How to Stop Nightmares & Bad Dreams

For some unfortunate people, sleep is not something to look forward to because that is when they are confronted with unpleasant and upsetting dreams, which can be extremely vivid, and sometimes even become full-fledged nightmares. Read on to learn how to stop nightmares and bad dreams naturally, without resorting to pharmaceuticals.

Nightmare disorder affects approximately 4% of adults, however, bad dreams may be a lot more common.

Night after night losing sleep due to bad dreams can result in a state of exhaustion and even depression, significantly impairing quality of life.

In this article, I explore the various treatment options – both natural and medical – that can help prevent and treat bad dreams.

Treating the Underlying Cause

Bad dreams can have many causes. It is important to recognize what the cause is in each particular case in order to treat it. Otherwise, treating the symptoms will only provide temporary relief.

Why do some people experience bad dreams almost every time they sleep?

This can happen for different reasons, including:

• as a side effect of some medications and drugs, especially anti-depressants and anti-hypertensives (a list is provided below.)
• alcohol and caffeine may cause bad dreams and nightmares and so can some herbs and supplements.
• withdrawal from REM-suppressants and drugs which affect GABA and acetylcholine, such as:
  • barbiturates
  • benzodiazepines
  • anti-depressants (including TCAs, SSRIs, and MAOIs)
  • stimulants
  • alcohol
• because of underlying mental disorders, such as:
  • PTSD (Post-Traumatic Stress Disorder) is characterized by disturbing thoughts, feelings, or dreams following exposure to a traumatic event
  • borderline personality disorder, characterized by a long-term pattern of unstable relationships, a distorted sense of self, and strong emotional reactions
  • the spectrum of schizophrenia disorders, characterized by relapsing episodes of psychosis
• due to other sleep disorders, including sleep apnea.
• sleep deprivation
• pregnancy – during pregnancy dreams can become more intense and vivid, and there may be an increase in nightmares and anxious dreams due to hormonal changes.

If there is an underlying PTSD or other disorders, then these must be treated.

Any medical condition that afflicts the nervous system may trigger nightmares, including brain parasites and tumors. Therefore, do not neglect to visit a neurologist before attempting to cure the problem on your own.

If bad dreams are caused by drugs or medications, then these should be changed or stopped (by the prescribing physician.)

Abnormal Dream/Nightmare-Inducing Medications

Anti-depressants:

• serotonin and norepinephrine reuptake inhibitors (SNRIs)
• selective serotonin reuptake inhibitors (SSRIs)
• tricyclic anti-depressants (TCAs)
• bupropion (Wellbutrin)
• vortioxetine (e.g., Trintellix, Brintellix)

Anti-hypertensives:

• prazosin (Minipress, Vasoflex, Lentopres)
• methyldopa (Aldomet)
• clonidine (Catapres)
• beta-blockers
• reserpine

Hypnotics:

• benzodiazepine receptor agonists (BZRAs) tend to cause abnormal dreams
• benzodiazepines, especially triazolam (Halcion)
• chloral hydrate
• barbiturates

Anti-parkinsonian drugs:

• carbidopa-levodopa (Atamet, Carbilev, Sinemet)
• pramipexole (Mirapex, Mirapexin, Sifrol)
• ropinirole (Requip, Repreve, Ronirol)

Anti-microbials:

• erythromycin (Eryc, Erythrocin)
• hydroxychloroquine (Plaquenil)
• quinolones, such as:
  • levofloxacin (Levaquin, Tavanic, Iquix)
  • ciprofloxacin (Ciloxan, Cipro, Neofloxin)
• anti-viral agents:
  • zanamivir (Relenza)
  • ganciclovir (Cytovene, Cymevene, Vitrasert)

Additional drugs:

• buspirone (Buspar)
• varenicline (Champix, Chantix)
• first and second-generation antipsychotics
• amiodarone (Cordarone, Nexterone, Pacerone)
• montelukast (Singulair) – may cause dream abnormalities
• donepezil (Aricept) – may cause disturbing/abnormal dreams
• stimulant medications (both during chronic use and withdrawal)

Smoking and Nicotine

Nicotine has a profound impact on dreaming.

A 2006 study published in the Physiology & Behavior journal found that a 24-hour transdermal nicotine patch may cause awakenings during sleep as well as vivid dreams even though the percentage of REM sleep decreased.

Nicotine dreams may have a disturbing quality to them.

Dietary Factors

Dairy products, particularly cheese, may increase the likelihood of suffering from bizarre and nightmarish dreams, especially if an MAOI (monoamine oxidase inhibitor) is taken concurrently, which suggests that the tyramine content in cheese is the culprit.

Alternatively, “cheese-induced dreams” can result from the amino acid, tryptophan, which is also present in cheese (as well as other foods, such as seeds, meats, and eggs). Tryptophan becomes serotonin in the brain, and as we shall see later, increased serotonin levels are associated with vivid dreams.

Spicy food may also adversely affect dreams. A 1992 study published in the International Journal of Psychophysiology found that including Tabasco sauce and mustard in an evening meal disturbs sleep, reducing deep sleep and increasing total time awake.

Vitamin B6 (pyridoxine), a vitamin that exists in high amounts in meats and fish, sweet potatoes, and bananas, is also believed to increase dream vividness. A 2018 randomized, double-blind, placebo-controlled study published in the Perceptual and Motor Skills journal found that vitamin B6 significantly increased the amount of dream content participants recalled.

Eating a large meal near bedtime in general – no matter what you eat – can be a trigger for bad dreams, particularly if it contains large amounts of tryptophan and vitamin B6 or if it is very spicy.

None of this is relevant to me

When a specific cause for bad dreams cannot be determined, what can be done?

There are therapies that can help us transform our dreams. They can empower us to work with our bad dreams, explore them and learn from them, and even change them according to our will.

Before we get to these therapies, however, let us briefly review the pharmaceutical approach to treating bad dreams.

Medications for Treatment of Nightmares

The first-line pharmacological treatment for both nightmare disorder and PTSD-associated nightmares is the drug prazosin (Minipress, Vasoflex, Lentopres), which, ironically, may also cause nightmares.

Other drugs your sleep specialist might recommend for the treatment of nightmare disorder are benzodiazepine hypnotics, which may cause sedation, anterograde amnesia, as well as a reduction in REM and deep sleep. For example:

• nitrazepam (Mogadon)
• triazolam (Halcion) – this drug may cause nightmares.

If you have a PTSD diagnosis and suffer from nightmares, then your doctor may recommend one of the following medications:

• atypical antipsychotics – sedating and may cause nightmares, disturbing dreams, and severely low blood pressure:
  • olanzapine (Zyprexa) – increases the deeper stages of sleep, while reducing REM sleep
  • risperidone (Risperdal) – reduces REM sleep
  • aripiprazole (Abilify) – least sedating of the atypical antipsychotics
• clonidine (Catapres) – increases deep sleep, while reducing REM sleep; may cause nightmares.
• cyproheptadine (Periactin) – an anti-histamine, which may cause sedation.
• fluvoxamine (Luvox) – a selective serotonin reuptake inhibitor (SSRI) with anti-depressant and anxiolytic properties; reduces REM sleep and total sleep time and may cause daytime sedation and insomnia.
• gabapentin (Neurontin) – anti-seizure drug; sedating and may increase deep sleep by enhancing GABA activity.
• nabilone (Cesamet, Canemes) – a synthetic cannabinoid receptor agonist with anti-emetic and analgesic properties
• phenelzine (Nardil) – a potent monoamine oxidase inhibitor (MAOI)
• topiramate (Topamax, Trokendi XR, Qudexy XR) – an anti-convulsant
• trazodone (Desyrel) – sedating, may increase deep sleep and has little effect on REM.
• tricyclic antidepressants (TCAs) – suppress REM sleep; may cause nightmares.

So, you got your prescriptions. Will these medications take care of the problem?

Not necessarily. While many physicians prefer to prescribe drugs, medications are not more effective than behavioral or psychological therapies.

The evidence behind the use of most of these drugs for the treatment of bad dreams is weak. Moreover, many medications cause side effects and may dangerously interact with other drugs, supplements, and even foods.

