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What is a Nightmare?

A nightmare is a very distressing dream that usually wakes one up, usually causing fear and upset. Nightmares are not real, though they can feel very real.

How common are nightmares?

Most people have experienced a nightmare at some point in their life, but in most cases, they are temporary and do not persist.

However, when nightmares are severe and persist, they can cause numerous problems. They can:

• Affect the person having nightmares by leading the person to feel scared, anxious or depressed, and since they can interfere with sleep, can lead to fatigue.
• Affect family members, especially if their loved ones frequently wake them up from nightmares.

What Causes Nightmares?

Nightmares are believed to be a complicated mix of our memories, recent information that we are exposed to, visual representations of our feelings, along with other random information.

The exact cause of nightmares differs in each person, however common factors that may contribute to nightmares are:

• Stressful things that happen during the day. As the brain tries to process those stressful events and memories, nightmares may occur. Typical stresses include relationships, life changes, etc.
• Recent information that we have been exposed to, such as watching scary movies or reading scary books before bedtime.
• Medical issues such as being sick with a high fever
• Medications: Certain medications can cause nightmares.
• Painful or frightening memories
• Having conditions such as depression, anxiety or post-traumatic stress disorder (PTSD).
• Insomnia
• Being over tired.
• No reason at all: Many times, people may have nightmares and there is no obvious explanation.

Facts and Myths About Nightmares

There are many myths about nightmares, many of which are purposely promoted by scary movies.

Facts about Nightmares

• Nightmares cannot predict the future. Sometimes people have very scary nightmares about bad things happening. These are due to fears that you may have. Although scary, there is no evidence that nightmares can predict future events.
• Nightmares cannot harm you. Nightmares may be very scary. Unlike what some Hollywood movies may suggest however, nightmares cannot hurt you or harm you.
• Nightmares can be helpful. Although scary, some people find nightmares inspirational and exciting. For example, the author Stephen King and the artist Salvador Dali often used nightmares as inspiration for their books and art.

What Can I do to Prevent Nightmares?

The Environment

• Make sure that the following are comfortable:
  • Your bed (mattress, pillows, sheet)
  • The temperature of the room; we sleep better if it’s cool
  • If you get thirsty in the middle of the night, consider having a glass of water beside your bed, or consider a humidifier for dry air.
    
• Consider getting a red or orange light for your room, such as for your bedside lamp. This way, if you need to turn on the lamp in the middle of the night, it won’t be a harsh bright light that wakes you up.

Physical Health

• Take good care of your physical health
  • Get a good night’s sleep
  • Cut back on screen time, ideally to less than 2 hrs/day of recreational screens.
  • Cut back on alcohol use

Are you having problems with sleep?

• Learn more about strategies to help with sleep

Mental Health

• Do you have troubles with anxiety, depression or stress? If so, then consider seeing your primary care provider, or a mental health professional for help.

• Deal with any stresses
  • Are there any stresses with work or school? If so, consider getting help and support to deal with those. Consider accommodations, modifications or other means.

• Do you struggle with self-criticism?
  • If so, then consider working on your self-acceptance.
  • Do you find that your expectations are so high that you often feel bad about not meeting those expectations?
  • If high expectations cause you stress, then consider lower or have more realistic expectations.

Coping with Nightmares

• Re-writing the nightmare
  • The next day after a nightmare, write down the scary nightmare
  • Then, rewrite the nightmare with a positive ending.

• Self-exposure therapy is a variant of CBT that utilizes a technique of “graded exposure.” Make a list of anxiety-provoking events and/or dreams. Move through the situations on the list at your own own rate -- think about the lowest anxiety provoking situation; continue until the fear/anxiety has decreased. The exposure is done on a daily basis with documentation in a journal of his or her experiences.

Say That I’ve Just Woken Up From a Nightmare, What Can I Do?

Things you can do on your own

• Consider turning on a night light.
  
• Remind yourself that "That was a nightmare. It’s not real. I am safe."
  
• Grounding strategies. Try using the following:
  • What are 5 things that I can see?
    • E.g. the wall, the bed, the window...
  • What are 4 things that I can touch and feel?
    • E.g. the wall, the bed, the pillows, rubbing my hands, stomping my feet, stress balls…
  • What are 3 things that I can hear?
    • E.g. You could say, "I've just had a dream", "None of it was real", "I'm going to just chill...
    • E.g. Playing soothing, calming music
  • What are 2 things that I can smell?
    • E.g. scented aromatherapy oils, dried lavender, scented lotion
  • What is 1 thing that I am grateful for?
    • E.g. my family, my friends, having a bed to sleep in….

When to Get Help?

Are your nightmares causing troubles with sleep? Not getting better on their own? If so, then talk to a health professional.

Treatments for Nightmares

Professionals may use some of the following treatments for nightmares:

• Counseling/Therapy: A therapist can help you address some of the life circumstances, thoughts or feelings that might be contributing to the nightmares. More intensive counseling may be needed if the nightmares are caused by a traumatic event.
  
• Image Rehearsal Therapy (IRT). Developed by Dr. Krakow in the 1990’s for survivors of sexual assault, most patients using the technique report that it helps reduce the intensity of nightmares.
  IRT involves:
  a) Writing down the nightmares in detail
  b) Changing the story to include positive images and outcomes
  c) Practice reading and rehearsing the new dream each day for 10-20 minutes when you are awake. Do this for several weeks.

• Lucid dreaming. Lucid dreaming is developing an awareness that you are dreaming (i.e. to become lucid), which allows you to consciously alter the nightmare.

• Exposure therapy and systematic desensitization: When there are upsetting dreams, a therapist can help ensure gradual exposure to the content, with the intention of lessening your emotional response. Systematic desensitization is most useful when recurrent nightmares appear after traumatic experiences..

• Stress management. Learning how to manage stress in your life may help. Consider learning relaxation training or medication that you are able to reduce the anxiety or tension that keeps you from falling asleep, so you can go back to sleep after a nightmare.”

For More Information

The American Academy of Sleep Medicine has an excellent website with more information about nightmares.

http://www.sleepeducation.com/sleep-disorders-by-category/parasomnias/nightmares/overview

References

Aurora RN, Zak RS, Auerbach SH, Casey KR, Chowdhuri S, Karippot A, Maganti RK, Ramar K, Kristo DA, Bista SR, Lamm CI, Morgenthaler TI; Standards of Practice Committee; American Academy of Sleep Medicine. Best practice guide for the treatment of nightmare disorder in adults. J Clin Sleep Med. 2010 Aug 15;6(4):389-401. PMID: 20726290; PMCID: PMC2919672.

Authors

Written by members of the Mental Health Information Committee of the Children’s Hospital of Eastern Ontario (CHEO), an interdisciplinary group that includes psychiatry, psychology, child/ youth care, social work, nursing, and occupational therapy. Special thanks to Dr. Marjorie Robb for comments and suggestions.

License

Under a Creative Commons License. You are free to share, copy and distribute this work as in its entirety, with no alterations. This work may not be used for commercial purposes. View the full license at: http://creativecommons.org/licenses/by-nc-nd/2.5/ca/

Disclaimer

Information in this fact sheet may or may not apply to you. Your health care provider is the best source of information about your health.