Why do people have bad dreams

Adult Nightmares: Causes and Treatments

Written by Hilary Parker

What Are Nightmares?

Nightmares are vividly realistic, disturbing dreams that rattle you awake from a deep sleep. They often set your heart pounding from fear. Nightmares tend to occur most often during rapid eye movement (REM) sleep, when most dreaming takes place. Because periods of REM sleep become progressively longer as the night progresses, you may find you experience nightmares most often in the early morning hours.

The subjects of nightmares vary from person to person. There are, though, some common nightmares that many people experience. For example, a lot of adults have nightmares about not being able to run fast enough to escape danger or about falling from a great height. If you've gone through a traumatic event, such as an attack or accident, you may have recurrent nightmares about your experience.

Although nightmares and night terrors both cause people to awake in great fear, they are different. Night terrors typically occur in the first few hours after falling asleep. They are experienced as feelings, not dreams, so people do not recall why they are terrified upon awakening.

What Causes Nightmares in Adults?

Nightmares in adults are often spontaneous. But they can also be caused by a variety of factors and underlying disorders.

Some people have nightmares after having a late-night snack, which can increase metabolism and signal the brain to be more active. A number of medications also are known to contribute to nightmare frequency. Drugs that act on chemicals in the brain, such as antidepressants and narcotics, are often associated with nightmares. Non-psychological medications, including some blood pressure medications, can also cause nightmares in adults.

Withdrawal from medications and substances, including alcohol and tranquilizers, may trigger nightmares. If you notice a difference in your nightmare frequency after a change in medication, talk with your doctor.

Sleep deprivation may contribute to adult nightmares, which themselves often cause people to lose additional sleep. Though it's possible, it has not been confirmed whether this cycle could lead to nightmare disorder.

There can be a number of psychological triggers that cause nightmares in adults. For example, anxiety and depression can cause adult nightmares. Post-traumatic stress disorder (PTSD) also commonly causes people to experience chronic, recurrent nightmares.

Nightmares in adults can be caused by certain sleep disorders. These include sleep apnea and restless legs syndrome. If no other cause can be determined, chronic nightmares may be a distinct sleep disorder. People who have relatives with nightmare disorder may be more likely to have the condition themselves.

What Are the Health Effects of Nightmares in Adults?

Nightmares become much more than bad dreams when they have a significant effect on your health and well-being. Among people who experience nightmares, those who are anxious or depressed are more likely to be distressed about the experience and suffer even more psychological ill effects. Although the relationship is not understood, nightmares have been associated with suicide. Because nightmares may have a significant impact on your quality of life, it's important to consult a medical professional if you experience them regularly.

Sleep deprivation, which can be caused by nightmares, can cause a host of medical conditions, including heart disease, depression, and obesity.

If nightmares in adults are a symptom of untreated sleep apnea or post-traumatic stress disorder, the underlying disorders can also have significant negative effects on physical and mental health.

Treatments for Nightmares in Adults

Fortunately, there are steps you and your doctor can take to lessen the frequency of your nightmares and the effect they are having on your life. First, if your nightmares are the result of a particular medication, you may be able to change your dosage or prescription to eliminate this unwanted side effect.

For people whose nightmares are caused by conditions such as sleep apnea or restless legs syndrome, treating the underlying disorder may help alleviate symptoms.

If your nightmares aren't illness- or medication-related, don't despair. Behavioral changes have proven effective for 70% of adults who suffer from nightmares, including those caused by anxiety, depression, and PTSD.

Imagery rehearsal treatment is a promising cognitive behavioral therapy for recurrent nightmares and nightmares caused by PTSD. The technique helps chronic sufferers change their nightmares by rehearsing how they would like them to transpire. In some cases, medications may be used in conjunction with therapy to treat PTSD-related nightmares, though their efficacy has not been demonstrated as clearly as that of imagery rehearsal treatment.

There are a number of other steps you can take on your own that may help reduce your nightmare frequency. Keeping a regular wake-sleep schedule is important. So is engaging in regular exercise, which will help alleviate nightmare-causing anxiety and stress. You may find that yoga and meditation are also helpful.