Some of the drugs paradoxically may even cause nightmares and bad dreams.

Let us then move forward and review some better alternatives.

Behavioral and Psychological Treatment Options for Nightmare Disorder

If you’re lucky, your doctor will recommend behavioral/psychological treatments in addition to prescribing medications.

What are the treatment options?

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is used both for the treatment of PTSD-associated nightmares and for the treatment of nightmare disorder.

It is a short-term, goal-oriented psychotherapy that attempts to change a person’s dysfunctional thoughts, emotions, and behaviors.

Imagery Rehearsal Therapy

Image rehearsal therapy (IRT) is recommended for the treatment of PTSD-associated nightmares and nightmare disorder.

It is a type of cognitive behavioral therapy (CBT) technique in which you create an alternative, positive dream scenario, and rehearse it for 10-20 minutes every day with the hope that it will alter the content of the nightmare.

Lucid Dreaming Therapy

Lucid dreaming therapy (LDT) is used for the treatment of nightmare disorders. (As well as for insomnia.)

LDT is a variant of IRT. The difference is that with this technique, you try to change the content of the nightmare while dreaming by becoming aware that you’re dreaming (lucid dreaming).

Anecdotal evidence suggests that lucid dreaming may even help with PTSD-induced nightmares.

CBT for insomnia (CBT-I)

A variant of CBT targeting the symptoms of insomnia, CBT-I is used for the treatment of PTSD-associated nightmares.

It is a psychotherapeutic approach that involves different techniques, such as sleep restriction, stimulus control, sleep hygiene, and cognitive restructuring to treat insomnia.

Systematic Desensitization / Graduated Exposure Therapy

Systematic desensitization is used for the treatment of nightmare disorders.

It is a type of behavioral therapy that involves gradually exposing the patient to what s/he fears to make coping with the stressors less overwhelming.

Self-Exposure Therapy

Self-exposure therapy is used for the treatment of nightmare disorders.

Like systematic desensitization, it utilizes graded exposure. The patient moves on a daily basis through the situations on the hierarchical list of anxiety-provoking dreams at a comfortable pace, starting with the lowest anxiety situation, until the fear/anxiety has decreased.

Exposure, Relaxation, and Rescripting Therapy

Exposure, relaxation, and rescripting therapy (ERRT) is used for the treatment of PTSD-associated nightmares and for the treatment of nightmare disorder.

It is a 3-week CBT for nightmares that combines sleep hygiene education, progressive muscle relaxation, and exposure to the trauma with rescripting of nightmares.

Eye Movement Desensitization and Reprocessing

Eye movement desensitization and reprocessing (EMDR) is used for the treatment of PTSD-associated nightmares.

It is a psychotherapeutic intervention that attempts to facilitate the processing of disturbing memories and experiences by stimulating neural mechanisms (through bilateral eye movements, tones, and taps) that are similar to those activated during REM sleep.

Hypnosis

Hypnosis is used for the treatment of nightmare disorder.

It creates a trance-like state of mind which allows the mind to be open to suggestions that can be used to modify certain thoughts or behaviors.

Progressive Deep Muscle Relaxation

Progressive deep muscle relaxation (PDMR) is used for the treatment of nightmare disorder.

It involves tensing and releasing muscles, one body part at a time, in order to induce physical relaxation as well as reduce anxiety and stress.

Unproven Treatment Strategies

Up until now, I have presented the current medical approach to dealing with nightmares. Below you will find additional suggestions, which have no scientific evidence to back them up.

Binaural Beats (BB)

When two different sound waves, with frequencies lower than 1500 Hz and with less than a 40 Hz difference between them, are heard one through each ear, an illusory sound is heard in the frequency of the difference between the two real sounds. This illusory sound is known as a binaural beat.

Binaural beats therapy is claimed to have many benefits, including reduced stress and anxiety.

Some binaural beats can induce a state of relaxation and even help fall asleep, which is why they may help with insomnia.

To induce a specific state of consciousness using binaural beats, you want to listen to a binaural beat in the same frequency as the brain waves which characterize that state of consciousness.

1. Gamma waves (30-40 Hz) – lucid dreaming
2. Beta waves (12-30 Hz) – waking
3. Alpha waves (8-12 Hz) – Relaxation
4. Theta waves (4-8 Hz) – light sleep
5. Delta waves (0.5-4 Hz) – deep sleep

So to counter bad dreams, you have three options:

1. You can listen to binaural beats at a frequency of less than 4 Hz to promote deeper sleep.
2. Or, you can ramp the frequency to higher than 30 Hz to encourage lucidity during dreams. (Useful when going through lucid dreaming therapy.)
3. Combine the two approaches by listening to 4 Hz during the first half of the night when one should mostly experience deep sleep, and change it to 30 Hz during the second half of the night when dreams are common.

Stereo earphones are necessary for binaural beats to work, and if you find it difficult to sleep with earphones, then I recommend using SleepPhones.

Dream Interpretation

If you cannot determine what causes your nightmares, the answer can sometimes be found in the dreams themselves. Deconstructing dreams and interpreting them in order to unravel their sometimes hidden guidance can be insightful.

For that purpose, keep a dream journal and record your dreams daily. Then, analyze them on your own or with the guidance of a dream therapist.

Sometimes “getting the message,” is enough to rid yourself of the dreams, whose only goal was to bring you to a certain understanding.

Stress Reduction Methods

If there is no apparent cause for your bad dreams, they may simply be a result of stress. Not only Post-Traumatic Stress Disorder causes nightmares, but also just regular stress, which can manifest as difficulty falling asleep, unsatisfying sleep, fatigue upon waking, night terrors, broken sleep, dreams, and nightmares.

If you are very stressed, try a few stress-reduction techniques, particularly 1-2 hours before bedtime, and see if they help, for example:

• Avoid listening/watching the news, exciting/upsetting films, etc.
• Relaxation techniques – such as progressive muscle relaxation
• A meditation practice
• Breathing techniques
• Listening to music
• Moderate exercise
• Guided imagery
• Warm bath
• Massage
• Yoga

There are also herbs that can help deal with stress, but more on that below.

Spiritual Protection

Finally, when nothing else works, the cause may be “spiritual.”

In order to deal with negative “energies,” dream catcher, can be used. For example, you can wear a talisman or put a crystal in your pocket, on the bedside table, or under the pillow.

Amethyst, Dalmatian Jasper, Lepidolite, Selenite, and Rose Quartz are some rocks that can ward against nightmares.

Praying or reciting a mantra before bed may help.

In the realm of spirituality, faith is the key. So do something you believe will work. If you’re a skeptic, then this will probably not work for you.

Natural Dream Suppressants

Treating the underlying cause is not always enough. PTSD-associated nightmares can persist even after the PTSD resolves. Also, sometimes the cause cannot be determined. And some people simply prefer not to use pharmaceuticals, so are there any natural alternatives?

Acquiring a natural ally to help dream better is always a good idea.

Natural dream suppressants should exhibit one or all of the following actions:

1. Interfere with dream recall
2. Reduce dreaming/REM sleep
3. Change the dreams, making them less vivid or threatening

Using herbs to change or suppress dreams can help you catch up on some much-needed sleep, however, they do not fix the underlying problem, and your subconscious may still require healing in order to attain a healthy state of mind.

Below are some herbs and substances that can be considered natural dream suppressants. (However, there is no scientific evidence that they can prevent or cure bad dreams and nightmares.)

Remember that herbs are often as powerful as drugs and there may be important interactions and contraindications. So always consult with your physician before starting a new herbal regime.

Cannabis

Cannabis causes a mild reduction in REM sleep, and therefore dreaming, however, its most potent action is to interfere with short-term memory. Many people notice that while they chronically smoke cannabis, they fail to remember their dreams almost every night, even if they set a strong intention to remember them.

If you want to use cannabis, for example, if you live in a place where it is legal, keep in mind that low-THC strains should be used if there’s an anxiety problem. High-THC Cannabis strains can trigger anxiety.

Also, it may be better to use Cannabis indica strains, which are more sedative than the energizing Cannabis sativa strains.

Alcohol

Alcohol is an even better REM suppressant than cannabis. It can also help you fall asleep faster and sleep longer and deeper during the first half of the night.

