Complete Guide To Nightmare Disorder


Each of us has nightmares now and then. They’re a fact of life and not uncommon. Of course, they’re just dreams, and cannot cause harm beyond frightening us.

They can definitely result in a terrible night, but what happens when they start affecting our day to day lives?

nightmare disorder symptoms

For those who suffer from nightmare disorder, nightmares are more than just a bedtime nuisance. They can quickly destroy a person’s life, affecting their work or ability to socialize.

What causes this, and how is it different from typical nightmares? If you think you, or a loved one, is suffering from nightmare disorder, then read on to learn more about this illness.

What Are Nightmares?

Nightmares are dreams that have two characteristics: they are vividly disturbing and they wake you up from a deep sleep.

When you wake up from a nightmare, you may feel physical symptoms of anxiety: sweating, a fast heartbeat, and disorientation. Other characteristics of a nightmare may include:

  • A dream subject that is related to threats to your safety.
  • You can recall the details of your dream when woken up.
  • The dream is so distressing that it can keep you from falling back to sleep.

Nightmares occur during the deepest part of sleep, the rapid eye movement (or REM) stage. This stage is when dreaming often occurs.

Being aroused during the REM stage of sleep can be very disorienting, making it harder for you to fall back to sleep.

Nightmare Disorder Definition

Nightmares are a type of parasomnia. Parasomnias are defined to be an ‘abnormal or unusual behavior’ that an individual goes through during sleep. Other, more common examples of parasomnias include sleepwalking and sleep paralysis.

While nightmares may seem tame when compared to other parasomnias, they can deserve medical attention. Like most types of parasomnias, a nightmare disorder can affect the quality of your life and impair your ability to function during the day.

Everyone gets nightmares now and then, but when do nightmares become a disorder? Nightmare disorder, also known as dream anxiety disorder, is characterized by nightmares that occur with unnatural frequency.

what causes nightmare disorder

Sleep Terror Disorder vs. Nightmare Disorder

While they may look the same on the surface, sleep terrors are different from nightmares. First, they have a different cause.

Both sleep terrors and nightmares cause someone to abruptly wake up in fear, but sleep terrors occur not because of dreams. Rather, they wake you up due to a great ‘feeling of fear.’

There is no source for this feeling, at least none that the sleeping person can recall. This reaction of fear also tends to be more dramatic than the reactions people have to nightmares.

Secondly, people who wake up from a nightmare often remember what woke them up, and can recall the imagery in their nightmare. Those who cannot remember the nightmare specifically can still recall that they had a nightmare.

Thirdly, night terrors occur early in the sleep cycle, just a few hours after falling asleep. Nightmares, on the other hand, occur later in the night during the REM stage of sleep.

This video goes into more detail on nightmare disorder.

Nightmare Disorder Causes

What causes nightmare disorder? Like many parasomnias, professionals have yet to determine the leading cause of nightmares and nightmare disorder.

However, there are common factors that can lead to most nightmares, including:

  • Stress and anxiety: As perhaps the most common cause of nightmares, stress can be a result of many things happening in your life. A big change, like moving to a new city or the death of a loved one, can be a significant stress point for many people. Anxieties in your day to day activities, like a stressful work environment or pressure from schoolwork, can also trigger nightmares.
  • Lack of sleep: In our modern day, it’s tough to maintain good sleep hygiene. Irregular sleeping and waking times, as well as failing to get enough hours of sleep, can lead to sleep deprivation. Insomnia has been linked to an increased risk of nightmares. The catch with nightmares, however, is that it makes you apprehensive about getting more sleep—putting at you at even higher risk for nightmare disorder.
  • Trauma: Nightmare disorders can be co-morbid, meaning that they occur due to another medical issue that you have, like trauma. You may be familiar with nightmares as a symptom of post-traumatic stress disorder, or PTSD. However, other types of trauma, be they physical, emotional, or sexual, can also be a trigger for nightmares.
  • Existing disorders: Existing disorders, especially mental disorders, can cause nightmares. Depression and anxiety are the most common. However, physical ailments, like cancer and heart disease, can also cause nightmares.
  • Medication: You may be taking medication that affects your sleep. Drugs like antidepressants or blood pressure medication can cause nightmares in some people. If this is the case, your doctor can easily prescribe you a different medicine or change the dosage of your prescription.
  • Substances: Substances that affect your sleep, like caffeine and alcohol, can be a cause for nightmare disorder. Alcohol and drug withdrawal symptoms can also include nightmares.
  • Scary movies and books: Watching or reading scary things can trigger nightmares, especially if these types of media are consumed before bed. Other frightening forms of entertainment, such as going to a haunted house, can be a trigger.

Who Gets Nightmare Disorder?

Everyone can develop symptoms of nightmare disorder. However, some factors put you at greater risk:

nightmare disorder medications

  • High levels of stress and anxiety: High levels of stress are often the leading cause of nightmares and nightmare disorder.
  • Age: Adults are more likely to develop nightmare disorder than children, even though children tend to have nightmares more often.
  • Pre-existing mental illnesses: Nightmare disorders often occur alongside other mental illnesses, especially those that are due to trauma, like PTSD. Seeking treatment for mental disorders is very likely to solve nightmare disorders as well.

Nightmare Disorder Symptoms

The following is a list of characteristics that your doctor may consider when diagnosing you with nightmare disorder.