Remember to practice good sleep hygiene, which will help prevent the sleep deprivation that can bring on nightmares in adults. Make your bedroom a relaxing, tranquil place that is reserved for sleep and sex, so that you don't associate it with stressful activities. Also, be cautious about the use of alcohol, caffeine, and nicotine, which can remain in your system for more than 12 hours and often disrupt sleep patterns.

Nightmares: Symptoms, Causes, & Treatment

Dreaming is one of the most complicated and mysterious aspects of sleep. While dreams can include visions of grandeur and bliss, they can also be scary, threatening, or stressful.

When a bad dream causes you to wake up, it’s known as a nightmare. It’s normal to occasionally have a nightmare or bad dream, but for some people, they recur frequently, disrupting sleep and negatively impacting their waking life as well.

Knowing the differences between bad dreams, nightmares, and nightmare disorder is a first step to addressing the causes of nightmares, starting appropriate treatment, and getting better sleep.

What Are Nightmares?

In sleep medicine, nightmares have a more strict definition than in everyday language. This definition helps distinguish nightmares from bad dreams: while both involve disturbing dream content, only a nightmare causes you to wake up from sleep.

Nightmares are vivid dreams that may be threatening, upsetting, bizarre, or otherwise bothersome. They occur more often during rapid eye movement (REM) sleep, the stage of sleep associated with intense dreaming. Nightmares arise more frequently in the second half of the night when more time is spent in REM sleep.

Upon waking up from a nightmare, it’s normal to be acutely aware of what happened in the dream, and many people find themselves feeling upset or anxious. Physical symptoms like heart rate changes or sweating may be detected after waking up as well.

What Is Nightmare Disorder?

While most people have nightmares from time to time, nightmare disorder occurs when a person has frequent nightmares that interfere with their sleep, mood, and/or daytime functioning. It is a sleep disorder known as a parasomnia. Parasomnias include numerous types of abnormal behaviors during sleep.

People who have occasional nightmares don’t have nightmare disorder. Instead, nightmare disorder involves recurring nightmares that bring about notable distress in their daily life.

Are Nightmares Normal?

It’s normal for both children and adults to have bad dreams and nightmares every now and again. For example, a study found that 47% of college students had at least one nightmare in the past two weeks.

Nightmare disorder, though, is far less common. Research studies estimate that about 2%-8% of adults have problems with nightmares.

Frequent nightmares are more common in children than in adults. Nightmares in children are most prevalent between the ages of 3 and 6 and tend to occur less often as children get older. In some cases, though, nightmares persist into adolescence and adulthood.

Nightmares affect males and females, although women are generally more likely to report having nightmares, especially during adolescence through middle age.

Why Do We Have Nightmares?

There is no consensus explanation for why we have nightmares. In fact, there is an ongoing debate in sleep medicine and neuroscience about why we dream at all. Many experts believe that dreaming is part of the mind’s methods for processing emotion and consolidating memory. Bad dreams, then, may be a component of the emotional response to fear and trauma, but more research is needed to definitively explain why nightmares occur.

How Are Nightmares Different From Sleep Terrors?

Sleep terrors, sometimes called night terrors, are another type of parasomnia in which a sleeper appears agitated and frightened during sleep. Nightmares and sleep terrors have several distinguishing characteristics:

Nightmares happen during REM sleep while sleep terrors happen during non-REM (NREM) sleep.
Sleep terrors don’t involve a full awakening; instead, a person remains mostly asleep and difficult to awaken. If awakened, they likely will be disoriented. In contrast, when a person wakes up from a nightmare, they tend to be alert and aware of what was happening in their dream.
The following day, a person with nightmares usually has a clear memory of the dream. People with sleep terrors very rarely have any awareness of the episode.
Nightmares are more common in the second half of the night while sleep terrors happen more often in the first half.

Causes

Many different factors can contribute to a higher risk of nightmares:

Stress and anxiety: Sad, traumatic, or worrisome situations that induce stress and fear may provoke nightmares. People with chronic stress and anxiety may be more likely to develop nightmare disorder.
Mental health conditions: Nightmares are often reported at much higher rates by people with mental health disorders like post-traumatic stress disorder (PTSD), depression, general anxiety disorder, bipolar disorder, and schizophrenia. People with PTSD often have frequent, intense nightmares in which they relive traumatic events, worsening symptoms of PTSD, and often contributing to insomnia.
Certain drugs and medications: Using some types of illicit substances or prescription medications that affect the nervous system is associated with a higher risk of nightmares.
Withdrawal from some medications: Some medications suppress REM sleep, so when a person stops taking those medications, there is a short-term rebound effect of more REM sleep accompanied by more nightmares.
Sleep deprivation: After a period of insufficient sleep, a person often experiences a REM rebound, that can trigger vivid dreams and nightmares.
Personal history of nightmares: In adults, a risk factor for nightmare disorder is a history of having had recurring nightmares during childhood and adolescence.