However, in the second half of the night, a REM rebound may occur as well as an increase in dreaming together with sympathetic arousal (associated with the “fight-or-flight response”), potentially resulting in higher chances of experiencing bad dreams, and even nightmares.

Moreover, alcohol damages the liver and may cause dependency, associated with reduced total sleep time and fragmented sleep.

Withdrawal symptoms often include insomnia, reduction of total sleep time, deep sleep, and REM rebound along with nightmares.

Dream Herbs and Supplements

While dream herbs are usually employed to induce dreaming, they may also help with changing dreams.

For example, the dream herb Calea zacatechichi can help induce lucid dreaming, which may then make you able to modify the dream while it’s happening.

The supplement galantamine (Razadyne) can also be used to induce lucid dreaming as well as trigger long vivid, yet pleasant dreams. However, galantamine should not be taken more than 1-2 times per week because if it is not allowed to completely clear out of the body, dreams can become bizarre, and even nightmarish. Using Piracetam can help prevent this phenomenon.

Fly agaric mushroom (Amanita muscaria) is a potent sleep and dream mushroom, which may improve the content of the dreams and dream recall as well as facilitate lucidity, however, it may also make dreams more vivid and intense. Also, it is a strong sedative, which affects the brain much like benzodiazepines.

MAOIs

Pharmacological MAOIs are potent REM suppressors and may cause almost total disappearance of REM.

What effects do herbal MAOIs have on dreams?

A 2008 study published in the Psychopharmacology journal found that daytime ingestion of Ayahuasca (a medicinal tea made from Banisteriopsis caapi which contains MAO-inhibiting beta-carboline alkaloids such as harmaline) inhibits REM sleep, decreasing its duration, both in absolute values and as a percentage of total sleep time.

Passionflower (Passiflora incarnata) is another MAOI herb that contains harmala alkaloids, which is also a relaxing, calming, and soothing sleep herb, used to treat anxiety and sleep problems.

A 2017 study published in the Sleep Science journal found that an extract of Passiflora incarnata increased total sleep time and deep sleep. REM sleep was reduced, both in frequency and duration. This study however was done on rats.

Another study used cats who received threshold doses of harmaline (2-3 mg/kg) following which REM sleep was suppressed for 7 hours.

While I could not locate conclusive findings regarding the effects of harmala alkaloids on REM sleep in humans, these plants have the potential of reducing REM, and may therefore reduce dreaming.

Other Helpful Herbs & Supplements

Sleep Herbs

Besides Passionflower, there are other sleep herbs, which may improve the quality of sleep in various ways when they are taken before bedtime.

Some examples are:

• Hops (Humulus lupulus) – this calming and sedating herb can improve sleep quality and help with restlessness, anxiety, and sleep disturbances.
• Damiana (Turnera diffusa) – a moderate-strength relaxing nervine and a mild euphoriant.
• Lemon balm (Melissa officinalis) – reduces tension, anxiety, and stress and promotes sleep.
• Valerian (Valeriana officinalis) is a sedative used to treat nervousness, insomnia, and anxiety.
• Skullcap (Scutellaria lateriflora) – a calming herb used to treat anxiety and sleep difficulties.
• Wild lettuce (Lactuca virosa) – a nervine and hypnotic used to treat insomnia and restlessness.
• German Chamomile (Matricaria chamomilla) – a nervine used to treat insomnia, stress, and anxiety.
• Kava kava (Piper methysticum) – a relaxing nervine and hypnotic used to treat anxiety and mild insomnia.
• California poppy (Eschscholzia californica) – a nervine and hypnotic used to treat sleeplessness in children.

Adaptogens

Adaptogens are herbs that increase the body’s resistance to stressors and its general capacity to withstand stressful situations. They should be taken in the morning as they may be stimulating/energizing.

• Ashwagandha (Withania somnifera) – helps combat anxiety, stress, and insomnia. It is calming and promotes deep, dreamless sleep.
• Siberian ginseng (Eleutherococcus senticosus) is beneficial against the effects of prolonged stress such as insomnia and improves well-being.
• Korean ginseng (Panax ginseng) and American/Canadian ginseng (Panax quinquefolius)
• Chinese magnolia vine (Schisandra chinensis)
• Holy basil (Ocimum sanctum)

Chinese Medicine

In Chinese medicine, an unstable spirit (caused by a yin/blood heart deficiency), brings on insomnia as well as excessive dreaming. This condition is treated with acupuncture, nutrition, and spirit-stabilizing herbal remedies as well as by treating the root cause.

Liver heat, for example, can cause yin to be consumed in excess, leaving the heart with no sufficient yin to stabilize the spirit. Specific herbs that help sedate liver heat/fire, include:

• Huang Lian (Coptis spp.) – interestingly, this plant contains berberine, an alkaloid that inhibits tyramine (the substance that may be responsible for the dream effects caused by cheese)
• Long Dan Cao (Gentiana spp.)

Herbs that calm and nourish the spirit and heart include:

• Suan Zao Ren (Ziziphus jujuba) – used to treat insomnia or difficulty falling or staying asleep, excessive dreaming, shallow sleep with a tendency to wake easily, and fatigue.
• Yuan Zhi (Polygala spp.) – used to treat insomnia and excessive dreaming
• Ye Jiao Teng (Polygonum multiflorum) – used to treat insomnia, difficulty falling asleep or staying asleep, and excessive dreams.
• Xiao Mai (Triticum aestivum; common wheat) – used to treat Zang Zao, a Chinese term more or less corresponding to PTSD, which involves symptoms such as excessive worrying, anxiety, frequent melancholy, and crying spells, dream-disturbed sleep, and depression.
• Ci Wu Jia (Eleutherococcus senticosus) – used to relieve insomnia or dream-disturbed sleep
• Wu Wei Zi (Schisandra chinensis) is used to treat yin and blood deficiencies with symptoms such as anxiety, insomnia, and dream-disturbed sleep
• Lian Zi (Nelumbo nucifera) – used to treat anxiety, dream-disturbed sleep, and insomnia
• Lian Xu (Nelumbo nucifera) – used for excessive dreaming at night

There are also Chinese herbal blends that may help combat bad dreams through multiple mechanisms.

An Mian Pian (peaceful sleep tablet), for example, is used for:

• Anxiety
• Disturbing dreams
• Insomnia
• Many dreams
• Mental hyperactivity
• Nervous breakdown
• Restless sleep
• Restlessness
• Phobia

Bai Zi Yang Xin Wan is another formulation that can help with:

• Anxiety
• Disturbing dreams
• Insomnia
• Night sweating
• Restless sleep

Learn more about herbs for insomnia in Chinese medicine.

Levodopa (L-Dopa)

L-dopa is an amino acid that in the body is turned into the neurotransmitter dopamine.

Increased dopamine levels due to L-dopa supplementation can make dreams more vivid and longer in duration. For some people it may be a trigger for nightmares, however, others report dreams in which one experiences extreme confidence and a total lack of fear.

Dopamine lucid dreams are characterized by an increased ability to control the dream, which would be beneficial for those undergoing lucid dreaming therapy.

Melatonin, 5-HTP & Tryptophan

Melatonin, 5-HTP, and the amino acid tryptophan are precursors of serotonin. When they are ingested, they enter the brain, where they increase serotonin levels.

Increased serotonin levels in the brain during sleep may improve sleep quality, but also cause vivid dreams.

For the first 1-2 hours, REM sleep is suppressed, and one experiences restorative, uninterrupted deep sleep. Then, as serotonin levels start dropping, the REM rebound effect occurs, and the brain compensates for losing REM by creating longer and more intense dreaming periods.

Serotonin dreams tend to be calm, relaxing, and vivid, but are sometimes more difficult to recall.

Combining an MAOI with 5-HTP (which may be dangerous) or taking it after 3-4 hours of sleep in cases where the bad dreams occur during the second half of the night, may help prevent bad dreams.

Some people with PTSD only get nightmares if they sleep 3 hours or longer. This is because normally REM periods, where nightmares occur, are short during the first half of the night, and longer during the second half. Setting an alarm to wake yourself after 3 hours, then taking a REM suppressor can work to prevent nightmares.

