Frequent bad dreams can be linked to stress, anxiety, trauma, medicines, alcohol, or irregular sleep. See a doctor if they disrupt your life.
Common causes
- Stress and anxiety.
- Trauma or PTSD.
- Medicines such as beta blockers and antidepressants.
- Alcohol and drug use or withdrawal.
- Irregular sleep and sleep apnea.
- Eating late.
Nightmare disorder
Frequent nightmares that cause distress or sleep loss.
What helps
- Regular sleep.
- Relaxation before bed.
- Imagery rehearsal therapy.
See a doctor
If nightmares happen weekly or disturb daytime function.
Why bad dreams occur
Nightmares mostly happen in REM sleep, typically in the second half of the night, and often wake the sleeper with strong emotions. Dreams reflect the brain processing emotion and memory.
Common triggers
- Stress and anxiety.
- Trauma and post traumatic stress disorder (PTSD).
- Sleep deprivation and irregular sleep.
- Medications such as some antidepressants, beta blockers, blood pressure drugs and Parkinson’s drugs. Stopping some drugs, like sleeping pills, alcohol or antidepressants, can also cause vivid dreams (REM rebound).
- Alcohol and drug use.
- Scary movies or media before bed.
- Eating late at night.
- Fever and illness.
Prevalence
About 2% to 8% of adults have nightmares frequently, and about 50% to 85% have occasional nightmares, according to the American Academy of Sleep Medicine. Children have more.
Nightmare disorder
Frequent distressing nightmares that disrupt sleep or cause daytime impairment are diagnosed as nightmare disorder.
Treatments
- Imagery rehearsal therapy (IRT), where you rewrite the nightmare and rehearse the new ending while awake.
- Cognitive behavioral therapy for insomnia.
- Treating PTSD, sleep apnea or other causes.
- Prazosin is a medicine sometimes used for PTSD nightmares, though evidence is mixed.
Self help
- Keep a regular sleep schedule.
- Create a calm bedtime routine.
- Limit alcohol and heavy meals at night.
- Practice relaxation and journaling.
- Keep the bedroom cool and dark.
See a doctor if
Nightmares happen several times a week, cause fear of sleep or daytime problems, or began after starting a medicine or a traumatic event.
Frequency and triggers
Occasional nightmares affect most adults, and about 2 to 8 percent of adults have frequent nightmares that cause distress, a condition called nightmare disorder. Triggers include stress, anxiety, trauma and posttraumatic stress disorder, sleep deprivation, irregular schedules, alcohol or drug withdrawal, scary media before bed and some medicines such as certain antidepressants and beta blockers. Illness with fever can also lead to vivid dreams.
Treatments and self help
Imagery rehearsal therapy, where you rewrite the ending of a nightmare while awake and rehearse the new version, is recommended by the American Academy of Sleep Medicine as an effective treatment. Prazosin has been used for trauma related nightmares, though evidence is mixed. Keep a regular sleep schedule, avoid alcohol and heavy meals before bed, use relaxation techniques and keep the room dark and cool. Talk to a doctor if nightmares occur most nights, disturb sleep, cause daytime anxiety or follow a traumatic event.
Based on data from the American Academy of Sleep Medicine and the National Center for PTSD