Though not fully understood, a genetic predisposition may exist that makes it more likely for frequent nightmares to run in a family. This association may be driven by genetic risk factors for mental health conditions that are tied to nightmares.

Some evidence indicates that people who have nightmares may have altered sleep architecture, meaning that they progress abnormally through sleep stages. Some studies have also found a correlation between nightmares and obstructive sleep apnea (OSA), a breathing disorder that causes fragmented sleep, although further research is needed to clarify this association.

Are Nightmares Connected To Waking Activity?

Nightmares can have a clear connection to things that happen while you’re awake. Nightmares tied to anxiety and stress, especially PTSD, may involve flashbacks or imagery that is directly linked to traumatic events.

However, not all nightmares have an easily identified relationship to waking activity. Nightmares can have bizarre or bewildering content that is difficult to trace to any specific circumstances in a person’s life.

Can Nightmares Affect Sleep?

Nightmares, especially recurrent nightmares, can have a significant impact on a person’s sleep. People with nightmare disorder are more likely to suffer from decreases in both sleep quantity and quality.

Sleep problems can be induced by nightmares in several ways. People who have nighttime disruptions from nightmares may wake up feeling anxious, making it hard to relax their mind and get back to sleep. Fear of nightmares may cause sleep avoidance and less time allocated to sleep.

Unfortunately, these steps can make nightmares worse. Sleep avoidance can cause sleep deprivation, which can provoke a REM sleep rebound with even more intense dreams and nightmares. This often leads to further sleep avoidance, giving rise to a pattern of disturbed sleep that culminates in insomnia.

Nightmares may exacerbate mental health conditions that can worsen sleep, and insufficient sleep can give rise to more pronounced symptoms of conditions like depression and anxiety.

Insufficient sleep connected to nightmares and nightmare disorder can cause excessive daytime sleepiness, mood changes, and worsened cognitive function, all of which can have a substantial negative impact on a person’s daytime activities and quality of life.

When Should You See a Doctor About Nightmares?

Because it’s common to have an occasional nightmare, some people may find it hard to know when nightmares are a cause for concern. You should talk to your doctor about nightmares if:

Nightmares happen more than once a week
Nightmares affect your sleep, mood, and/or daily activity
Nightmares begin at the same time that you start a new medication

To help your doctor understand how nightmares are affecting you, you can keep a sleep diary that tracks your total sleep and sleep disruptions, including nightmares.

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How Is Nightmare Disorder Treated?

Infrequent nightmares don’t normally need any treatment, but both psychotherapy and medications can help people who have nightmare disorder. By reducing nightmares, treatments can promote better sleep and overall health.

Treatment for nightmares should always be overseen by a health professional who can identify the most appropriate therapy based on a patient’s overall health and the underlying cause of their nightmares.

Psychotherapy

Psychotherapy, also known as talk therapy, is a category of treatment that works to understand and reorient negative thinking. Talk therapy has broad applications in addressing mental health disorders and sleeping problems like insomnia.

Many types of psychotherapy fall under the umbrella of cognitive-behavioral therapy (CBT), including a specialized form of CBT for insomnia (CBT-I) that may be used to treat nightmares. A central component of CBT is reorienting negative thoughts and feelings and modifying detrimental patterns of behavior.