Piracetam

Piracetam is a nootropic, or “smart” drug, a substance that is believed to have a positive impact on cognitive function.

It significantly suppresses dreaming and inhibits dream recall.

Vitamin B1 (Thiamine)

We saw that vitamin B6 may improve dream recall, which can make you remember your dreams, including any bad dreams you may have.

Another vitamin B, thiamine (vitamin B1), has been used successfully to treat patients with anxiety disorders, including symptoms manifesting as chronic fatigue, insomnia, nightmares, and depression.

Homeopathy

Homeopathy is a system of alternative medicine, which uses extremely minute amounts of natural substances, like plants and minerals to stimulate the body’s ability to heal itself.

Homeopathic remedies which may help with bad dreams include:

• Ignatia – used for insomnia due to emotional upset, which is accompanied by long and troubling nightmares.
• Arsenicum – used for anxious and disturbed sleep with fearful dreams full of insecurity.
• Silicea – used for anxious dreams.

Bach flower remedies

Bach flower remedies are solutions of brandy and water, based on the principles of homeopathy, which contain extreme dilutions of flowers of wild plants.

Recommended Bach flower remedies for bad dreams include:

• Aspen is used for panic, anxiety, and nightmares.
• Star of Bethlehem – used for processing trauma.

External Remedies

Dreams can be affected by plants even without internal use.

Sleeping Ointment

A sleeping ointment is a narcotic ointment, containing sedating ingredients which are can be absorbed through the skin, such as:

• Cannabis
• Thorn apple (Datura spp.)
• Henbane (Hyoscyamus spp.)
• Wild lettuce (Lactuca virosa)
• Mandrake (Mandragora spp.)
• Kava kava (Piper methysticum)
• Black nightshade (Solanum nigrum)
• Blue lotus flower (Nymphaea caerulea)
• Fly agaric mushroom (Amanita muscaria)

Aromatherapy

In addition to absorbing sleep-promoting chemicals through the skin, they can be inhaled. There are essential oils that have a sedating/calming quality and also some which are claimed to affect dreams.

Some ways to inhale volatile oils include:

• a few drops on the pillow
• massage oils – dilute (10-12 drops of essential oil per ounce of vegetable oil, such as sweet almond oil)
• baths – add 5 drops to a warm water bath. Stir and relax in the bath for 10-15 minutes.
• put 2 drops in a bowl filled with hot water, cover the head and bowl with a towel, and breath deeply.
• use an essential oil diffuser.

It’s important to choose a scent that feels good to you. Here are some suggestions:

• Rosemary (Salvia rosmarinus) essential oil is said to prevent nightmares and help remember good dreams.
• Lavender (Lavandula spp.) essential oil is often used for insomnia and is said to promote peaceful sleep
• German chamomile (Matricaria chamomilla) and lemon balm (Melissa officinalis) are also relaxing.
• Tulsi (Ocimum tenuiflorum; holy basil) allegedly prevents nightmares.
• Thyme (Thymus vulgaris) too is said to relieve nightmares.

Herbal Dream Pillows

Another way to utilize aromatherapy is by using herbal sleep and dream pillows. These are pillows stuffed with sleep-inducing herbs.

Beneficial herbs for sleep pillows include:

• Lavender (Lavandula spp.)
• Lemon balm (Melissa officinalis)
• Linden (Tilia platyphyllos) – relaxing
• German chamomile (Matricaria chamomilla)
• Catnip (Nepeta cataria) – a relaxing sedative
• Hops (Humulus lupulus) – promote calm and to relieve difficulty in sleeping

Bottom Line

Following some of the advice in this article may cause less REM sleep. Should you be concerned about not getting enough REM?

REM sleep is important, however, deep sleep may be even more important. And the body will usually compensate for the loss of this sleep stage (REM rebound effect). For example, if you manage not to have REM sleep at all for a night, then the next night, you may sleep into REM sleep immediately (reduced REM latency).

This highlights the fact that suppressing REM sleep is a symptomatic treatment, and not a cure. It is crucial to determine not why bad dreams are happening, but why they are happening to you.

I’m here to help you figure it out.

Frequently Asked Questions (FAQ)

Many people suffer from nightmares and other types of bad dreams. They are so prevalent that some people may be wondering if bad dreams serve us in some way.

Here are some statistics:

• About 4 people out of a hundred experience a nightmare at least once a week.
• 85 people out of a hundred experience a nightmare at least once a year.
• Bad dreams/anxiety dreams, which are less emotionally intense than nightmares and do not result in an awakening, are 4 times more frequent than nightmares.
• 7-20% of children suffer from nightmares.

Clearly, nightmares and bad dreams are natural and quite common. The problem starts when your nightmares become more and more frequent and start interfering with your life.

What is a nightmare?

We define a nightmare as a dream in which the dreamer experiences an intense negative emotion, such as a sense of threat, anxiety, fear, anger, or even sadness. Nightmares occur during late-night REM sleep and are clearly remembered upon awakening.

Having a bad dream every now and then doesn’t mean you have a Nightmare Disorder.

Nightmares should not be confused with anxiety dreams, which are scary dreams recalled only upon waking up in the morning. Real nightmares lead to an awakening.

To be diagnosed as suffering from a Nightmare Disorder, there are several criteria that have to be met:

1. Nature of dream – repeated dreams involving negative emotions, which are well-remembered and usually involve threats and occur in the second half of sleep.
2. Nature of awakening – if the dreamer awakens from the dream, he immediately becomes alert and oriented.
3. Nature of distress – significant distress or impairment is experienced.
4. Not caused by taking a drug or a substance.
5. Not related to other mental or medical disorders. An exception would be suffering from REM sleep behavior disorder (RBD), PTSD (Post-Traumatic Stress Disorder), or acute stress disorder as long as the nightmares started before the condition.

Types of Nightmare Disorders by Severity

How many nightmares do you experience per week?

If you have less than 1 nightmare per week, then you are said to have a Mild Nightmare Disorder.

If 1-6 nightmares occur per week, then your condition is classified as a Moderate Nightmare Disorder.

Finally, experiencing more than 6 nightmares per week is known as a Severe Nightmare Disorder

Types of Nightmare Disorders by Duration

Acute Nightmare Disorder diagnosis is given to those suffering from nightmares for one month or less.

If your nightmares occur for more than one month, you will be diagnosed with Subacute Nightmare Disorder.

Persistent Nightmare Disorder sufferers experience bad dreams longer than 6 months.

Children are often only diagnosed with Nightmare Disorder in cases of persistent distress.

Types of Nightmares by When They Occur

There is a subtype of nightmares that are experienced before falling asleep. It’s called sleep-onset nightmares and involves experiencing terrifying hypnagogic hallucinations while trying to fall asleep.

Nightmares can also occur during NREM (non-REM) sleep.

Why do nightmares occur? What is their function/purpose?

While some theories claim that mild, infrequent, and non-recurring nightmares may have a purpose (specifically for emotional regulation), many other sleep researchers agree that nightmares occur as a symptom of an underlying disorder and not as a separate condition with a specific function.

Therefore, we should probably rephrase the title of this subsection as:

What causes nightmares?

And the answer is…we don’t know.

There is evidence that nightmares are more prevalent among people who also suffer from impaired sleep quality, sleep disorders, PTSD (Post-Traumatic Stress Disorder), depression, suicidal tendencies, and anxiety as well as other psychiatric conditions and neurologic diseases.

Also, people who are “night owls” seem to be suffering more from nightmares than “early birds.”

Some drugs and medications, such as hypnotics, antidepressants, and antihypertensives, may cause nightmares.

Nightmares and Other Sleep Disorders

Nightmares can be experienced during episodes of sleepwalking or night terror. Patients can leave their beds to escape perceived danger.

In REM sleep behavior aggressive dreams may occur and are enacted, usually with the dreamer counterattacking from their beds.

In narcolepsy, nightmares are experienced during long REM periods which occur immediately upon falling asleep.

PTSD and Nightmares

PTSD, or Post-Traumatic Stress Disorder, is a condition that some people develop after being exposed to a severely threatening traumatic experience.

One of the diagnostic criteria of PTSD is the presence of intrusive symptoms, such as reexperiencing the trauma in nightmares.

