Nightmare Causes and the Best Treatments

Find relief for recurrent, disturbing bad dreams

Updated on August 09, 2022

Medically reviewed by Sanja Jelic, MD

If you suffer from bad dreams and nightmares, you no doubt wonder how to diagnose their cause and what nightmare treatments may be available. Nightmares are not considered a disorder needing treatment unless they are recurrent and cause significant distress or difficulty getting back to sleep, resulting in insomnia. Fortunately, there are effective treatment options available, including medications and therapy. Learn about some of the best options.

Woman having a nightmare — Tetra Images / Getty Images

Potential Causes

If nightmares do become problematic, the first step is to identify and eliminate any of the potential causes, including:

Medications
Seizures
Non-REM parasomnias
Sleep-disordered breathing (i.e., sleep apnea)
Post-traumatic stress disorder (PTSD)
Sleep terrors
REM behavior disorder
Sleep paralysis

By addressing these underlying causes, it is possible that no further evaluation or treatment will be necessary. It may be necessary to speak with a doctor, often either a sleep specialist or psychiatrist or psychologist, to rule out some of these potential causes.

Diagnosis

In some cases, it may be necessary to undergo a standard sleep study called a polysomnogram. This study is slightly modified to include additional brainwave measurements. This expanded electroencephalogram (EEG) identifies possible seizure activity as a contributor to the nightmares. This study will also rule out sleep apnea as a potential contributor.

Treatments

As noted, nightmare treatment may require the assistance of a sleep or mental health specialist. The medication prazosin has been used in adults with PTSD who have nightmares, but it has not been studied in children. In addition, it may be helpful to undergo therapy, such as:

Psychotherapy
Relaxation techniques
Hypnosis
Lucid dreaming

One of the most common treatments is dream rehearsal therapy. In brief, recurrent nightmares are practiced with an alternative, more favorable, ending. If you dream about being chased and attacked, you find a way to escape, for example.

Finally, the use of certain medications to suppress REM sleep can also be effective. These include medications for anxiety and depression, such as selective serotonin reuptake inhibitors and tricyclic antidepressants.

If you suffer from recurrent nightmares that are disruptive to your sleep and your life, you may wish to start by talking with your healthcare provider about some of the options available to you. If the problems persist, get the specialized evaluation that you need to resolve the condition.

Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Durmer, JS and Chervin, RD. "Pediatric sleep medicine." Continuum Neurol 2007;13(3):153-200.
Hobson, JA et al. "The neuropsychology of REM sleep dreaming." Neuroreport 1998;9(3):R1-14.
Raskind, MA et al. "Reduction of nightmares and other PTSD symptoms in combat veterans by prazosin: a placebo-controlled study." Am J Psychiatry 2003;160(2):371-373.