There are numerous types of talk therapy and CBT that may help reduce nightmares:

Image Rehearsal Therapy: This approach involves rewriting a recurring nightmare into a script that is rewritten and then rehearsed when awake in order to change how it unfolds and impacts the sleeper.
Lucid Dreaming Therapy: In a lucid dream, a person is actively aware that they are dreaming. Lucid dreaming therapy seizes on this idea to give a person the ability to positively modify the content of a nightmare through their awareness of it in the moment.
Exposure and Desensitization Therapies: Because many nightmares are driven by fears, a number of approaches utilize controlled exposure to that fear to reduce the emotional reaction to it. Examples of these techniques to “face your fears” include self-exposure therapy and systematic desensitization.
Hypnosis: This approach creates a relaxed, trance-like mental state in which a person can more easily take in positive thoughts to combat stress.
Progressive deep muscle relaxation: While not a direct form of talk therapy, progressive deep muscle relaxation is a technique for calming the mind and body. It involves deep breathing and a sequence of tension and release in muscles throughout the body. Relaxation methods like this are a tool developed in talk therapy to counteract stress buildup.

Behavioral recommendations associated with talk therapy frequently involve changes to sleep hygiene. This includes making the bedroom more conducive to sleep as well as cultivating daily routines and habits that facilitate consistent sleep.

Many psychotherapies for nightmares involve a combination of methods. Examples include CBT-I, Sleep Dynamic Therapy and Exposure, Relaxation, and Rescripting Therapy (ERRT). Mental health professionals can tailor talk therapy for nightmares to fit a patient, including, when appropriate, account for a coexisting mental health disorder.

Medication

Several types of prescription medications may be used to treat nightmare disorder. Most often, these are medications that affect the nervous system such as anti-anxiety, antidepressant, or antipsychotic drugs. Different medications may be used for people who have nightmares associated with PTSD.

Medications benefit some patients, but they can also come with side effects. For that reason, it is important to talk with a doctor who can describe the potential benefits and downsides of prescription drugs for nightmare disorder.

How Can You Help Stop Nightmares and Get Better Sleep?

If you have nightmares that interfere with your sleep or daily life, the first step is to talk with your doctor. Identifying and addressing an underlying cause can help make nightmares less frequent and less bothersome.

Whether nightmares are common or occasional, you may get relief from improving sleep hygiene. Building better sleep habits is a component of many therapies for nightmare disorder and can pave the way for high-quality sleep on a regular basis.

There are many elements of sleep hygiene, but some of the most important ones, especially in the context of nightmares, include:

Following a consistent sleep schedule: Having a set bedtime and sleep schedule helps keep your sleep stable, preventing sleep avoidance and nightmare-inducing REM rebound after sleep deprivation.
Utilizing relaxation methods: Finding ways to wind down, even basic deep breathing, can help decrease the stress and worry that give rise to nightmares.
Avoiding caffeine and alcohol: Caffeine can stimulate your mind, which makes it harder to relax and fall asleep. Drinking alcohol close to bedtime can induce a REM rebound in the second half of the night that may worsen nightmares. As much as possible, it’s best to avoid alcohol and caffeine in the evening.
Reducing screen time before bed: Using a smartphone, tablet, or laptop before bed can amp up your brain activity and make it difficult to fall asleep. If the screen time involves negative or worrying imagery, it may make nightmares more likely. To avoid this, create a bedtime routine with no screen time for an hour or more before going to sleep.
Creating a comforting sleep environment: Your bedroom should promote a sense of calm with as few distractions or disruptions as possible. Set a comfortable temperature, block out excess light and sound, and set up your bed and bedding to be supportive and inviting.

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About Our Editorial Team

Eric Suni

Staff Writer

Eric Suni has over a decade of experience as a science writer and was previously an information specialist for the National Cancer Institute.

Dr. Abhinav Singh

Sleep Physician

Dr. Singh is the Medical Director of the Indiana Sleep Center. His research and clinical practice focuses on the entire myriad of sleep disorders.

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Levin, R., & Nielsen, T. A. (2007). Disturbed dreaming, posttraumatic stress disorder, and affect distress: a review and neurocognitive model. Psychological bulletin, 133(3), 482–528. https://doi.org/10.1037/0033-2909.133.3.482
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Scientists told why nightmares occur

Why do nightmares occur? What biological function do they perform? Swiss and American scientists in the course of the study found the answer to this question: this is a kind of training of the nervous system, which helps a person cope with negative emotions in everyday life.

In an article published in the journal Human Brain Mapping, scientists from the University of Geneva (Switzerland) and their colleagues from the University of Wisconsin (USA) write that "emotions experienced in a dream contribute to the resolution of emotional stress and preparation for future affective reactions. "

18 people participated in the experiment by Virginia Sterpenich, the head of the study. Using electroencephalogram (EEG), scientists studied the activity of various parts of the brain during sleep. In addition, volunteers were awakened several times during the night and asked what kind of dreams they had and whether they were scary.

