents

Prevelance of Nightmare Disorder

Causes of Nightmare Disorder

Comorbidity

Impact on Quality of Life

Treatment

Close

Nightmare disorder (ND) is a sleep disorder in which a person consistently experiences ”frightening, vivid or disturbing dreams,” defined asnightmares, that suddenly wakes them.

Most people have a nightmare every once in a while, but when nightmares occur regularly, it may be considered nightmare disorder.

Nightmares only occur duringrapid eye movement (REM)sleep, which means they’re more likely to make an appearance after entering into a deeper sleep.

What About Night Terrors?

Night terrorsare similar tonightmaresbut do not happen during REM sleep. Bad dreams are also different from nightmares because they do not cause an individual to wake up in a startled state.

Although they differ, both nightmares and bad dreams are negativedreamsthat can affect the rest of your day. They also can be treated with similar medical or behavioral interventions.

What to Do When You Wake Up Screaming

Nightmares are more common during childhood but also prevalent throughout all ages of life.Almost 20% of children have a nightmare at least one time a week.

Bad dreams are, however, more common than nightmares for both children and adults.

Nightmare disorder is prevalent in 2% to 6% of adults. It is more prevalent in women than men, and the highest peak in women is between the ages of 20 and 39. The likelihood of getting nightmares tends to decrease between the ages of 50 and 59. By the age of 60, they are more consistent and there is no longer anygender difference.

A study compared the prevalence of nightmares in older adults and college students.They found nightmares to exist in about 20% of college students and a little over 4% in older adults, presenting a very large difference.

The following are possible causes of nightmare disorder or conditions that coexist with nightmare disorder:

The following disorders and conditions tend to coexist with nightmare disorders.

Post-Traumatic Stress Disorder (PTSD)

Post-traumatic stress disorder (PTSD)has been shown to be greatly connected to nightmare disorder. A review of different literature included many research studies that found correlations between nightmares and PTSD.

One study, in particular, discovered that nightmares after a traumatic event can triggerPTSD.It was determined that a history of nightmares can produce a greater chance of developing PTSD.

Researchers also found that those with a history of nightmares reported having greater PTSD symptoms than those without.

Additionally, nightmares related to atraumatic eventare associated with more severe PTSD symptoms. PTSD can also predispose an individual to other psychological conditions, like anxiety or depression, and these neurological or mental symptoms can increase the likelihood of having nightmares.

Anxiety, Depression, and Stress

Anxietyanddepressivesymptoms are associated with the experience of constant nightmares, especially anxiety.

A research studythat included children andadolescentsstudents found an association between trauma, PTSD, anxiety, and sleep disturbance.

A different study explored the connection that disturbing dreams had with anxiety and depression in adolescents ages 13 and 16.There was a correlation between SDs with anxiety symptoms and generalized anxiety disorder (GAD) for participants who were 13 years old. Those who were the age of 16, demonstrated a relationship between anxiety disorders, like overly anxious disorder and separation anxiety with SDs.

There was also a connection between depressive symptoms and nightmares in older adults. Adults who have severe anxiety and depression reported a larger number of nightmares.

Research has found that the prevalence of nightmare disorder is high in nurses due to anxiety, depression, and stress.

460 nurses were asked to maintain a 14-day sleep diary, about 44% reported some experiences with nightmares and 7.4% met the criteria for nightmare disorder. Healthcare workers are one group of many that endure aheavy workloadcausing them a great deal of stress and mental adversities equating to sleep disturbances, such as nightmares.

Suicidality

Researchers are beginning to believe that “nightmares increase one’s risk of suicidality and suicidal behavior across the lifespan.”In a review of various studies, a link betweensuicidal ideationsand nightmare disorder is blatantly prevalent.

In a study involving women who overcame sexual assault, of those with nightmares 43% reported suicidal ideations.

Another study examined severe suicide attempts that equated to an emergency room visit, which included 165 patients admitted to the hospital.Althoughinsomniawas the greatest sleep complaint, of the 165 participants, two-thirds reported constant nightmares.

If you are having suicidal thoughts, contact theNational Suicide Prevention Lifelineat988for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.For more mental health resources, see ourNational Helpline Database.

If you are having suicidal thoughts, contact theNational Suicide Prevention Lifelineat988for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911.

For more mental health resources, see ourNational Helpline Database.

