Nightmare Causes and the Best Treatments

Find relief for recurrent, disturbing bad dreams

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
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Potential Causes

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

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.


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.


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:

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.

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  • 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.

By Brandon Peters, MD
Brandon Peters, MD, is a board-certified neurologist and sleep medicine specialist.