Nightmare Disorder

You regularly have extremely frightening, well-remembered dreams resulting in rapid alertness on awakening. It may be difficult to fall back to sleep. The experience of the nightmares or ongoing sleep disruption negatively impacts your functioning during the day. These are the essential features of nightmare disorder.

Nightmare Disorder: A 24-hour disorder. 

Nightmares disrupt your sleep, resulting in daytime fatigue and sleepiness. It’s harder for you to concentrate, learn, and remember. You have intrusive thoughts or images of your nightmares during the day. Your work and school performance suffers. You notice feeling more irritable, angry, and depressed. Your interpersonal relationships suffer. 

You feel anxiety as bedtime approaches. You fear that tonight is yet another night with extremely frightening nightmares. You avoid bedtime by scrolling social media or watching one more YouTube video (or seven). Your sleep is further disrupted. More daytime fatigue. More daytime sleepiness. The vicious cycle of nightmare disorder begins. 


The importance of sleep-focused assessment. 

A critical step in overcoming your nightmares is determining why they’re happening.

If you’ve experienced a lifetime of intense emotions (possibly including self-injury or suicidality) or one or more traumas, it’s likely that you have frequent nightmares. 

Research indicates that approximately 50% of individuals diagnosed with borderline personality disorder report regularly experiencing nightmares. 

Over 70% of individuals diagnosed with post-traumatic stress disorder report regularly experiencing post-traumatic nightmares. Even if you successfully complete trauma-focused treatment, nightmares tend to remain problematic if they’re not treated directly. 

Nightmares can be triggered by many other factors, including specific medical conditions, prescription medications, or substance use.

Like all of us, nightmare disorder is complex. It can feel overwhelming to untangle this web of extremely frightening dreams, sleep disruption, changes in mood, relationships, and seemingly every other aspect of your life. Where to even begin?

A free 15-minute consultation with a sleep specialist is one solution to consider.


What is the most effective treatment for nightmare disorder?

Science-based Skills.

Based on over 30 years of experimental evidence, the American Academy of Sleep Medicine recommends Imagery Rehearsal Therapy (IRT) and related interventions like Exposure, Relaxation, and Rescripting Therapy (ERRT) as the most effective treatment options for nightmare disorder in adults.

IRT and ERRT are multi-component, individualized treatments involving daily monitoring of your sleep-wake pattern (including nightmare frequency and intensity) using a sleep log, learning about the nature of nightmares, daily practice of skills targeting nightmare-related imagery, thoughts, and emotions, and refining treatment until nightmares are no longer problematic.

As IRT and ERRT are skill-based, you’ll learn and practice tools that you can continue to use for the rest of your life without concern for side effects of nightmare-specific sleep medications, which include fatigue, restlessness, dizziness, dry mouth, headache, and worsening nightmares. 


How long will it take to successfully treat my nightmare disorder? 

Although your total number of appointments will depend on your individualized treatment plan, clinical research trials of IRT and ERRT and our own clinical experience delivering these interventions suggest that most nightmare disorders are successfully treated within the equivalent of only 6 to 9 weekly sessions following your initial clinical assessment.