Borderline Personality Disorder (BPD)

A study examining the association betweenborderline personality disorder (BPD)and nightmares, found nightmares, as well as dream anxiety, and negative quality of sleep, to be more prevalent in those with BPD, than in those without.

Of the people diagnosed with BPD, 49% suffered from consistent nightmares, and 95.5% reported some form of sleep disturbance.

Trauma

Both adults and children who have experiencedearly traumahave a history of altered sleep quality and nightmares.

77% of individuals who’ve overcomesexual assaultreported some form of sleep disturbance, whether it be insomnia, nightmares, or other sleep-related issues that may affect breathing or movement.

Dissociative Disorders

Dissociative disorders, which are mental disorders in which an individual experience disconnects from reality, thoughts, feelings, and identity, is also associated with nightmare disorder. Dissociative disorders may be connected to nightmares due to their comorbidity with PTSD and stress.

A study found that 57% of participants with a dissociative disorder also had nightmare disorder, and those with nightmares presented greater dissociative symptoms.

It was also discovered that undergraduate college students who reported having nightmares had more dissociative-like experiences.

Nightmare disorder has a great impact onsleep quality, mood, and energy levels. Constantly awakening in the middle of the night, especially when not going back to sleep, affects both the quantity and quality of sleep.

Sleep is a very vital aspect of life. It is how one regenerates their body and mind. Poor sleep quality is related to inflammation in the body, fatigue, mental distress, and chronic illnesses.Lack of sleep can cause great consequences to an individual’s quality of life,wellness, and health.

Thepanic, anxiety, and depression associated with nightmares are also very impactful on one’s quality of life.

Those who experience PTSD nightmares could have those images resonating with them throughout their day.It is important to seek the appropriate help when nightmares begin to interfere with your quality of life and daily functioning.

Treatment for nightmare disorder could be both pharmacological and/or psychotherapeutic interventions.

Pharmacological Treatment

After various clinical trials throughout the years examining the effectiveness of different medications on the reduction of nightmares, only prazosin exemplifies the most effective results.

Prazosin is an FDA-approved medication for high blood pressure but has been shown to treat nightmares associated with PTSD. Research has recently discovered its benefits in treating nightmares.  There are a few other medications that may also help in treating nightmare disorder,  but more research must be conducted on them.

Psychotherapeutic Treatment

Psychotherapeutic interventions consist of methodologies that are most likely conducted during therapy sessions. Some of these techniques would include cognitive-behavioral therapies, likeimagery rehearsal therapy (IRT), which involves the client revisiting a specific nightmare, rewriting it to be a more pleasing dream, and imagining experiencing the new dream.

Exposure, Relaxation, and Rescripting Therapy

Another cognitive-behavioral therapy is exposure, relaxation, and rescripting therapy (ERRT), which “combinesIRTwithexposureand relaxation therapy.”

This type of therapy is specifically for addressing nightmares related to trauma. It helps one to approach these nightmares and discover methods of how toself-sootheduring the revisitation of these experiences. It also involves being informed of healthy sleep habits and techniques for managing trauma.

There are various other techniques that can be used in therapy, likeexposure therapyon its own to lessen fear related to nightmares. Another technique is a therapy treatment that helps increaselucid dreamsto help an individual have more control and awareness during their nightmares to be able to alter them.

Keep in Mind

Nightmares can bring a great deal of disturbance to an individual’s life. If you are experiencing constant nightmares that are impacting your life in some way, consider speaking with a psychiatrist.

Although nightmare disorder can appear alongside the disorders/conditions discussed in this article, that does not mean that you must have one of these in order to have constant nightmares. There could be plenty of other reasons you could be getting nightmares. It also doesn’t mean you will get nightmares just because you have any of these conditions.

A nightmare every once in a while is expected, but every day or even every week can become depleting and depressing. If you are getting nightmares this frequently, itmay be time to seek professional helpso that you can develop a useful treatment method and gain back control of your sleep.

What Can a Sleep Study Tell You About Your Mental Health?