Indeed, the main way to distinguish PTSD-related nightmares from Nightmare Disorder is in the reliving of the actual traumatic memories which triggered the PTSD within nightmares.

Regular nightmares are usually not episodic and rarely correspond to actual events in the dreamer’s waking life.

Also, while regular nightmares occur mostly during the second half of the night when REM sleep predominates, PTSD nightmares can also occur during sleep stages 1 and 2.

Treatment of PTSD-Related Nightmares (PTN)

The medical approach to treating PTSD-related nightmares up until recently was to use drugs such as Prazosin HCl (Minipress, Vasoflex, Lentopres, Hypovase, etc.).

However, the use of this drug entails some side effects, including dizziness, headache, drowsiness, lack of energy, weakness, palpitations, nausea, vomiting, diarrhea, constipation, edema, orthostatic hypotension, dyspnea, syncope, vertigo, depression, nervousness, and rash.

Fortunately, according to a review recently published in Current Psychiatry Reports of the medical literature about the management of post-traumatic nightmares using drugs and non-drug treatments, “Prazosin is no longer considered a first-line pharmacological intervention for PTN.”

So what are the alternatives, you may be wondering?

A synthetic cannabinoid known as Nabilone shows promise, although long-term effects are not yet fully understood.

Psychological treatments are available in which the patient is exposed to nightmares and/or goes through a restructuring of their nightmares.

In Imagery Rehearsal Therapy (IRT), for instance, patients learn how to deal with unpleasant imagery while they’re awake. They write down their nightmare, then rescript it with a better outcome. Finally, they rehearse the images of the altered dream story.

Combining this method with relaxation techniques or lucid dreaming techniques, wherein patients can change their dream while it’s happening, can make this a highly beneficial approach.

This psychological intervention can significantly reduce the severity and frequency of nightmares as well as improve insomnia (especially when combined with Cognitive-Behavioral Therapy, or CBT) and other symptoms of PTSD.

How to Stop Nightmares & Bad Dreams

As I mentioned above, there is no consensus among sleep researchers as to whether nightmares have a function or are just a symptom of a different condition.

Why is this question so important?

We really need to know if nightmares have a positive function, or purpose because if they do, perhaps treating them is not such a good idea as it might disrupt an important emotional process.

For this reason, only nightmares that are frequent, severe, and disruptive of daily functioning should be treated.

Nightmare Disorder

Do you experience recurrent dreams that involve feelings of extreme threat, anxiety, fear, terror, anger, rage, embarrassment, or disgust?

Do these dreams most often occur during the second half of the night and do they result in a rapid awakening and a clear memory of the nightmare you just experienced?

If you answered yes to both these questions, you may be suffering from a Nightmare Disorder.

It’s important to treat Nightmare Disorder since it can lead to avoiding sleep, which in turn can lead to sleep deprivation, more intense nightmares, and insomnia.

The best treatments options for Nightmare Disorder include:

• Imagery rehearsal therapy (IRT)
• Systematic desensitization
• Progressive deep muscle relaxation
• Lucid dreaming therapy – learning how to change your nightmare while you’re experiencing it.
• Self-exposure therapy

Sleepwalking and Sleep Terrors

While regular nightmares occur during REM sleep, there is a subtype of nightmares that occur during NREM sleep. These nightmares are often associated with sleepwalking and night terrors.

If you find yourself having bad dreams that make you do things, such as sleepwalking or screaming in terror, then this is “your” subtype of nightmares.

Treating your sleepwalking or night terror will often improve your dreams as well.

Here are some suggestions:

• Avoid sleep deprivation and daytime stress
• Don’t drink alcohol or eat heavy meals before bed
• Avoid hyperthermia (overheating)
• Instruct your sleeping partner to guide you back to bed if they “catch” you sleepwalking
• Obviously, you should close (and lock) all doors and windows if you sleepwalk
• Learn how to “practice” Relaxation
• Eat melatonin-rich foods 1 hour before going to bed (e.g., 2 pistachio nuts)
• Hypnosis and some drugs may help if everything else fails

REM Sleep Behavior Disorder (RBD)

If you enact violent dreams, then you may be suffering from REM Sleep Behavior Disorder (RBD), a disorder common in patients with some neurodegenerative diseases, such as Parkinson’s disease.

Apart from the enactment of dreams, RBD nightmares (as well as Parkinson’s dreams) contain aggression and animals.

3-12 mg of melatonin before sleep can alleviate this type of nightmare.

Narcolepsy

A narcoleptic’s dream life is quite fascinating. They recall more dreams and experience more false awakenings, stronger emotions, recurrent dreams, and lucid dreams. Unfortunately, nightmares are also common.

Luckily, most narcoleptics can easily learn how to lucid dream, and therefore lucid dreaming therapy by which the patient learns how to turn recurrent nightmares into good dreams, would be an ideal treatment approach.

Some narcoleptics also experience frightening visual, verbal, and non-verbal auditory, tactile and kinetic hallucinations, including the sensation of having out-of-body experiences. Full-fledged visions and sleep paralysis can also occur. These experiences are not nightmares and can be reduced with drugs.

Other Causes of Nightmares

The following disorders which are associated with nightmares (hallucinations and enacted dreams with open eyes, to be more precise) are beyond the scope of this article, but still deserve a mention:

• Parkinson’s Disease, especially when treated with levodopa
• Guillain-Barré Syndrome
• Dementia with Lewy bodies
• Alcohol withdrawal syndrome (delirium tremens)
• Fatal familial insomnia
• Morvan chorea

Lucid Dreaming Therapy for Nightmare Disorder

Tired of waking up in a pool of sweat, your heart racing and your mind overwhelmed with terror? What if you could take control of your dreams and “tame” your nightmares? Sleep science says you can do just that with Lucid Dreaming Therapy.

Lucid dreaming is an altered state of consciousness, during which you are aware that you are dreaming. LD has been considered a prized avenue of learning among oneironauts. It is also a potent therapeutic tool.

In this piece, we take a look at lucid dreaming therapy for the treatment of nightmare disorder. More precisely:

• What are nightmares? What types of nightmares are there?
• Your treatment options for nightmare disorder.
• How Lucid Dreaming Therapy Works in Practice.
• The Limitations of Lucid Dreaming Therapy.
• The scientific background of LDT.

How Does Science Define Nightmares? What Types of Nightmares Are There?

According to the International Classification of Sleep Disorders, a dream/sleep problem has to satisfy a minimum number of criteria to be considered a nightmare disorder.

These criteria are:

• Dreams have to occur repeatedly. Sufferers need to remember such dreams well, and the dreams have to be highly dysphoric. They need to contain perceived threats to the dreamer’s bodily integrity, survival, and/or security.
• A nightmare sufferer becomes highly alert immediately after awakening from such a dream.
• The dreams and the sleep disorder resulting from them have caused the sufferer significant distress, socially, occupationally, or in some other essential aspect of life.

The distress angle may be somewhat subjective. The ICSD has therefore provided a few criteria to help patients identify the condition. If you suffer from one or more of the following issues, you are experiencing significant nightmare-induced distress.

• Anxiety, depression.
• Fear of going to bed, in anticipation of the likely nightmare experience that awaits.
• Problems concentrating.
• Memory problems.
• Persistent fatigue. Lack of energy.
• Trouble initiating and handling social interaction.
• Fear of the dark.
• Sleepiness during the day.

Nightmares can be of several types. Some are milder and do not require treatment. Others are persistent and recurring. This is the category that affects the quality of life, requiring treatment.

• Idiopathic nightmares are randomly occurring sleep disturbances. As such, they are little more than one-off nuisances.
• Comorbid nightmares are coupled with a condition, which is usually responsible for their presence. Such conditions can be PTSD (Post-traumatic Stress Disorder), substance abuse, schizophrenia, etc.

What Options Do You Have for the Treatment of Nightmare Disorder?

Nightmare disorder sufferers can turn to scores of treatment options to alleviate their condition. The Journal of Clinical Sleep Medicine has defined two main treatment avenues.

