Picture this: you finally crawl into bed after a long day at work. 
You’ve showered, done your skincare, and have cozied up with a book. As you doze off to sleep you’re suddenly woken by your heart racing out of your chest.
As you calm yourself down you realize it was a nightmare… again.
While nightmare disorder is rare, your sleep can still suffer greatly from this frightening occurrence, especially if it’s frequent.
So, what counts as a nightmare and when should you seek help? If you’re struggling with these unfortunate experiences you’re not alone. Let’s talk about all things nightmares so you can rest peacefully once and for all.
What Counts As A Nightmare?
A nightmare can be any bad dream that is disturbing, terrifying, or gruesome in nature. Nightmares trigger negative emotions such as fear, sorrow, or anxiety and often linger well after the dream has ended.
Not only do nightmares wake you from your sleep, but they may also leave you feeling unable to relax and fall back asleep afterward.
A few distinct features of nightmares include:
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Incredibly vivid details
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Emotionally triggering visuals
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Increase in disturbance as the dream continues
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Often pertains to threats of safety or survival
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Can be about yourself or others you care about
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May have other elements such as phobias, monsters, or torture
Nightmares primarily focus on dangers to our personal wellbeing and can range in severity. You may wake feeling sweaty or shaky as you lie in bed. As you emerge from sleep you can often recall many disturbing details of your dream. The defining factor, however, is that nightmares wake you up – while a simple bad dream may not.
Nightmare Disorder:
While everyone has experienced a nightmare before, suffering from a diagnosable nightmare disorder only affects around 4% of adults.
Nightmare disorder is classified as persistent nightmares that happen often and cause distress, sleeping problems, and a fear of sleep. Due to these horrifying bouts of wakefulness, symptoms often follow individuals into the next day.
A few characteristics of nightmare disorder may look like:
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Frequent, often nightly occurrences
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Impairment during the day from feelings of distress
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Anxiety or fear surrounding bedtime
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Concentration and memory problems
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Intrusive thoughts and images from your nightmares
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Daytime sleepiness
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Functioning problems at school, work, or other settings
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Behavior problems
There are three types of nightmare disorders, all diagnosed by how often they’ve been occurring:
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Acute: Nightmares have been occurring for 1 month or less
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Subacute: Nightmares have been occurring for over 1 month but less than 6 months
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Persistent: Nightmares have been occurring for over 6 months
Nightmares can also range by severity from more mild cases in which they occur once a week, to more severe cases where nightmares are an every night occurrence.
Common Themes Of Nightmares:
Think of some common nightmares you’ve had. Were you being chased? Were you falling off a cliff? If so, you’re part of a large majority! Most nightmares fall into those categories.
Some incredibly interesting research was conducted on groups of men and women to see what most people dream anxiously about.
The top 5 most common themes were as follows:
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65% reported nightmares about falling
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63% reported nightmares about being chased
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54% reported nightmares about dying
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53% reported nightmares about becoming lost
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52% reported nightmares about feeling trapped
The least common themes included:
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14% reported nightmares about a house fire
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13% reported nightmares about car troubles
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12% reported nightmares about the inability to start their car
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7% reported nightmares about technology failing
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4% reported nightmares about balding
As you can see, these statistics show universal anxiety about survival and physical harm. Each and every nightmare is a realistic dream distorted and wrapped in fear and sorrow. While some may be more disturbing than others, the severity and oftentimes ridiculousness of the situations being dreamt about can make even small situations seem devastating.
Why Do Nightmares Occur?
Nightmares or nightmare disorders are most likely to occur during the second phase of sleep – REM sleep. While doctors aren’t exactly sure what causes nightmares, they are often triggered by a few universal causes.
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Stress: The everyday anxieties of life can cause a great risk for nightmares. From moving, the death of a loved one, or even changing jobs, any situation that causes a major change in an individual’s life can cause nightmares.
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Trauma: After a traumatic event you may experience nightmares about the incident. This is common in both people with and without PTSD.