15 SourcesVerywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Nadorff MR, Lambdin KK, Germain A.Pharmacological and non-pharmacological treatments for nightmare disorder.International review of psychiatry. 2014;26(2):225-236. doi:10.3109/09540261.2014.888989Sleep Foundation.Nightmares.Schredl M, Biemelt J, Roos K, Dunkel T, Harris N.Nightmares and stress in children. Sleep and Hypnosis. 2008; 10(1):19–25.Salvio MA, Wood JM, Schwartz J, Eichling PS.Nightmare prevalence in the healthy elderly.Psychology and Aging. 1992; 7(1):324 – 325. doi:10.1037/0882-7974.7.2.324Mellman TA. David D. Bustamante V.et al.Dreams in the Acute Aftermath of Trauma and Their Relationship to PTSD.J Trauma Stress. 2001;14:241–247. doi:10.1023/A:1007812321136Charuvastra A, Cloitre M. Safe enough to sleep: sleep disruptions associated with trauma, posttraumatic stress, and anxiety in children and adolescents.Child Adolesc Psychiatr Clin N Am. 2009;18(4):877-891. doi:10.1016/j.chc.2009.04.002Nielsen TA. Laberge L. Paquet J. Tremblay RE.Development of disturbing dreams during adolescence and their relation to anxiety symptoms.Sleep.2000;23(60):727-36. doi:10.1093/sleep/23.6.1Dietch JR, Taylor DJ, Pruiksma K, et al.The Nightmare Disorder Index: development and initial validation in a sample of nurses.Sleep. 2021;44(5):zsaa254. doi:10.1093/sleep/zsaa254Krakow B, Artar A, Warner TD, et al.Sleep disorder, depression, and suicidality in female sexual assault survivors.Crisis. 2000;21(4):163-170. doi:10.1027//0227-5910.21.4.163Sjöström N, Hetta J, Waern M.Persistent nightmares are associated with repeat suicide attempt: a prospective study.Psychiatry Res. 2009;170(2-3):208-211. doi:10.1016/j.psychres.2008.09.006Semiz UB, Basoglu C, Ebrinc S, Cetin M.Nightmare disorder, dream anxiety, and subjective sleep quality in patients with borderline personality disorder.Psychiatry Clin Neurosci. 2008;62(1):48-55. doi:10.1111/j.1440-1819.2007.01789.xKrakow B, Melendrez D, Johnston L, et al.Sleep-disordered breathing, psychiatric distress, and quality of life impairment in sexual assault survivors.J. Nerv. Ment. Dis.2002; 190:442-452.Agargun MY, Kara H, Ozer OA, Selvi Y, Kiran U, Ozer B.Clinical importance of nightmare disorder in patients with dissociative disorders.Psychiatry Clin Neurosci. 2003;57(6):575-579. doi:10.1046/j.1440-1819.2003.01169.xAgargun MY, Kara H, Ozer OA, Selvi Y, Kiran U, Kiran S.Nightmares and dissociative experiences: the key role of childhood traumatic events.Psychiatry Clin Neurosci. 2003;57(2):139-145. doi:10.1046/j.1440-1819.2003.01093.xVail-Smith, K., Felts, W. and Becker, C.Relationship between Sleep Quality and Health Risk Behaviors in Undergraduate College Students.College Student Journal. 2009;43:924-930.