• The pharmacologic option category includes various drugs. The JCSM, in a June 15, 2018 literature review, has declared some drugs “recommended” for nightmare disorder treatment. It has defined a couple of other categories of medicines that “may be used” for treatment and that are “not recommended.”
• The same publication has also analyzed an array of behavioral and psychological treatment options. Within this category, it has yet again defined “recommended,” “may be used,” and “not recommended” sub-categories.
• In the “recommended” category, Imagery Rehearsal Therapy (IRT) has taken the top spot. This is interesting because Lucid Dreaming Therapy (LDT) is a variant of IRT.

What is IRT?

IRT is a cognitive behavioral therapy method, which consists of modifying the image content of a nightmare, thus turning it into a benign dream. Those who embark on this type of treatment rehearse the modified dream scenario several times a day. This way, they condition their brains to bend the nightmare into a benign dream when it happens. Despite its seemingly far-fetched nature, the technique is surprisingly effective.

LDT takes this concept and runs with it. Lucid dreaming allows the dreamer to retain consciousness while in a dream. Some lucid dreamers can even bend the dream content to their will. The only problem with lucid dreaming is that it is a rather difficult cognitive state to achieve. You cannot just will yourself to become lucid when dreaming.

How Does Lucid Dreaming Therapy Work in Practice?

Lucid dreaming enthusiasts will tell you that you can learn to trigger lucid dreaming episodes. We have dissected several such methods on the pages of this website as well.

No. It is not easy to achieve lucidity in a dream. Yes. You can learn to do it. Lucid dreaming therapy for the treatment of nightmare disorder is a multi-step process.

The first step is to convince patients that this is not some far-fetched, occult approach. They can indeed learn to control their dreams. There is plenty of scientific evidence available in this regard.

During this stage of the treatment, the therapist/coordinator introduces various LD induction techniques to participants. The first results might come extremely early. Some patients respond after a single session. In other cases, it may take six weeks for results to show.

Once nightmare sufferers gain control over their dreams, their situation improves drastically. The sense of control derived from LDT endows them with in-dream fearlessness. Even if they continue to have nightmares, these bad dreams will never be as distressing as before.

According to a 2006 study by Spoormaker V. I. and van den Bout J., once patients learn to control their dreams, their frequency of nightmares automatically decreases.

Facing the primary threat in a nightmare is a popular way to address this sleep disorder among lucid dreamers. If, for instance, an entity chases you in your nightmare, stop, face it, and ask it what it wants from you. In many cases, the threat reveals itself to be a familiar source of waking-life stress of the dreamer.

The second step of LDT aims to explore the conscious psyche of the nightmare sufferer. It seeks answers regarding the source(s) of nightmares.

Turning LDT into long-term psychotherapy makes sense for several reasons. As mentioned, lucid dreaming can be much more than a quick solution for nightmares. Through it, the oneironaut gains an unequaled peek into his/her psyche. Eventually, it may even sort out the very issues which lead to the appearance of nightmares.

The biggest hurdle to effective LDT therapy is the difficulty of achieving a lucid in-dream state. Some people may have serious difficulties in this regard. Others may see their efforts hampered by preconceptions and skepticism. Attaining quick results should always be the therapist’s objective. It motivates the patient to stick with the program and to pursue further objectives.

Those who find it difficult to induce LD can resort to several techniques beyond the most common/popular ones. Applying external sensory stimulation during the REM stage of sleep is one such technique.

There are a few substances (like galantamine) that can also help with LD induction. Some of these solutions do promote nightmares, however, so they should not be used unless recommended by a specialist.

Changing the dream content without achieving lucidity is also an option. According to a 1990 study by Brylowski A., published in the Psychiatric Journal of the University of Ottawa, even if patients fail to achieve in-dream lucidity, the lucidity-focused exercises they do while awake, help them wake up when a nightmare commences.

Some specialists, among them the “father” of lucid dream theory, Stephen LaBerge, do not see this approach as an ideal one. Instead of allowing the patient to face his/her fears, just waking up becomes another way to run from the nightmare.

In his book Lucid Dreaming: A Concise Guide to Awakening in Your Dreams and in Your Life, LaBerge argues that nightmares are “dreams gone wrong.” Their original intent was healing, which is revealed by becoming lucid within the dream. We miss the whole point if we wake ourselves up. Rather, he suggests facing a bad dream and that “staying with the nightmare and accepting its challenge, as lucidity makes possible, allows us to resolve the dream problem in a fashion that leaves us healthier than before.”

Still other authors, like Stumbrys T. and Erlacher D., in a 2017 study have pointed out that trying to make dream figures disappear may enhance their threatening nature. When one looks at a dream figure with confidence and courage within the dream, this figure tends to shed its threatening nature.

In many cases, however, would-be lucid dreamers will still wake up as a direct result of having achieved lucidity.

This discussion makes it clear that Lucid Dream Therapy has its limitations when tackling nightmare disorder.

How Do You Confront a Nightmare?

If you manage to achieve lucidity in a nightmare, here is what you can do to confront the entity terrorizing you.

If you are having a dream in which an unknown entity chases you, stop. Bear in mind that the fact that you can control your dream makes you all-powerful in that instance. Assume a confident and bold attitude. Ask your pursuer: “Who are you?” “Why are you chasing me?” At this point, your nightmare is defeated, regardless of how the entity responds to you.

If you are having a falling nightmare, let go of your fear as soon as you become lucid. Understand that nothing bad can happen to you. Instead of dreading the fall, try to enjoy it. You may turn the dream into a floating/flying experience.

The Limitations of Lucid Dream Therapy for Nightmare Disorder

As impressive a weapon as in-dream lucidity is against nightmares, it is not the be-all-end-all solution to the problem. In some cases, lucidity may result in enhancing the nightmare, instead of emptying it of threats.

According to a May 2000 study, published in the Journal of Abnormal Psychology, by Zadra A. and Donderi D. C., researchers have recorded cases where lucidity amplified the terrifying nature of nightmares. Cases have been reported, where lucid dreamers found themselves unable to control dream content or to wake up. Thus, they had no choice but to observe with a lucid mind as the nightmare unfolded before them.

According to a 1991 Lucidity Letter by Scott G. Sparrow, LDT is a dangerous approach to treating nightmare disorders. Sparrow explains that those with nightmare problems are especially vulnerable to lucid nightmares. Dopamine and community support have been found to help in reducing lucid nightmares.

There is little consensus among researchers concerning the extra-potent nature of lucid nightmares. In a 2018 study, Stumbrys T. found no difference in the distress levels of lucid nightmares and regular ones.

The difficulty of lucid dream induction is yet another limitation for LDT. Some people find it quite impossible to achieve lucidity, even after months and years of lucidity-focused exercise. Those most likely to achieve lucidity are people suffering from narcolepsy.

A 2015 study by Rak M., Beitinger P., and others established that some narcolepsy sufferers successfully used their lucid dreams to combat nightmares. Researchers concluded that lucid dreaming was an efficient way for narcoleptics to deal with nightmare disorder.

The Scientific Background of Lucid Dream Therapy

The position paper on the treatment of nightmares in adults, of the Clinical Journal of Sleep Medicine, has identified two randomized studies and a case series report on the use of Lucid Dreaming Therapy.

The results of the first randomized trial were published by Spoormaker V. I., and van den Bout J., in 2006. 23 test subjects took part in the trial, which evaluated the frequency of nightmares in a 12-week period. Participants used self-reporting. The conclusion of the study saw a statistically significant drop in nightmare frequency as a response to LDT.

A second study took aim at Gestalt Therapy and LDT. This January 2015 exercise by B. Holzinger, G. Klosch, and B. Saletu divided 32 participants into two groups. The first group received Gestalt therapy. Gestalt is a psychotherapy method focused on the interpretation of present circumstances without any preconceptions stemming from previous experiences.

The second group used Gestalt combined with LDT. Both methods proved equally effective in reducing nightmare frequency.

The case series report by Zadra A. L. and Pihl R. O. followed five test subjects receiving either LDT alone or LDT in combination with progressive deep muscle relaxation and guided imagery. The results after a year of treatment were amazing. Except for a single participant, all patients stopped having nightmares. Even the exempt person reported a significant reduction of nightmare frequency.

