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Nightmare disorder: Causes, symptoms, and treatment

Nightmare disorder: Causes, symptoms, and treatment

Everyone has a disturbing dream from time to time. However, when these dreams become persistent, they can interfere with one’s everyday life. And when this happens, it could be a sign of nightmare disorder.

What Is a Nightmare Disorder?

A nightmare disorder is a sleep disorder that involves nightly nightmares that are usually terrifying in nature. They often involve the individual being placed in dangerous situations, ones which they attempt to escape. These nightmares cause severe distress and impairment to an individual’s sleep patterns as well as functioning when awake. 

Nightmare disorders are often very intense and accompanied by feelings of hypervigilance, high anxiety, and avoidant behavior patterns. They typically occur as you emerge from the rapid eye movement (REM) stage of sleep — the period in which memories of dreams are solidified.  Once the nightmares have awoken them, the individuals can readily and easily remember and recall these dreams.

Nightmare disorders are not to be confused with night terrors which can occur as a result of a traumatic event — however, they can be equally as impairing. 

What Are the Symptoms of a Nightmare Disorder?

Some of the most common symptoms of nightmare disorder are:

  • Frequent dreams that are vivid and can be easily recalled while awake
  • Being alert and hypervigilant when woken up from a dream
  • Nightmares that cause a disturbance in other areas of your life, such as school, your job, or interpersonal relationships
  • Sleep deprivation (usually caused by avoiding sleep out of fear)
  • Having nightmares that aren’t a result of substance use or medication
  • Having nightmares that aren’t related to another mental illness, such as post-traumatic stress disorder (PTSD)

Is There a Cure for Nightmare Disorder?

There is currently no cure for nightmare disorder. However, this doesn’t mean it has to be a lifelong condition. There are many actions you can take to avoid or prevent symptoms.

Typically, treating nightmare disorder involves significant mindfulness training, cognitive behavioral therapy (CBT), and even dialectical behavior therapy (DBT). If you’re able to develop a strong set of coping skills, you’ll be able to better process the stress that nightmares cause. Additionally, engaging in mindfulness training will allow you to create a nighttime routine that can lower psychological and physiological stress levels.

Imagery rehearsal therapy, or IRT, is another recommended treatment for nightmare disorder. This type of therapy works to change the ending of a remembered threat or nightmare while awake, in order to remove the threat. When nightmares occur, you’d reimagine the ending of your dream to make it positive, write it down, and rehearse the newly constructed dream to dispel the negative feelings caused by the nightmare.

How Common Are Nightmare Disorders?

While nightmares themselves are common, nightmare disorders are relatively uncommon. Many people who have frequent nightmares have another mental disorder that causes them.

Despite their rarity, nightmare disorders are very real — and should be treated with the same level of respect that other disorders have. There are some professions, for example, that can predispose you to have a higher likelihood of nightmares, such as: 

  • Military
  • Medical professions
  • Law enforcement

The frequency of nightmares increases through childhood into adolescence, increasing majorly from ages 10 to 13—for both males and females—and again from ages 20-29, only this time exclusively in females. And although the gender difference remains, this prevalence decreases at a steady pace, as both men and women continue to age. Additionally, individuals who suffer from sleep deprivation or inconsistent sleep-wake schedules may be at a higher risk of developing nightmare disorder.

What Is the Biggest Difference Between Nightmare Disorder and Night Terrors?

Nightmare disorder and night terrors are different in nature. Nightmare disorder occurs in isolation from another physiological or psychological cause. It also creates more psychological impairments than physical ones. 

Night terrors, on the other hand, often have significantly more physiological effects, and they do not have to be repetitive in nature in order to meet diagnostic criteria. Sufferers of night terrors can experience a host of symptoms including: 

  • Hallucinations 
  • Perceived paralysis
  • Difficulty breathing
  • Chest pain
  • Numbness

Additionally, most people do not remember night terrors.

How Can You Stop Nightmare Disorder in Adults?