15 Sources

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Nadorff MR, Lambdin KK, Germain A.Pharmacological and non-pharmacological treatments for nightmare disorder.International review of psychiatry. 2014;26(2):225-236. doi:10.3109/09540261.2014.888989Sleep Foundation.Nightmares.Schredl M, Biemelt J, Roos K, Dunkel T, Harris N.Nightmares and stress in children. Sleep and Hypnosis. 2008; 10(1):19–25.Salvio MA, Wood JM, Schwartz J, Eichling PS.Nightmare prevalence in the healthy elderly.Psychology and Aging. 1992; 7(1):324 – 325. doi:10.1037/0882-7974.7.2.324Mellman TA. David D. Bustamante V.et al.Dreams in the Acute Aftermath of Trauma and Their Relationship to PTSD.J Trauma Stress. 2001;14:241–247. doi:10.1023/A:1007812321136Charuvastra A, Cloitre M. Safe enough to sleep: sleep disruptions associated with trauma, posttraumatic stress, and anxiety in children and adolescents.Child Adolesc Psychiatr Clin N Am. 2009;18(4):877-891. doi:10.1016/j.chc.2009.04.002Nielsen TA. Laberge L. Paquet J. Tremblay RE.Development of disturbing dreams during adolescence and their relation to anxiety symptoms.Sleep.2000;23(60):727-36. doi:10.1093/sleep/23.6.1Dietch JR, Taylor DJ, Pruiksma K, et al.The Nightmare Disorder Index: development and initial validation in a sample of nurses.Sleep. 2021;44(5):zsaa254. doi:10.1093/sleep/zsaa254Krakow B, Artar A, Warner TD, et al.Sleep disorder, depression, and suicidality in female sexual assault survivors.Crisis. 2000;21(4):163-170. doi:10.1027//0227-5910.21.4.163Sjöström N, Hetta J, Waern M.Persistent nightmares are associated with repeat suicide attempt: a prospective study.Psychiatry Res. 2009;170(2-3):208-211. doi:10.1016/j.psychres.2008.09.006Semiz UB, Basoglu C, Ebrinc S, Cetin M.Nightmare disorder, dream anxiety, and subjective sleep quality in patients with borderline personality disorder.Psychiatry Clin Neurosci. 2008;62(1):48-55. doi:10.1111/j.1440-1819.2007.01789.xKrakow B, Melendrez D, Johnston L, et al.Sleep-disordered breathing, psychiatric distress, and quality of life impairment in sexual assault survivors.J. Nerv. Ment. Dis.2002; 190:442-452.Agargun MY, Kara H, Ozer OA, Selvi Y, Kiran U, Ozer B.Clinical importance of nightmare disorder in patients with dissociative disorders.Psychiatry Clin Neurosci. 2003;57(6):575-579. doi:10.1046/j.1440-1819.2003.01169.xAgargun MY, Kara H, Ozer OA, Selvi Y, Kiran U, Kiran S.Nightmares and dissociative experiences: the key role of childhood traumatic events.Psychiatry Clin Neurosci. 2003;57(2):139-145. doi:10.1046/j.1440-1819.2003.01093.xVail-Smith, K., Felts, W. and Becker, C.Relationship between Sleep Quality and Health Risk Behaviors in Undergraduate College Students.College Student Journal. 2009;43:924-930.

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Nadorff MR, Lambdin KK, Germain A.Pharmacological and non-pharmacological treatments for nightmare disorder.International review of psychiatry. 2014;26(2):225-236. doi:10.3109/09540261.2014.888989Sleep Foundation.Nightmares.Schredl M, Biemelt J, Roos K, Dunkel T, Harris N.Nightmares and stress in children. Sleep and Hypnosis. 2008; 10(1):19–25.Salvio MA, Wood JM, Schwartz J, Eichling PS.Nightmare prevalence in the healthy elderly.Psychology and Aging. 1992; 7(1):324 – 325. doi:10.1037/0882-7974.7.2.324Mellman TA. David D. Bustamante V.et al.Dreams in the Acute Aftermath of Trauma and Their Relationship to PTSD.J Trauma Stress. 2001;14:241–247. doi:10.1023/A:1007812321136Charuvastra A, Cloitre M. Safe enough to sleep: sleep disruptions associated with trauma, posttraumatic stress, and anxiety in children and adolescents.Child Adolesc Psychiatr Clin N Am. 2009;18(4):877-891. doi:10.1016/j.chc.2009.04.002Nielsen TA. Laberge L. Paquet J. Tremblay RE.Development of disturbing dreams during adolescence and their relation to anxiety symptoms.Sleep.2000;23(60):727-36. doi:10.1093/sleep/23.6.1Dietch JR, Taylor DJ, Pruiksma K, et al.The Nightmare Disorder Index: development and initial validation in a sample of nurses.Sleep. 2021;44(5):zsaa254. doi:10.1093/sleep/zsaa254Krakow B, Artar A, Warner TD, et al.Sleep disorder, depression, and suicidality in female sexual assault survivors.Crisis. 2000;21(4):163-170. doi:10.1027//0227-5910.21.4.163Sjöström N, Hetta J, Waern M.Persistent nightmares are associated with repeat suicide attempt: a prospective study.Psychiatry Res. 2009;170(2-3):208-211. doi:10.1016/j.psychres.2008.09.006Semiz UB, Basoglu C, Ebrinc S, Cetin M.Nightmare disorder, dream anxiety, and subjective sleep quality in patients with borderline personality disorder.Psychiatry Clin Neurosci. 2008;62(1):48-55. doi:10.1111/j.1440-1819.2007.01789.xKrakow B, Melendrez D, Johnston L, et al.Sleep-disordered breathing, psychiatric distress, and quality of life impairment in sexual assault survivors.J. Nerv. Ment. Dis.2002; 190:442-452.Agargun MY, Kara H, Ozer OA, Selvi Y, Kiran U, Ozer B.Clinical importance of nightmare disorder in patients with dissociative disorders.Psychiatry Clin Neurosci. 2003;57(6):575-579. doi:10.1046/j.1440-1819.2003.01169.xAgargun MY, Kara H, Ozer OA, Selvi Y, Kiran U, Kiran S.Nightmares and dissociative experiences: the key role of childhood traumatic events.Psychiatry Clin Neurosci. 2003;57(2):139-145. doi:10.1046/j.1440-1819.2003.01093.xVail-Smith, K., Felts, W. and Becker, C.Relationship between Sleep Quality and Health Risk Behaviors in Undergraduate College Students.College Student Journal. 2009;43:924-930.