Through participants' responses and analysis of brain activity, the researchers identified two areas of the brain that are responsible for causing nightmares during sleep. "It's the insula and the cingulate cortex," says Lampros Perogamvros, co-author of the paper.

An interesting fact: both of these areas of the brain are also activated in situations where a person is worried or frightened in real life. Thus, the insula is responsible for evaluating emotions and is triggered automatically as soon as a person feels anxious. The cingulate cortex, in turn, prepares for an adequate response in a situation of threat. It controls how a person behaves in the face of danger. "For the first time, we show that similar areas are activated when fear occurs during sleep and in the waking state," says Perogamvros.

But what is the connection between fear in a dream and emotions after waking up? To answer this question, the researchers conducted a second experiment. They asked 89 volunteers to keep a dream diary for a week. Every morning, immediately after waking up, the participants in the experiment wrote if they could remember the dream, and, if so, what emotions they experienced after it. At the end of the test week, each participant was examined using functional magnetic resonance imaging (MRI).

The scientists then showed the subjects both neutral and disturbing images, such as a robbery. The result, according to the researchers, was striking: those who had longer and more frequent nightmares reacted less emotionally to these negative images. "They had less activation of the insula, cingulate cortex, and amygdala when viewing negative images," Sterpenich said.

In addition, it turned out that the prefrontal cortex was more active, and this is the area of the brain that can suppress the activity of the amygdala in anxious situations and thus ensure that we are not paralyzed with fear and can act,” said Sterpenich .

According to the researchers, the results suggest that there is a strong relationship between fear in dreams and reality. At the same time, the emotions that arise during sleep serve as a kind of training: they help us to react better in reality in dangerous situations. "Dreams can be a preparation for our future reactions to real threats and dangers," says Perogamvros.

Scientists hope that the findings will form the basis for new approaches in the treatment of anxiety disorders. However, in their opinion, "the healing power of nightmares can have a limit" when it comes to the worst nightmares. "We believe that if a dream has too high a level of anxiety and a person experiences excessive fear, such a dream loses its function as an emotional regulator," concludes Perogamvros.

Why do I have nightmares and what if they don't go away?

No one is safe from nightmares. They can torment adults and children, men and women, people of various professions and marital status. In order not to jump up in the middle of the night in a cold sweat, you first need to understand why nightmares can occur. As it turns out, there are a number of reasons for bad dreams, and some of them are very easy to deal with.

Why I have nightmares

Poor sleep often occurs as a result of physical discomfort: stuffiness, uncomfortable beds, loud music, bright lights, overeating (especially in combination with alcohol), overwork.
A high fever during illness can also trigger nightmares. In this case, the only thing left is to wait for recovery.
If you are under a lot of stress (due to a personal drama or an extreme situation), you can't solve a problem or forget a long-standing psychological trauma or resentment, your subconscious mind will actively signal this to you at night.
The profession also leaves an imprint on dreams - both people who encounter blood, death, cruelty (doctors, military men) and representatives of creative professions can suffer from nightmares because of their rich imagination. That is why no one is immune from nightmares.

Nightmares: what to do

Regular “watching” of horror movies in your sleep is a reason to adjust your habits and lifestyle. First of all, create a comfortable environment for sound, restful sleep:

walk outdoors in the evening;
well ventilate the room in which you rest;
do not overeat at night and do not drink alcohol (at least three hours before bedtime), it is better to drink herbal tea to calm the nervous system;
take relaxing baths;
turn off the TV and turn on pleasant, calm music;
don't watch horror movies. Fear and a sense of danger are deposited on the subconscious;
remove objects from the room that distract you or annoy you.

How to get rid of nightmares

How to get rid of nightmares and get healthy sound sleep, advises psychologist-consultant, member of the Russian Psychological Society Elena Akhromeeva.

— Nightmares are not just a bad dream, but a whole storehouse of useful information about your life and experiences. Therefore, in order to get rid of nightmares, first of all, you need to try to decipher the message about the causes of anxiety and worries that a bad dream contains. Here are 7 tips to help you meet this challenge.