Conclusion

The efficacy of LDT in the treatment of nightmare disorder is real and impressive. The therapy can be used in combination with other behavioral and psychological treatment options such as:

• Image rehearsal therapy.
• Cognitive-behavioral therapy.
• Hypnosis.
• Eye movement desensitization.
• Exposure, relaxation, and rescripting therapy.
• Progressive deep muscle relaxation.
• Self-exposure therapy.
• Sleep dynamic therapy.
• etc.

I find it interesting (but not surprising) that two of the most common sleep disorders can be successfully treated with awareness: Insomnia with mindfulness-based therapy and nightmares with lucid dreaming therapy.

Imagery Rehearsal Therapy for Nightmares

Imagery Rehearsal Therapy (IRT) is one of the best-suited methods for the treatment of nightmares in adults. At least this is what the 2018 position paper of the Journal of Sleep Medicine concluded.

What is IRT? Is it something you should consider for the treatment of your nightmare problems?

Below, we dissect this relatively novel treatment method. While at it, we will hopefully answer those questions and more.

• What is IRT?
• What therapeutic components make it up?
• What can you expect from an IRT treatment session?
• How does science rate the efficacy of IRT for the treatment of nightmares?
• Are there any risks associated with IRT?

What is Imagery Rehearsal Therapy?

Image Rehearsal Therapy is a cognitive behavioral therapy variant. Its goal is to alter the image content of a nightmare and to have nightmare sufferers rehearse this altered dream scenario. This way, when the nightmare pops up again, the brain will give it the rehearsed positive twist.

IRT’s therapeutic process is a two-pronged approach.

First, it aims to familiarize patients with the idea that their nightmares are the results of a learned sleep disorder. Once people recognize that their nightmares are sustained by habit, they become open to having them treated directly.

Nightmares are associated with insomnia. In a way, they represent yet another symptom of insomnia. As such, they can, and should, be treated as a sleep disorder.

Secondly, IRT familiarizes patients with imagery techniques. Eventually, it uses these techniques to alter undesired dream content, conditioning the mind to directly address disturbing dream imagery. This stage of the treatment identifies nightmares as symptoms of imagery system damage.

What are the Therapeutic Components of IRT?

A typical IRT treatment consists of four sessions, each of them two hours long. The first two sessions focus on the first stage of the therapeutic process. The last two focus on the second stage.

During the first session, the therapist sows the seeds of therapeutic credibility and builds rapport with the patients. Given the somewhat novel nature of the therapy, patient skepticism can be a problem at this stage.

The first therapeutic step is linking nightmares to poor sleep quality. In this regard, the therapist touches on several factors, such as:

• Disrupted sleep due to nightmare-induced awakenings.
• Pre-sleep anxiety.
• Sleep avoidance after a nightmare-induced awakening.
• Nightmare-induced emotions.
• The wakeful reliving of nightmare-induced emotions.

The second step links the treatment of nightmares to improving sleep quality.

• Therapy will result in the elimination of pre-sleep anxiety.
• Reduction of fragmented sleep.
• Better sleep consolidation.
• More restful sleep.

It is worth noting that during the first session, patients will NOT have to detail their past traumatic experiences and nightmares. This stage of the treatment is dedicated to building credibility, linking insomnia to nightmares, and addressing the transition of the nightmare disorder from the acute to the chronic stage. The therapist will also discuss the psychological benefits of nightmares.

During the second session of the treatment, the therapist discusses nightmare persistence. The first imagery-focused exercises enter the picture. The analysis focuses on the following concepts:

• Why do nightmares persist after traumatic exposure? The learned/habit-based nature of nightmares is introduced to patients.
• When treatment takes direct aim at nightmares, what happens with the symptoms? (They subside surprisingly quickly.)
• The therapist asks participants to define their proportion of trauma-based and habit-based nightmares.
• The specialist introduces the first concepts of imagery.
• Patients practice pleasant imagery. The therapist addresses eventual difficulties linked to using imagery.

The third session focuses entirely on imagery. More precisely, it introduces the role of imagery in eliciting change.

• The therapist first explains the role of imagery in the change process. Patients are asked to reflect on the processes involving imagery that preceded some previous changes in their lives.
• Patients perform imagery exercises. For example, they imagine re-modeling a room in their home.
• Once he/she cements imagery as a vehicle of change, the therapist focuses on patients’ nightmare identities.
• The therapist concludes that nightmares result from learned behavior. Likewise, one’s nightmare identity is learned.
• Imagery is used to change nightmare identities.

The fourth and final session marks the first time patients attempt to address their nightmares directly. At this point, therapy subjects should be aware that they can change their nightmares the way they wish.

• Patients select a less intense nightmare first. It is important from a therapeutic perspective to adopt this gradual approach. Having chosen such a nightmare, the patient then changes it. According to Barry Krakow and Antonio Zadra, choosing a daunting nightmare initially may throw the patient off the treatment course, due to its difficulty.
• Next, patients change their chosen nightmare through imagery. All they have to do is to imagine a different course for their nightmare. There is no clear-cut technique in this regard. Nightmares should obviously be given a positive imaginary twist. Patients change their dreams in different ways. Some resume tweaking some details, while others change the entire storyline.
• Rehearsal is about the new/changed dream only. It does not involve the original nightmare in any form. At this stage of the treatment, patients should be able to handle potentially negative images that may arise during the imaging/rehearsal exercise.

How Does Science Rate the Efficacy of IRT for Nightmares?

Scores of researchers have proven beyond doubt that IRT is highly efficacious in the treatment of idiopathic as well as PTSD-related nightmares.

In their 2004 study, titled Increased Mastery Elements Associated With Imagery Rehearsal Treatment for Nightmares in Sexual Assault Survivors With PTSD, Germain A., Krakow B., Zadra A., and others, have concluded that IRT does not just significantly reduce nightmare frequency and intensity, it also achieves its effects with minimal exposure.

In a 2003 study, Germain A. and Nielsen T. investigated the impact of IRT on nightmare frequency and psychological distress. The results of the study found the method efficacious for the reduction of nightmare frequency as well as psychological distress.

In a 1987 literature review, Halliday G. took a close look at direct psychological therapies for nightmares. Among several other methods, “storyline alteration” has been found to be an effective way of treating nightmares.

Does Imagery Rehearsal Therapy Carry Any Risks?

As mentioned, IRT involves minimal exposure, and therefore it is an extremely safe nightmare treatment method. At no point during the treatment will the therapist ask you to relive a trauma or a nightmare. That said, imagery exercises may unearth negative results in some patients.

In this regard, I have to note that:

• For patients with PTSD, negative imagery carries increased risks. Such patients should stop the exercises as soon as they conjure up such images.
• The activation of the imagery system should take a gradual course. Patients ease into the imaging flow, even if they show affinity and curiosity toward the process.
• It is important to teach patients how to handle negative imagery before more consistent exercises commence.
• Patients should bear in mind that some of the unpleasant imagery they may experience stems from learned behaviors, rather than stress-triggered psychological processes.

Bottom Line: Imagery Rehearsal Therapy

While personally, I prefer to prescribe to my clients a more powerful technique which consists of altering the nightmare from inside the dreamworld by becoming lucid (see: Lucid Dreaming Therapy), for some people lucid dreaming doesn’t come easily. For them, I would absolutely recommend image rehearsal therapy.

Conclusion

Since there are many disorders and conditions which may be causing a persistent nightmare problem, it’s important to make a full assessment when trying to come up with a treatment plan.

Uninformed doctors and physicians will most likely prescribe medications when there may be better alternatives, such as imagery rehearsal therapy and lucid dreaming therapy. For this reason, I suggest getting in touch with a sleep specialist who will be able to guide you through the process of diagnosing your issue and setting up the best treatment plan possible.

Are you taking drugs? Some drugs may cause nightmares so it’s important to go over the list of side effects of every drug you’re taking to make sure it’s not the cause of your bad dreams.

Is the frightening aspect of the dream an episodic memory? Something you experienced in the past?

Do you have PTSD?

Do you have any sleep disorders, such as sleepwalking, narcolepsy, night terror or REM sleep behavior disorder (RBD)? If unsure, tests, such as video polysomnography (PSG) and Multiple Sleep Latency Tests, should be conducted to rule out any sleep disorders.

