How to deal with nightmares: A practical guide for better sleep

We all get nightmares from time to time, so we know how frightening and unsettling they can be. Sometimes they are so vivid that the feelings of fear, anxiety, anger, guilt, and sadness rest with us upon waking.

But why do we get nightmares; is there a way to reduce their frequency; and how do we deal with them?

In this article, we’re going to dig deep into the subject of nightmares and answer these and any other questions you may have.

I. Understanding dreams

Nightmares are essentially bad dreams. In order to understand nightmares, one has to understand dreams.

Dreams: Background

Dreams are the brain’s attempts to process and make sense of the information collected while awake.

Throughout history, people have tried to find the reason for dreaming. Ancient civilizations believed that dreams were prophetic messages or omens.

It wasn’t until the end of the 19th century that some of the most widely-known modern theories of dreaming were put forth by Sigmund Freud and Carl Jung.

Freud believed that dreams are a way of expressing unconscious desires and wishes. He believed that the content, symbols, and images in dreams are a reflection of the unconscious mind and reveal a person’s deepest desires and repressed emotions.

Jung believed that dreams are not just a reflection of our unconscious desires, but also a way of communicating with the unconscious mind. According to him, dreams can provide insight into the unconscious and help us understand our life journey and the part we play in it.

While Freud and Jung disagreed on many aspects of dream psychology, their theories have helped shape how we think about and interpret our dreams, and have had an immense impact on the field of dream psychology.

Today, the prevalent dream theory is the “Activation-synthesis hypothesis” put forward by Allan Hobson and Robert McCarley in 1977.

According to their theory, dreams are the brain’s attempt to make sense of the electrical impulses it receives during REM sleep (see explanation below). These impulses are thought to originate from the brain regions associated with emotion, memory, and sensory processing. When the brain synthesizes these impulses, it produces dream images, thoughts, and emotions.

According to them, dreams have no hidden meanings and do not reflect unconscious wishes or desires. Instead, they are a product of the brain’s attempt to make sense of random signals.

Rapid eye movement (REM), dreams, and nightmares

Rapid eye movement (REM) is a stage of sleep characterized by rapid eye movement, increased brain activity, irregular breathing, and elevated heart rate, and it is when most dreams and nightmares occur.

REM sleep usually occurs about 90 minutes after you fall asleep and recurs every 90 minutes.

During REM sleep, the muscles become temporarily paralyzed, which can help prevent the body from acting out.

It is believed that REM sleep plays an important role in non-declarative (implicit) memory consolidation and the processing of emotions. It is during REM sleep that vividly recalled dreams occur the most.

“Because we tend to dream on the sleep-wake cusp, images imagined while dreaming, including the vivid, often terrifying images produced during nightmares, are remembered.” – Nightmares and the brain.

II. Causes of Nightmares

While everyone has nightmares, they are most common in children under the age of 10 and are more prevalent in girls than in boys.

It is thought that the reason that nightmares are more common in children than in adults is evolutionary. According to Deirdre Barrett, Ph.D, assistant clinical professor of psychology at Cambridge Health Alliance, “Children are smaller and are vulnerable to many more threats than adults. Nightmares may partially reflect this vulnerability.”

While nightmares are a normal part of the sleeping cycle, if they become too frequent and disrupt one’s sleep patterns, they may have an underlying cause such as a medical condition or mental disorder.

Nightmares can be caused by many things, let’s take a closer look:

1) Watching scary movies, reading scary books, or playing scary video games

The images and stories presented in scary movies, books, and video games can be unsettling and cause fear which is why they’re potential triggers for nightmares.

This is especially true for children who get frightened easily.

2) Drinking caffeine late in the day

Caffeine is a well-known stimulant that can disrupt the natural sleep cycle and increase anxiety – leading to frequent and intense nightmares.
People who are sensitive to caffeine should avoid drinking it late in the day to ensure a good night’s rest.

3) Having a heavy meal before bed

Digesting a heavy meal can lead to an increase in body temperature and heart rate which can increase the likelihood of a nightmare.

What’s more, eating late at night can also lead to indigestion and heartburn, which can further increase the chances of having a nightmare.

To reduce the chances of having nightmares, one should avoid eating large meals before bed.

4) Stress, anxiety, and depression

Now we come to some more serious causes of nightmares.

• Stress is often caused by external pressures such as work, school, or the death of a loved one and can trigger nightmares. It can also result in physical symptoms such as back pain, headaches, and trouble sleeping.

• Anxiety, or the feeling of apprehension or fear, can be caused by things like financial worries, trauma, or an underlying medical condition. People who experience anxiety have a greater risk of nightmares. These nightmares often involve fear, danger, and panic.

• Depression is a mental health disorder that causes persistent feelings of sadness, hopelessness, emptiness, and disinterest in taking part in day-to-day activities. Depression can lead to a wide range of psychological and physical symptoms – such as nightmares and trouble sleeping – and interfere with one’s ability to function.

