Nightmares: what they are and what helps

Bad dream or nightmare?

The clinical distinction is simple: a nightmare wakes you. A frightening dream you sleep through is a bad dream. The line matters because nightmare frequency, defined that way, is what the research measures and what treatment targets.

What raises nightmare frequency

• Waking stress and anxiety.
• Trauma. Trauma-related nightmares are more repetitive and more literal than ordinary ones.
• Some medications, and withdrawal from others.
• Alcohol, particularly on withdrawal or rebound.
• Fever and illness.
• Sleep deprivation, via REM rebound.

What actually helps

Imagery rehearsal therapy has the best evidence of any nightmare treatment, and the method fits in a paragraph:

1. Choose one recurring nightmare.
2. Write it down.
3. Change the ending to something you would rather happen. Any change, as long as it is yours.
4. Rehearse the new version while awake, a few minutes a day.

That is it. It has meaningful evidence behind it, including in PTSD, and it is the basis of the nightmare-rescripting programme in the Learn section.

Other things that help: treating the underlying stress or trauma, regularising sleep, and reducing alcohol.

When to get help

If nightmares are waking you regularly and affecting your days, that is worth a doctor's time. Frequent nightmares are treatable, and people wait far too long, usually because they assume nothing can be done.