Mindfulness training and therapies and CBT are evidence-based treatments that can be effective tools in eradicating nightmares in adults. 

Mindfulness training focuses on being in touch with the body and being able to be fully present, which increases your internal locus of control. CBT increases a client’s toolkit of coping strategies — it enables them to identify, challenge, and replace thought patterns that are not based in reality and that are potentially harmful. By increasing your self-efficacy during the daytime with a large selection of coping skills, you can make significant improvements to your sleep patterns and habits.

Is There a Natural Remedy for Nightmares?

As mentioned before, mindfulness and meditative practices can be significantly helpful for nightmares, which serve as natural remedies. Also, some herbal remedies and teas have a correlational effect on improved sleeping patterns and habits:

  • Drinking tart cherry juice
  • Drinking herbal tea (caffeine-free, of course!)
  • Taking melatonin supplements
  • Avoiding dairy products at least 3 hours before bedtime 

The above have been shown to increase sleep quality and ease of falling asleep, which can lead to a decrease in nightmares. Other natural remedies that can ensure you have a great sleep include:

  • Exercise 
  • Regular self-care and wellness behaviors, like eating balanced meals 
  • Yoga
  • Functional stretching

Persistent nightmares are upsetting, and the disruption they cause can create serious stress. If you’re struggling with frequent nightmares, help is available. Reaching out to a mental health professional who specializes in sleep is a great first step in moving towards healthier, uninterrupted sleep. 

  • Clinical writer
  • Editorial writer
  • Medical reviewer
  • 4 sources
  • Update history
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Alexandra “Alex” Cromer is a Licensed Professional Counselor (LPC) who has 4 years of experience partnering with adults, families, adolescents, and couples seeking help with depression, anxiety, eating disorders, and trauma-related disorders.

Kate Hanselman, PMHNP in New Haven, CT
Kate Hanselman, PMHNP-BCBoard-Certified Psychiatric Mental Health Nurse Practitioner
See Kate's availability

Kate Hanselman is a board-certified Psychiatric Mental Health Nurse Practitioner (PMHNP-BC). She specializes in family conflict, transgender issues, grief, sexual orientation issues, trauma, PTSD, anxiety, behavioral issues, and women’s issues.

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Delaney is a Marketing Writer Intern at Thriveworks, working toward her bachelor’s degree in English and Media Studies at the University of Virginia. Delaney has experience as a copywriter for her university’s chemistry department and as a journalist for the student newspaper Cavalier Daily.

We only use authoritative, trusted, and current sources in our articles. Read our editorial policy to learn more about our efforts to deliver factual, trustworthy information.

  • Aurora, R. N. et al. (2010). Best Practice Guide for the Treatment of Nightmare Disorder in Adults. Journal of Clinical Sleep Medicine, 6(4). 

  • Edwards, S. (2015). Nightmares and the brain. Harvard Medical School. 

  • Paul F, Schredl M, Alpers GW. Nightmares affect the experience of sleep quality but not sleep architecture: an ambulatory polysomnographic study. Borderline Personal Disord Emot Dysregul. 2015 Feb 13;2:3. doi: 10.1186/s40479-014-0023-4. PMID: 26401306; PMCID: PMC4579510.

  • Nightmare disorder. PsychDB. (2021, March 29).

We update our content on a regular basis to ensure it reflects the most up-to-date, relevant, and valuable information. When we make a significant change, we summarize the updates and list the date on which they occurred. Read our editorial policy to learn more.

  • Originally published on 08/19/2017

    Author: Taylor Bennett 

  • Updated on 07/13/2023 

    Authors: Alexandra Cromer, LPC & Delaney Hammond

    Reviewer: Kate Hanselman, PMHNP-BC

    Updates: Updated by a Thriveworks clinician in collaboration with our editorial team, adding additional information regarding what nightmare disorder is, how to treat it, and more; the article was clinically reviewed to double confirm the accuracy and enhance value.

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