Nightmares can be uncomfortable, but they’re a common experience.
Nightmare disorder is a sleep disorder in which recurring disturbing dreams disrupt your daily life.
Therapy and medication can help make nightmares more manageable.
Research shows that 85% of adults have at least one nightmare per year. Having occasional nightmares — especially when you’re under a lot of stress — is normal. But if you have frequent nightmares that get in the way of your daily functioning, you might have nightmare disorder.
Even though nightmares are common, nightmare disorder is relatively rare. But if you live with it, it can significantly affect both your sleeping and waking life. The good news is that with the right treatment and support, restful sleep and peaceful nights are possible.
Symptoms of nightmare disorder
Having the occasional nightmare doesn’t mean you have nightmare disorder. You can’t be diagnosed with nightmare disorder if your nightmares are primarily related to another health condition, medical issue, or certain substance use.According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the following criteria must be met for a diagnosis of nightmare disorder:
Frequent and vivid nightmares: You regularly experience long, extremely disturbing dreams that you remember clearly after waking up. These nightmares often feel realistic and cause strong emotions like fear or anxiety.
Threatening or distressing themes: The nightmares often center around danger or threats to your safety — for example, being chased or trapped. They usually occur during the second half of the night, when rapid eye movement (REM) sleep is most common.
Quick reorientation after waking: When you wake up, you become alert and aware that the dream wasn’t real. However, the emotional distress from the nightmare often lingers.
Significant distress or daytime impact: The nightmares and resulting poor sleep cause noticeable problems in your daily life. You may feel exhausted, have trouble concentrating, or find it hard to perform well at work, school, or in relationships.
Not better explained by another condition: The symptoms aren’t fully caused by another sleep disorder, mental health condition, medication, or substance.
Nightmare disorder is also different from sleep terrors. People with sleep terrors will suddenly wake up from a deep sleep and be inconsolably upset (often crying or screaming) for 10 to 30 minutes. They may not understand or even be conscious of what’s upsetting them. People with nightmare disorder may wake up upset and frightened from their dreams but quickly become oriented to reality.
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Underlying causes of nightmare disorder
The exact causes of nightmare disorder are unknown. Usually, a few different factors come together to raise your risk of experiencing nightmares.
Risk factors include:
Past trauma or upsetting events: Some research shows that people who have experienced upsetting events may be more likely to face frequent nightmares.
Sleep deprivation or irregular sleep patterns: Sleep deprivation or irregular sleep cycles can disrupt your sleep. When you’re not getting enough restful sleep, you could be more prone to nightmares.
Brain differences: People who have more frequent nightmares may have differences in certain areas of the brain. Specifically, they could have hyperactive amygdalas (the brain’s “fear center”) but lower activity in the prefrontal cortex.
Genetics: Twin studies have found that there may be a genetic component to nightmares. If you have a direct relative who has nightmare disorder, you may be more likely to live with it yourself.
Personality traits: Certain personality traits, like being more likely to seek novelty, are linked with nightmare disorder.
It’s important to note that you’re more likely to have nightmares when you’re under a lot of stress. Being under considerable stress doesn’t necessarily raise your risk of nightmare disorder. But if you’re always under stress, you could be more likely to have more frequent nightmares.
Nightmares also frequently co-occur with other health conditions, including:
Heart disease
Cancer
However, it’s unclear what comes first.
Getting a diagnosis for nightmare disorder
Most people have nightmares sometimes. Even if you find that you’re having more nightmares than usual when you’re under a lot of stress, this could still be within what’s considered “normal.”
But if your nightmares have become so frequent that they’re getting in the way of your daily functioning, it could be helpful to seek professional support.
While some sleep disorders are diagnosed through sleep studies, there’s no specific test to diagnose nightmare disorder. Usually, your provider will ask you questions about your nightmares, including:
When you started experiencing them
How often you experience them
How they affect your daily life
How you feel when you wake up from them
In addition, your provider might have you fill out clinical questionnaires, like the Nightmare Frequency Questionnaire.
You may not get a diagnosis if your nightmares are primarily a symptom of another mental health condition. For example, many people with PTSD experience nightmares. But unless the nightmares continue even after your other PTSD symptoms have resolved, you wouldn’t usually receive a separate diagnosis for nightmare disorder.
Exploring treatment options for nightmares
Fortunately, nightmare disorder can be managed. There are ways to stop having such intense nightmares. You can get your nightmares to a point where they’re no longer affecting your daily functioning.
Some of the most effective treatments to address nightmares include:
Image rehearsal therapy (IRT): This evidence-based treatment method has been found to be highly effective for reducing both the frequency and intensity of nightmares. During IRT, you’re guided to “rescript” your nightmares when you wake up. You rewrite the story to have a neutral or more positive ending.
Systematic desensitization: During systematic desensitization, a therapist helps you gradually confront the content of your nightmares so that they no longer scare you so much. This is considered an evidence-based treatment for nightmare disorder.
Exposure, relaxation, and rescripting therapy (ERRT): ERRT can help you confront your nightmares while practicing relaxation. It helps reduce both how intense and how often you experience nightmares.
Medication: Some medications may be helpful for nightmare disorder, but it depends on your unique situation. It’s important to talk to a qualified mental health provider about adding medication to your treatment plan.
If you dread going to sleep because of recurring disturbing dreams, try reminding yourself that nightmares are your brain’s way of processing stress. Creating a calming pre-sleep routine and talking about the dreams in therapy can help you feel safer at night and start to regain control of your rest.
Brandy Chalmers, LPC
Clinical reviewer
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Nightmare disorder can feel overwhelming — especially if it’s been interrupting your rest for a long time. The good news is that effective treatments are available. Reaching out for professional support can help you understand what’s driving your nightmares and find relief.
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Saya Des Marais
Saya graduated with her Master in Social Work (MSW) with a concentration in mental health from the University of Southern California in 2010. She formerly worked as a therapist and motivational interviewing trainer in community clinics, public schools, mental health startups, and more.
Her writing has been featured in FORTUNE, GoodRX, PsychCentral, and dozens of mental health apps and therapy websites. Through both her clinical work and her personal OCD diagnosis, she’s learned the importance of making empathetic and accurate mental health content available online.
She lives in Portland, Oregon but you can find her almost just as often in Mexico or in her birthplace, Tokyo.
Brandy Chalmers, LPC
Having faced challenges like childhood abuse, neglect, and the loss of her father to suicide, Brandy Chalmers is deeply passionate about providing compassionate care. She is a Licensed Professional Counselor, Nationally Certified Counselor, and Registered Play Therapist with a Master’s Degree in Clinical Counseling and Marriage and Family Therapy.
Brandy also teaches at a university, sharing her expertise with future mental health professionals. With over a decade of experience in settings like inpatient care and private practice, she specializes in helping clients with perfectionism, trauma, personality disorders, eating disorders, and life changes.
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