It’s important to answer these questions because as you saw above, every nightmare type is treated differently.

Suffering from Nightmares? I can help.

We all have bad dreams/nightmares every now and then, but for some people, these manifestations of the subconscious mind can become serious disruptors of everyday existence.

Do these dreams carry any hidden meanings? What causes them and what can be done to get rid of them? These are the questions I shall attempt to answer for you below.

What is the meaning of bad dreams?

There are two types of nightmares defined by science and these are the garden-variety type (that are randomly occurring nightmares, the frequency of which can vary from a handful per year to daily – especially in the case of children), and post-traumatic.

The trigger behind the latter variety is obvious: having gone through a real-life trauma, the sufferer has his/her subconscious mind overloaded with the negative sensations generated by this trauma. These sensations then surface in the form of nightmares, with varying frequency. Such nightmares are expected to subside over time, as the trauma itself fades in the memory of the sufferer.

As far as garden-variety nightmares are concerned, their main trigger can be usually traced back to anxiety. People experiencing such nightmares frequently are thought to be more weary of the real world that surrounds them, and more afraid of certain real-life situations too.

Even infrequent nightmares can be traced back to certain anxieties, which take hold of the dreamer’s subconscious and bubble to the surface when the sufferer loses the ability to consciously suppress them.

Bad dreams are always followed by a flood of relief upon waking up when the sufferer finds solace in the real world, where sanity and normalcy rule.

Despite the bothersome and even irritating nature of these dreams, they should generally not be suppressed, as they offer a potentially useful peek into one’s fears and stresses, and can yield a trove of information for therapists working on the elimination/management of these fears.

What can cause nightmares?

Besides the nightmare triggers already addressed above, science has identified a trove of other issues which can promote and trigger bad dreams.

Nightmares are surprisingly frequent among the 5-12 year-olds, though baby nightmares are apparently rather frequent as well. Children are thought to grow out of nightmares, and indeed, while in the above said age group, the prevalence of the issue can be as high as 50%, in adults it drops to 2-8%.

With children, triggers can indeed be diverse. Scary stories, movies, and TV shows can result in bad dreams, as can school-related stress (whether it originates in bullying or in certain obligations students are required to fulfill).

Adults will experience bad dreams due to a diverse range of issues too, some of them trivial, others less so.

Late-night eating can and will induce nightmares in those who indulge in this type of activity. Carbohydrate-rich foods, when ingested late at night, will up the metabolic rate of the body, and they will increase brain activity.

Unresolved conflicts can also surface at night, in the shape of nightmares, and apparently, one’s momentary hormonal state has an impact on dreaming and thus on nightmares, as well.

Sleep disorders such as sleep apnea can induce bad dreams in adults too.

What medication can cause bad dreams?

If the multitude of potential nightmare triggers listed above feels overwhelming to you, you may not want to read on, because the list is indeed still longer.

Some prescription medications, such as Remeron, have been known to trigger bad dreams as well. Physicians actually have a list of drugs that can elicit such side effects, and this list is indeed rather formidable, given that it’s not about a handful of pills used for the treatment of some rare and obscure conditions.

In fact, some antibiotics have made the above-said list, together with antidepressants (which should theoretically have the opposite effect), blood pressure medications, cholesterol management drugs, and antihistamines.

The list does not stop there though.

If you are taking dietary supplements for whatever reason (and yes that includes bodybuilding supplements and various over-the-counter supplements people use to treat a range of real or imagined “health issues”), you may want to double-check the label for ingredients that may be pushing you down Freddy Krueger’s hallways of terror.

The same goes for alcohol, though in that case, there isn’t really a list of ingredients to check.

Why do such medications result in nightmares for some?

Science believes these chemicals interfere with various stages of the sleep process, interference which often results in the unnatural lengthening of the REM sleep cycle, the stage where most dreaming occurs.

How to Stop Nightmares?

If you get what you suspect are nothing more than “normal” adult nightmares, there’s not much you should do. Just forget about it and move on with your life.

How do you know whether your bad dreams fall into this category or not?

Simple: ask yourself whether they have a significant negative impact on the overall quality of your life.

If the answer is yes, only then, you should start exploring ways of stopping your nightmares.

In addition to that, you should also educate yourself on the nature of bad dreams, learning to differentiate between nightmares and night terrors. Nightmares are said to mostly occur during the REM stages of sleep – as stated above – which means they come about during the last few hours of sleep, in the morning. “Proper” nightmares are associated with vivid images, sometimes as clear as reality itself.

Night terrors, on the other hand, occur within the first few hours of sleep and they are comprised of intense bouts of irrational fear, unaccompanied by the images characteristic of nightmares.

Given how nightmares are merely the symptoms of an underlying psychological issue, the best way to do away with them is to treat this underlying cause.

Reducing stress in your life is the best way to go about that.

Avoiding late-night snacking is another move you can make on the nightmare front, as is the overall improvement of your sleep quality.

Talking about your nightmares to someone also helps sometimes.

There are some herbal remedies that may help, such as:

• Chamomile (Matricaria chamomilla)
• Valerian root (Valeriana officinalis)
• Lemon Balm (Melissa officinalis)
• Passion Flower (Passiflora incarnata)
• St. John’s Wort (Hypericum perforatum)

Learn more about Chinese herbs for nightmares or Chinese non-herbs for various sleep problems.

What are the symptoms of night terror?

Night terrors are intense bouts of fear during sleep, which activate the sufferer’s fight-or-flight systems.

Like nightmares, they affect children as well as adults.

Unlike nightmares though, night terrors occur during the deepest stages of sleep.

Night terrors in children are also associated with sleepwalking. Indeed, the victim of a night terror may sit up screaming, while remaining largely unaware of his/her surroundings and partially asleep. This explains why such victims are often inconsolable and why they seldom remember they even had a night terror.

Fever, extreme exhaustion, and substance abuse are just some of the factors which can trigger night terrors. This form of sleep disorder is much more frequent in children than it is in adults.

In adults, the presence of night terrors can also be indicative of bipolar disorder and PTSD.

Why do we have bad dreams as kids?

Children can start having nightmares from a very early age, though it is thought that they are most vulnerable to this issue between the ages of 3 and 6 when their brains go through an accelerated period of development, which goes hand-in-hand with the development of fear and imagination.

As it’s obvious, those are indeed all the right ingredients for nightmares to blow up. As many as 50% of the children falling into this age group are thought to have problems with bad dreams, and for some of these kids, the problem can be quite debilitating.

In many cases, children’s nightmare problems negatively impact the sleep quality of their parents too.

While the triggers are mostly the same as listed above (stress, anxiety, unresolved conflicts, trauma, etc), researchers have spotted a genetic factor in childhood nightmare problems too. Around 7% of children who have a family history of nightmares (older siblings who struggled with the same problems) go on to have problems associated with bad dreams themselves.

Children with depression and mental retardation have more nightmares, and fevers can be a major trigger for some too (though that holds true for adults as well).

How do I give myself nightmares?

Although nightmares are generally considered a nuisance by most people, some don’t seem to mind having them, and then there are those who actually enjoy them. To such people, nightmares are the sources of fear-triggered adrenaline rushes, not unlike those experienced during the viewing of a scary movie.

Can one really exert some kind of control over how his/her subconscious mind serves up these “delightfully” vivid episodes of “virtual” terror?

Apparently, there are indeed a few measures you can take to invite nightmares into your life.

Altering your sleeping position is possibly the simplest such exercise. People who sleep face-down are more prone to having nightmares about being smothered/unable to breathe. Those sleeping on their right sides seem to be less inclined to have nightmares than those who sleep on their left sides.

Watching a frightening horror movie right before bed is another way to mentally grab a bazaar of bad dreams and try to take it to bed with you. We do tend to dream about things that are on our minds for most of the day, so willingly filling our minds with visually shocking images of gore and terror just before bed, may indeed exert an effect on what we’ll dream about.

Taking Vitamin B6 is apparently another way to bring about nightmares, as is drinking alcohol and leading a generally stressful life.

Spicy foods – preferably eaten shortly before bedtime – will sometimes do the trick too.

Learn about Nightmare Oneirogens – Supplements that can Induce Nightmares