  • Frequent and persistent nightmares, even multiple times a night.
  • Anxiety about experiencing another nightmare, even during the day.
  • Regularly disrupting sleep.
  • Sleepiness during the daytime, low energy, or fatigue due to a lack of sleep.
  • Constant recall of the images of the nightmare during the day.
  • Problems focusing on daytime activities, causing you to function less effectively at work or school.
  • Being apprehensive or anxious about the dark, nighttime, and falling asleep.

Diagnosing Nightmare Disorder

When your nightmares are so severe that they cause anxiety and impair your quality of life, do not be afraid to seek a diagnosis. While it may seem scary, seeking a diagnosis is the first step to recovery.

Nightmare Disorder Treatment

When your doctor has determined that your nightmares qualify as a nightmare disorder, the first thing they will do is determine the cause.

Nightmares can be caused by an underlying medical condition, be it physical or mental. If your doctor finds a medical issue, they will then treat that condition and determine if your nightmares lessen after treatment.

If your doctor doesn’t find any underlying medical issues, or if the issues have been treated and your nightmares persist, they will present to you the available treatment options.

Here are some of the ways that your doctor may treat your nightmare disorder:

  • Psychotherapy: This is a common treatment for those suffering from parasomnias. Psychotherapy treatments will focus on alleviating stress and anxiety to lessen your nightmares.
  • Image rehearsal therapy: Image rehearsal therapy (IRT) is most often used to treat patients who experience nightmares due to PTSD. This treatment is a type of cognitive-behavioral treatment, aiming to give you a sense of control during nightmares. In this treatment, your therapist will help you ‘change’ the endings of your nightmares so that you can approach sleep with a healthier state of mind.
  • Exposure, relaxation, and rescripting therapy: Like IRT, exposure, relaxation, and rescripting therapy (EERT) was created specifically for treating nightmares in patients who have PTSD. It is similar to IRT, although EERT focuses on and targets the most disturbing nightmare of the patient.
  • Medications: On some occasions, medications can also be prescribed by your doctor alongside other treatment options. There are a few types of medication that are available to people who are suffering from a nightmare disorder. Prazosin, an alpha-blocker that can reduce nightmares, is the recommended treatment by the American Academy of Sleep Medicine. Other nightmare disorder medications include atypical antipsychotics, clonidine, and benzodiazepines.
  • Lifestyle changes: While not exactly a medical treatment, your doctor is likely to advise some lifestyle changes to help you have a better night’s rest.

sleep terror disorder vs nightmare disorder

Home Remedies

Seeing a doctor for mental illnesses is always a good idea. However, if you’re still waiting for an appointment or are in between treatments, there are methods you can use to alleviate your symptoms.

These activities aim to alleviate stress and anxiety, as well as provide better sleeping habits. Managing stress and getting enough sleep is the basis of treating nightmare disorder.

Here are some ways to help you achieve just that.

  • Create a nighttime routine: A nighttime routine is a set of activities that you regularly do before sleeping. The main goal of a nighttime routine is to prepare your mind for sleep. When done right, a nighttime routine should help you avoid those instances when you’re lying in bed, staring at the ceiling, unable to sleep. Nighttime routines will vary from person to person, but popular ones include reading a book, taking a warm bath, or listening to calming music. All that matters is that you do your routine every night before sleeping.
  • Avoid electronics before sleeping: Electronics can alter our ability to sleep. recommends avoiding bright screens 30 minutes before sleeping. If you have to use electronics before bed, install a blue light filter to lessen the effects that bright light has on your eyes. Check out how to do that here.
  • Try meditation: Meditation, even for just 10 minutes a day, has been proven to alleviate stress. Meditation isn’t just all in the mind; it can affect your body, too. It slows down your heart rate, normalizes blood pressure, and improves immune functions. For those who want to try meditation, you can download apps on your phone to guide you through the process. Of course, meditation isn’t for everyone. For those who just can’t meditate, there are other alternatives, such as yoga, journaling, or taking a walk in nature.

Of course, for some people, nightmare disorder isn’t just due to high levels of stress.

Existing conditions, like clinical depression and heart problems, may cause nightmare disorder. You certainly can’t sleep to solve those illnesses!

If your nightmares remain persistent despite your best efforts, it’s always a good idea to seek professional help.

nightmare disorder

When to See a Doctor

Nightmares often do not require medical intervention. Most of the time, creating better sleeping habits, as well as lessening stress, is enough to make frequent nightmares diminish.

However, there are cases wherein seeking a diagnosis is necessary. Consult your doctor when:

  • Your nightmares occur frequently and have been occurring for a long period.
  • Nightmares are so severe that they cause you to lose sleep.
  • You have anxiety about falling asleep
  • Lack of sleep is impairing your ability to function in the daytime

Nightmare Disorder in Children

Be aware that nightmares are naturally more frequent in children. However, this doesn’t mean they’re at a greater risk for nightmare disorder; it has been found that only 1% of children suffer from a nightmare disorder.

If your child is suffering from frequent nightmares, it is a good idea to mention it to your physician during a check-up.

Otherwise, guiding your child through a bedtime routine, providing a night light, and soothing them when a nightmare occurs should be sufficient.

Your child will eventually grow out of it and have less frequent nightmares.

Here’s a video with more information on why we get nightmares.


A nightmare disorder can be scary to deal with, whether it’s affecting you or a loved one.

Of course, you can always seek help. With proper medical intervention, you will soon find yourself sleeping soundly once more.

Have you had experience with nightmare disorder?


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