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Sleep Deprivation: When you’re sleep-deprived, you’re automatically at a higher risk for nightmares. When your body is in a sleep deficit, and you finally do fall asleep, you tend to sleep even harder, putting your brain into a deeper form of REM sleep. This stage of sleep known to cause nightmares can then work into overdrive.
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Medications: Antidepressants, blood pressure medications, drugs to quit smoking, and even beta blockers can all cause nightmares due to chemical changes in the brain that occur.
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Mental Health Disorders: Depression, anxiety, and other mental illnesses can put an individual at a higher risk for developing frequent nightmares.
Other reasons for nightmares include:
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Childhood trauma
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Sensitivity to negative stimuli or content
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Inability to suppress unwanted feelings
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Sleep apnea
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Smoking or alcohol use
When Should I See a Professional For My Nightmares?
If you’ve found peaking dread and anxiety before bedtime, you may want to seek professional help. In addition, if nightmares are occurring weekly and disrupting your sleep schedule it’s important to look for options to support your wellbeing. Sleep is our body’s way of repairing itself and prepping for the next day ahead. While being woken out of sleep is damaging in and of itself, to be woken frequently by feelings of horror, dread, and sorrow, is detrimental.
While occasional nightmares come and go, you should consider seeking therapy or medical assistance if:
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Nightmares occur often and don’t let up over time
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Affect your sleeping patterns or inhibit your ability to fall back asleep
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They are impairing your ability to function the next day
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Cause a resistance to falling asleep at night
There’s no shame in asking for help. Nightmares are not a phenomenon strictly affecting children. They can happen to anyone, at any age. No matter what the situation may be – whether you dream about your spouse leaving you, or you dream about your child drowning, nightmares can cause an unsettling feeling in your chest that may not go away without guidance.
How Can Therapy Help With Nightmares?
The first step to getting treated for nightmares is to ensure
they aren’t caused by any sort of genetic factor. Thankfully, most nightmares can be treated effectively.
If you’re sick of spending nights in bed awoken by feelings of fear and anxiety, there are a few options available to empower your best sleep yet.
Many therapists see nightmares through the lens of the ‘cognitive model of recurrent dreams’.
To keep it simple, this framework sees nightmares as a product of ‘recurring storylines’ that run in the background of our minds. These scripts are linked to a life stressor. When images in a dream relate to the original stressor, the nightmare storylines become activated even if the actual stressor is no longer a part of your conscious day.
Therapy Treatment For Nightmares
Image Rehearsal Therapy (IRT):
If you experience frequent nightmares, then you know you often wake up as soon as your dream peaks in intensity. This is typically because the imagery is far too frightening for a person’s mind to handle. This is where imagery rehearsal therapy comes in.
Image Rehearsal Therapy aims to take those vivid, horrifying images and confront them until they are no longer triggering. This is done by rewiring how the brain perceives these visuals.
In IRT treatment, a client is asked to picture the common images in their nightmares, and then redirect the storyline into a less frightening one – therefore defusing the power these dreams have over you. When a nightmare occurs again, your brain is better equipped to process what is happening.
What To Expect During Image Rehearsal Therapy:
You’ll be educated on the importance of sleep, why nightmares occur, and how overcoming these sleep disturbances is beneficial for your overall health. Then, your therapist will likely engage in practices such as :
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Asking you to think about a detailed, positive ending for your nightmares.
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Write these alternate endings down on paper
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Have you rehearsed these endings repeatedly
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Tasks to perform at home monitoring of your nightmares
While you may want to dig right into your most horrifying and upsetting nightmares right off the bat, your therapist will likely start small as a way to boost confidence. Starting too big may trigger intense emotional responses, which is not the end goal of IRT.
Final Thoughts:
Nightmares can leave you feeling shaken for hours afterward. While many adults fail to seek help due to embarrassment or shame, take heart knowing nightmares can affect anyone at any age. If therapy isn’t an option for you, at-home coping strategies such as keeping a dream journal, cutting back on alcohol before bed, establishing a regular sleep routine, and removing scary movies from your late-night binge list are extremely helpful. You deserve to sleep without fear, and so does your body.
Sources:
https://www.cnn.com/2020/09/04/health/how-to-stop-nightmares-in-adults-wellness/index.html
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