Tell your dream in detail

Tell your dream in great detail in the first person and in the present tense. For example: “I am running up a glass staircase. Suddenly I see a crack. The steps begin to crack underfoot ... ".

Pay attention to your feelings and thoughts. For example: “Fear - because I think that I can break. Interest, because the crack began to spread very beautifully along the steps.

Now connect your feelings with the current events that are happening in your life. For example: “I'm thinking about changing jobs, but I'm really scared to quit. But thanks to the dream, I realize that trying myself in a new field is very interesting. Now I will think about my interest, and not about fear.

As we can see, the nightmare helped resolve an inner doubt: I want to change jobs, but I'm scared. The dream helped to find motivation for action - this is interest!

Invent the end of the dream

If you suddenly woke up and did not finish watching the end of the nightmare (or do not remember it), then try to invent it. Write or say out loud in the first person how you would like the action in this dream to end. The fact is that our psyche does not tolerate incompleteness. If you complete the action, even in the imagination, then anxiety will decrease significantly.

Draw your nightmare

Analyze: what does this picture say? What message does this drawing convey? Who wants to show a picture? Who do you want support from? All these actions will also help reduce anxiety and understand the causes of bad dreams.

Do not look for esoteric meaning in a nightmare

Remember that dreams are just a product of your brain. Do not look for magical or esoteric meaning in your nightmares. During a nightmare, the unconscious part of the psyche tries to cope with the difficult feelings that you encounter in real life. Nightmares can even be considered as a useful function, as they help the unconscious part of the psyche to cope with stress, internal conflicts, traumatic events.

Practice good sleep hygiene

go to bed at the same time;
eat a nutritious diet, the last meal should be 2-4 hours before bedtime;
physical and mental activities should also be completed 2-4 hours before bedtime;
take a short walk before going to bed, get some fresh air;
sleep in a dark, cool, well-ventilated room;
Make sure you have a comfortable mattress and pillow, as well as comfortable sleepwear.

Learn how to lucid dream

Neuroscientists have proven that lucid dreaming (LU) is indeed possible. Lucid dreaming is a state in which a person is aware that they are dreaming and can influence its plot and their actions. By managing your sleep, you can "rewrite" your nightmare.

See a psychotherapist or psychiatrist for a consultation

A specialist will conduct a differential diagnosis. Since nightmares can mask hypnagogic hallucinations (when imaginary sensations, for example, images, sounds, touches, thoughts seem real), nocturnal panic attacks. Also, recurring nightmares that lead to insomnia can be symptoms of a depressive or anxiety disorder, PTSD (post-traumatic disorder).

During a nightmare, the hypothalamic-pituitary-adrenal system is excited, which should be relaxed Photo: Shutterstock

Why do people have bad dreams

Adult Nightmares: Causes and Treatments

In this Article

What Are Nightmares?

What Causes Nightmares in Adults?

What Are the Health Effects of Nightmares in Adults?

Treatments for Nightmares in Adults

Nightmares: Symptoms, Causes, & Treatment

What Are Nightmares?

What Is Nightmare Disorder?

Are Nightmares Normal?

Why Do We Have Nightmares?

How Are Nightmares Different From Sleep Terrors?

Causes

Are Nightmares Connected To Waking Activity?

Can Nightmares Affect Sleep?

When Should You See a Doctor About Nightmares?

How Is Nightmare Disorder Treated?

Psychotherapy

Medication

How Can You Help Stop Nightmares and Get Better Sleep?

About Our Editorial Team

Eric Suni

Dr. Abhinav Singh

References

Scientists told why nightmares occur

Why do I have nightmares and what if they don't go away?

Why I have nightmares

Nightmares: what to do

How to get rid of nightmares

Tell your dream in detail

Invent the end of the dream

Draw your nightmare

Do not look for esoteric meaning in a nightmare

Practice good sleep hygiene

Learn how to lucid dream

See a psychotherapist or psychiatrist for a consultation

Popular questions and answers

What happens to the brain and consciousness when you have nightmares?

Should I seek help from a specialist if I have nightmares?

Is it possible to get rid of nightmares by diligently engaging in physical activity, so that later "sleep without hind legs"?

Can a psychologist or psychotherapist prescribe sedatives to relieve nightmares?