Sleep and Dreaming What Is Nightmare Disorder? By Julia Childs Heyl Julia Childs Heyl Julia Childs Heyl is a clinical social worker who focuses on mental health disparities, the healing of generational trauma, and depth psychotherapy. Learn about our editorial process Published on March 07, 2022 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Steven Gans, MD Medically reviewed by Steven Gans, MD Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital. Learn about our Medical Review Board Print Boy_Anupong / Getty Images Table of Contents View All Table of Contents What Is Nightmare Disorder? Symptoms Diagnosis Causes Treatment Coping What Is Nightmare Disorder? Nightmare disorder is a sleep disorder marked by experiencing lengthy, extremely upsetting, and well remembered dreams that cause significant distress or disrupt a person's life. About 4% of adults experiences nightmare disorder. Nightmare disorder often co-occurs with a diagnosis of post-traumatic stress disorder (PTSD) in adults. For this reason, combat veterans, survivors of abuse, and those who have experienced other forms of trauma are at high risk for developing nightmare disorder. Other common co-occurring diagnoses are substance use disorders, schizophrenia, schizoaffective, and borderline personality disorders. Nightmare disorder can be extremely unsettling, but it is treatable. The first step to recovery is learning the symptoms. Here's Why You Might Have the Same Nightmare Over and Over Again Symptoms of Nightmare Disorder Maybe you’ve had a nightmare or two in the past but are beginning to experience them more regularly. At this point, you might be wondering what the difference between a bad dream and a diagnosis of nightmare disorder is. Here's what you should know. First, let's explore what a nightmare is. It isn’t necessarily a stressful or creepy dream. It is incredibly vivid and disturbing, often involving threats to survival or a lack of safety. Upon waking up, you may experience the following symptoms: Trouble falling back asleep Waking up with unsettling emotions regarding the dream Physical discomfort, including sweating or a racing heartbeat The ability to recall vivid images from the dream for days to come If you’re experiencing any of the critical symptoms of nightmare disorder, it is worth speaking to your healthcare provider for more support. Diagnosis of Nightmare Disorder Now that you’re aware of what constitutes a nightmare let’s look at the difference between a bad dream and a diagnosis of nightmare disorder. According to the DSM-5, the current diagnostic criteria for nightmare disorder include the previously mentioned indicators of a nightmare. In addition, to constitute a diagnosis of nightmare disorder, one must also experience a significant impact on their ability to function at work, in social settings, or their daily life due to the distress of the nightmares. It is important to note that the nightmares cannot be attributed to the physiological effects of a substance (such as drugs, alcohol, or certain prescription medications) or the result of another diagnosed mental health disorder. The last note regarding the nightmares not being attributed to another mental health disorder can be tricky because nightmare disorder is often co-occurring with post-traumatic stress disorder. This means that your medical provider will need to rule out any other diagnoses and assess any co-occurring conditions. To receive the most accurate diagnosis and most effective treatment possible, track your daily symptoms for a few weeks and review them with your medical provider. According to the DSM-5, a nightmare disorder can be further specified depending on the duration and severity of nightmares. An acute specifier means the nightmares have been occurring for less than one month.Subacute means the nightmares have been occurring anywhere between one to six months.A persistent specifier means the nightmares and subsequent distress has been present for over six months. Severity can be mild, moderate, and severe: Mild means the nightmares occur less than once a weekModerate means you’re experiencing the nightmares one or more times a week, but not nightly Severe means the nightmares are a nightly occurrence It is crucial to receive a proper diagnosis, as that opens up the possibilities for treatment and relief. Causes of Nightmare Disorder First, let’s explore what can trigger nightmares in the first place. Stressors like untreated trauma and upsetting life circumstances can lead to nightmares. It is worth noting that even medications, like some antidepressants, can increase nightmares. Severity and duration may be dependent upon the initial trigger of the nightmare and the presence of positive resources like social support, mental health treatment, and regulated sleep patterns. 10 Things You Should Know About Dreams Treatment for Nightmare Disorder Image rehearsal therapy (IRT) is one of the top treatments for nightmare disorder. It is a type of cognitive-behavioral therapy (CBT) that guides individuals in recalling the nightmare, writing it down, and changing the story—removing upsetting aspects of the nightmare. A person then rehearses and practices the new version of the story to displace the unwanted dream content. This approach aims at re-scripting the nightmare to lessen the painful emotional content of the dream. Independently or in conjunction with IRT, a doctor may prescribe psychiatric medications. Some of the most common medications include prazosin and gabapentin, particularly for PTSD-related nightmares. How Imagery Rehearsal Therapy (IRT) Is Used to Control PTSD Nightmares Coping With Nightmare Disorder Coping with nightmare disorder can be exhausting, frustrating, and unsettling. Aside from seeking support from a medical professional, it is essential to set up resources in your daily life to help you cope. First, establish a healthy sleep routine incorporating meditation, taking a bath, or sipping your favorite non-caffeinated herbal tea before bed. Second, find sources of comfort you can turn towards when you wake up in the middle of the night. Maybe it is keeping a hallway light on if darkness scares you, or perhaps it is a weighted blanket to snuggle up under. Finally, reach out to your support system by identifying a trusted individual available to chat on days when you’re feeling challenged by this disorder. Also, finding a therapist who can help you address any underlying trauma or other psychopathology that might be contributing to your nightmares can be especially helpful. Most of all, remember that this disorder is treatable, and by educating yourself on it today, you’re one step closer to feeling better. How Imagery Rehearsal Therapy (IRT) Is Used to Control PTSD Nightmares 7 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Morgenthaler TI, Auerbach S, Casey KR, et al. Position paper for the treatment of nightmare disorder in adults: an american academy of sleep medicine position paper. J Clin Sleep Med. 14(06):1041-1055. doi:10.5664/jcsm.7178 Nadorff MR, Porter B, Rhoades HM, Greisinger AJ, Kunik ME, Stanley MA. Bad dream frequency in older adults with generalized anxiety disorder: prevalence, correlates, and effect of cognitive behavioral treatment for anxiety. Behav Sleep Med. 2014;12(1):10.1080/15402002.2012.755125. Schredl M, Goeritz AS. Nightmare frequency and nightmare distress: Socio-demographic and personality factors. Sleep Sci. 2019;12(3):178-184. doi:10.5935/1984-0063.20190080 American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). SpringerReference. doi:10.1007/springerreference_179660 Schredl Michael, Gilles Maria, Wolf Isabell, et al. Nightmares and stress: a longitudinal study. Journal of Clinical Sleep Medicine. 15(09):1209-1215. doi:10.5664/jcsm.7904 Khandai AC, Sita EE, Attarian HP. Medication-induced nightmares. Comorbid Sleep and Psychiatric Disorders: A Clinical Casebook. Springer International Publishing; 2019:193-200. Aurora RN, Zak RS, et al. Best practice guide for the treatment of nightmare disorder in adults. Journal of Clinical Sleep Medicine. 2010;06(04):389-401. doi: doi/10.5664/jcsm.27883 By Julia Childs Heyl Julia Childs Heyl, MSW, is a clinical social worker and writer. As a writer, she focuses on mental health disparities and uses critical race theory as her preferred theoretical framework. In her clinical work, she specializes in treating people of color experiencing anxiety, depression, and trauma through depth therapy and EMDR (eye movement desensitization and reprocessing) trauma therapy. See Our Editorial Process Meet Our Review Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit Speak to a Therapist Online Advertiser Disclosure × The offers that appear in this table are from partnerships from which Verywell Mind receives compensation.