Nadorff MR, Lambdin KK, Germain A.Pharmacological and non-pharmacological treatments for nightmare disorder.International review of psychiatry. 2014;26(2):225-236. doi:10.3109/09540261.2014.888989

Sleep Foundation.Nightmares.

Schredl M, Biemelt J, Roos K, Dunkel T, Harris N.Nightmares and stress in children. Sleep and Hypnosis. 2008; 10(1):19–25.

Salvio MA, Wood JM, Schwartz J, Eichling PS.Nightmare prevalence in the healthy elderly.Psychology and Aging. 1992; 7(1):324 – 325. doi:10.1037/0882-7974.7.2.324

Mellman TA. David D. Bustamante V.et al.Dreams in the Acute Aftermath of Trauma and Their Relationship to PTSD.J Trauma Stress. 2001;14:241–247. doi:10.1023/A:1007812321136

Charuvastra A, Cloitre M. Safe enough to sleep: sleep disruptions associated with trauma, posttraumatic stress, and anxiety in children and adolescents.Child Adolesc Psychiatr Clin N Am. 2009;18(4):877-891. doi:10.1016/j.chc.2009.04.002

Nielsen TA. Laberge L. Paquet J. Tremblay RE.Development of disturbing dreams during adolescence and their relation to anxiety symptoms.Sleep.2000;23(60):727-36. doi:10.1093/sleep/23.6.1

Dietch JR, Taylor DJ, Pruiksma K, et al.The Nightmare Disorder Index: development and initial validation in a sample of nurses.Sleep. 2021;44(5):zsaa254. doi:10.1093/sleep/zsaa254

Krakow B, Artar A, Warner TD, et al.Sleep disorder, depression, and suicidality in female sexual assault survivors.Crisis. 2000;21(4):163-170. doi:10.1027//0227-5910.21.4.163

Sjöström N, Hetta J, Waern M.Persistent nightmares are associated with repeat suicide attempt: a prospective study.Psychiatry Res. 2009;170(2-3):208-211. doi:10.1016/j.psychres.2008.09.006

Semiz UB, Basoglu C, Ebrinc S, Cetin M.Nightmare disorder, dream anxiety, and subjective sleep quality in patients with borderline personality disorder.Psychiatry Clin Neurosci. 2008;62(1):48-55. doi:10.1111/j.1440-1819.2007.01789.x

Krakow B, Melendrez D, Johnston L, et al.Sleep-disordered breathing, psychiatric distress, and quality of life impairment in sexual assault survivors.J. Nerv. Ment. Dis.2002; 190:442-452.

Agargun MY, Kara H, Ozer OA, Selvi Y, Kiran U, Ozer B.Clinical importance of nightmare disorder in patients with dissociative disorders.Psychiatry Clin Neurosci. 2003;57(6):575-579. doi:10.1046/j.1440-1819.2003.01169.x

Agargun MY, Kara H, Ozer OA, Selvi Y, Kiran U, Kiran S.Nightmares and dissociative experiences: the key role of childhood traumatic events.Psychiatry Clin Neurosci. 2003;57(2):139-145. doi:10.1046/j.1440-1819.2003.01093.x

Vail-Smith, K., Felts, W. and Becker, C.Relationship between Sleep Quality and Health Risk Behaviors in Undergraduate College Students.College Student Journal. 2009;43:924-930.

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