If you are experiencing nightmares as a result of stress, anxiety, and depression, it is important to seek professional help.

A therapist or counselor can help individuals identify and address the underlying causes of their stress, anxiety, and depression, which can help reduce their nightmares. More on that further down.

5) Certain medications

Nightmares are a common side effect of certain medications such as antidepressants, antihistamines (such as chlorpheniramine), beta-blockers (by suppressing REM sleep), and even certain antibiotics (such as Erythromycin) as they are thought to act on the central nervous system.

6) Fever

Fever is known to cause nightmares or “fever dreams” as they’re often referred to. This is likely because of elevated brain temperatures which disrupt normal cognitive processes.
According to a 2016 study by M. Schredl et al., “The idea is that the brain is not functioning well during high fever”.

7) Alcohol and drug abuse

Alcohol disrupts your sleep cycle and can interfere with your REM sleep. In doing so, alcohol can bring on bad dreams.

Substance withdrawal can also trigger nightmares. This includes withdrawal from:

• Alcohol
• Marijuana
• Stimulants such as cocaine, methamphetamines, and even prescription drugs.

These drugs can also intensify any pre-existing nightmare disorders and should be avoided.

8) Post-traumatic stress disorder (PTSD)

Post-Traumatic Stress Disorder (PTSD) is a mental health condition that is triggered by a traumatic event. It is characterized by intrusive thoughts, flashbacks, and nightmares.

Nightmares associated with PTSD often involve reliving the traumatic event or contain elements of the event in a distorted form and can be extremely distressing

These nightmares often cause the sufferer to feel scared, isolated, and vulnerable. People with PTSD may also experience other forms of sleep disturbances, such as difficulty falling asleep and staying asleep.

Treatment for PTSD-related nightmares typically involves cognitive-behavioral therapy (see VI. Seeking professional help).

9) Sleep disorders such as sleep apnea, narcolepsy, and nightmare disorder

Sleep disorders are disturbances in sleeping patterns that can have serious implications.

They range from difficulty falling asleep or staying asleep, to excessive daytime sleepiness, to vivid dreams or nightmares.

• Sleep apnea prevents a person from breathing normally when they are asleep. Often, people with sleep apnea snore, stop breathing for short periods of time and wake up frequently from time to time.

• Narcolepsy is characterized by sudden and uncontrollable sleep attacks. People with narcolepsy may also have vivid dreams, hallucinations, and cataplexy (muscle weakness).

• Nightmare disorder is characterized by recurrent nightmares. The nightmares often put the dreamer into life-threatening situations.

Nightmare disorder is only diagnosed if it fits the following criteria:

1. Frequent nightmares that put the person in a dangerous situation and that impact their mood in a negative way

2. The person has to be alert upon waking from the nightmares

3. The nightmares have to impact the person’s personal, social, or professional life by affecting their mood, sleep, behavior, cognition, etc.

IV. Nightmares vs. night terrors

People often mistakenly think that nightmares and night terrors are the same thing.

While they are both unpleasant and disruptive experiences, their causes and symptoms differ.

Nightmares are scary, vivid dreams that normally occur during REM sleep and usually cause the person to wake up. The dreams are usually easy to remember.

Night terrors on the other hand actually occur during non-REM sleep and are characterized by screaming, thrashing, increased heart rate, sweating, and even sleepwalking. They are most common in children between the ages of three and five.

V. Dealing with nightmares

There are different ways to deal with nightmares, depending on their cause.

When it comes to nightmares caused by drinking coffee before going to bed or even mild stress and anxiety, there are certain things you can do to reduce their frequency or to get rid of them altogether.

1) Establish a healthy sleep routine

This means going to bed at a reasonable hour. In general, people should aim to go to sleep a few hours after sunset and wake up soon after sunrise. According to some researchers, this means that we should go to bed between 10 p.m. and 11 a.m.

For a good night’s rest, it is recommended to sleep between 7-9 hours each night. It’s also important to keep in mind the importance of a consistent schedule and routine. That means that if you normally go to bed at 10 and wake up at 7, you should try to keep up this routine on the weekend too. This will help you have a healthy sleep pattern.

The reason has to do with your circadian rhythm which is a sort of internal clock that regulates sleep. According to sleep disorders expert Colleen Lance, MD, “As the sun goes down, your brain perceives through the lack of light that it’s time to go to sleep, and it triggers a secretion of melatonin. It’s that tiny little burst of melatonin that triggers other neurochemicals to start the process to get you ready to go to sleep in a few hours.”

Other things to keep in mind are avoiding heavy meals before bed, avoiding caffeine and other stimulants late in the day, keeping away from screens for at least an hour before going to sleep, and creating a relaxing bedtime ritual to wind down before falling asleep.

2) Identifying triggers

Identifying nightmare triggers could be an important tool to help you deal with nightmares, decrease their frequency, and improve your sleep.

Once you identify the triggers that lead to nightmares, you can take the necessary steps to avoid them. For example:

• Avoid certain topics of conversation and arguments before going to bed that may bring up difficult emotions or painful memories.

• Identify potential stressors in your life and make changes to minimize their impact on your well-being and your sleep patterns. This could for example be work or relationship-related stress.

• Avoid watching horror movies before going to sleep.

3) Keep a dream journal

Dream journals are an important tool for dealing with nightmares.

Keeping a dream journal can provide insight into what may be causing the nightmares and how to best address them.

This may include identifying any underlying emotional issues at play, as well as recognizing any behavioral patterns that could be contributing to the nightmares.

In short, a dream journal can help identify nightmare triggers, manage stress, and develop coping strategies.

4) Exercise

When it comes to nightmares caused by stress and anxiety, engaging in regular exercise is a great way to reduce the frequency of nightmares.

Exercise helps to reduce the levels of stress hormones in the body, and this can help reduce the frequency and intensity of nightmares.

It also increases the levels of endorphins, the hormones that can help reduce stress and improve mood. What’s more, endorphins can also help improve the quality of sleep.

Regular exercise can also help to distract the mind from negative thoughts and the amount of time spent worrying, which can also help reduce the chances of having a nightmare.

5) Relaxation techniques

Relaxation techniques can be a great way to help deal with nightmares.

These are some relaxation techniques that may be helpful:

• Deep breathing – Taking slow, deep breaths can help to relax the body and mind after the nightmare.

• Grounding techniques – Grounding techniques, such as counting to ten, can help to bring the mind to the present moment and away from the nightmare.

• Progressive muscle relaxation – This technique involves tensing and relaxing different muscle groups throughout your body, to help relieve physical tension that may be causing the nightmare.

• Visualization – Imagining a peaceful, calming scene or environment can help to take the mind away from the nightmare. It can also help one relax before going to sleep and thus reduce the chance of a nightmare.

• Self-affirmations – Positive self-talk and affirmations can help to reduce the fear and anxiety associated with nightmares.

While using relaxation techniques can be an effective way to help cope with nightmares, it is important to remember that these techniques may not work for everyone.

VI. Seeking professional help

1) When to seek professional help

If you have tried to deal with your nightmares by yourself without much luck, if your nightmares are frequent and recurrent over long periods of time, disrupt your sleep patterns, and keep you from functioning normally, you should make an appointment with a health professional.

A medical professional can diagnose nightmares by taking a detailed history, including a person’s sleep patterns, day-to-day activities, and any recent stressors or traumas.

Other tests such as blood tests, EEGs, and brain scans may be performed to rule out any physical causes of nightmares.

A mental health professional can also be consulted to assess any psychological causes, such as depression, anxiety, or PTSD.

Finally, a sleep study may be conducted to monitor a person’s sleep cycle and any physical reactions to the nightmares. During a sleep study, a patient is monitored while they sleep to measure their brain activity and other physiological activity.

The results of the sleep study can be used to determine if the patient is suffering from a sleep disorder, such as nightmare disorder. A sleep study may also be used to diagnose other sleep disorders such as sleep apnea.

After the study, the medical professional would analyze the data to determine if the patient is suffering from nightmare disorder and recommend the appropriate treatment plan.

2) Treatment

The treatment depends on the cause of the nightmare disorder and may include:

• Medication: If the nightmares are the result of an underlying health condition, your doctor will aim the treatment at the underlying condition.

Medication is rarely used to treat the nightmares themselves, but with severe nightmares associated with disorders such as PTSD, medication may be recommended.

• Stress and anxiety: In the case of mild stress and anxiety, your doctor may suggest relaxation and stress-reduction techniques, while in the case of severe stress and anxiety, they will recommend therapy with a mental health professional.

• Imagery rehearsal therapy: Imagery rehearsal therapy (IRT) is a form of cognitive-behavioral therapy used to treat individuals who have severe nightmares.

IRT involves having the individual visualize a new, more positive resolution to their nightmare.

IRT can be used for both post-traumatic nightmares (such as in the treatment of PTSD) or idiopathic nightmares which have no clear cause. It can also be used to treat depression-related nightmares.

During IRT, the individual is asked by their therapist to recall their recurrent nightmare in detail. Then, together they create an alternative, more positive ending to the nightmare.

This new ending is then rehearsed mentally by the individual on a regular basis – 10 to 20 minutes a day – until the nightmare is replaced by a new, more positive resolution.
The aim is for your nightmare to become less frightening and to eventually disappear altogether.

Idiopathic nightmares may be resolved after just a couple of sessions with a therapist, whereas post-traumatic nightmares tend to be more severe and will normally take longer to treat.

VII. Conclusion

Understanding the cause of one’s nightmares is the first step to dealing with them.

Whether the cause is something simple like watching a scary movie, or something more complex such as a mental health disorder, taking the necessary steps can help the individual deal with the effects of the nightmares and significantly reduce their frequency or get rid of them altogether.