Definition

A nightmare is a bad dream that brings out strong feelings of fear, terror, distress, or anxiety.

Causes

Nightmares usually begin before age 10 and are most often considered a normal part of childhood. They tend to be more common in girls than boys. Nightmares may be triggered by seemingly routine events, such as starting at a new school, taking a trip, or a mild illness in a parent.

Nightmares may continue into adulthood. They can be one way our brain deals with the stresses and fears of everyday life. One or more nightmares over a short period of time may be caused by:

• A major life event, such as the loss of a loved one or a traumatic event
• Increased stress at home or work

Nightmares may also be triggered by:

• A new medicine prescribed by your health care provider
• Abrupt alcohol withdrawal
• Drinking too much alcohol
• Eating just before going to bed
• Illegal street drug use
• Illness with a fever
• Over-the-counter sleep aids and medicines
• Stopping certain medicines, such as sleeping pills or opioid pain pills

Repeated nightmares may also be a sign of:

• Breathing disorder in sleep (sleep apnea)
• Post-traumatic stress disorder (PTSD), which can occur after you have seen or experienced a traumatic event that involved the threat of injury or death
• More severe anxiety disorders or depression
• Sleep disorder (for example, narcolepsy or sleep terror disorder)

Home Care

Stress is a normal part of life. In small amounts, stress is good. It can motivate you and help you get more done. But too much stress can be harmful.

If you are under stress, ask for support from friends and relatives. Talking about what is on your mind can help.

Other tips include:

• Follow a regular fitness routine, with aerobic exercise, if possible. You will find that you will be able to fall asleep faster, sleep more deeply, and wake up feeling more refreshed.
• Limit caffeine and alcohol.
• Make more time for your personal interests and hobbies.
• Try relaxation techniques, such as guided imagery, listening to music, doing yoga, or meditating. With some practice, these techniques could help you reduce stress.
• Listen to your body when it tells you to slow down or take a break.

Practice good sleep habits. Go to bed at the same time each night and wake up at the same time each morning. Avoid long-term use of tranquilizers, as well as caffeine and other stimulants.

When to Contact a Medical Professional

Tell your provider if your nightmares started shortly after you began taking a new medicine. They will tell you if you should stop taking that medicine. Do not stop taking it before talking to your provider.

For nightmares caused by street drugs or regular alcohol use, ask for advice from your provider on the safest and most effective way to quit.

Also contact your provider if:

• You have nightmares more than once a week.
• Nightmares stop you from getting a good night's rest, or from keeping up with your daily activities for a long period.

What to Expect at Your Office Visit

Your provider will examine you and ask questions about the nightmares you are having. Next steps may include:

• Certain tests
• Changes in your medicines
• New medicines to help with some of your symptoms
• Referral to a mental health provider

References

Arnulf I. Nightmares and dream disturbances. In: Kryger M, Roth T, Goldstein CA, Dement WC, eds. Principles and Practice of Sleep Medicine. 7th ed. Philadelphia, PA: Elsevier; 2022:chap 119.

Avidan AY. Sleep and its disorders. In: Jankovic J, Mazziotta JC, Pomeroy SL, Newman NJ, eds. Bradley and Daroff's Neurology in Clinical Practice. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 101.

Pigeon WR, Carr M. Dreams and nightmares in posttraumatic stress disorder. In: Kryger M, Roth T, Goldstein CA, Dement WC, eds. Principles and Practice of Sleep Medicine. 7th ed. Philadelphia, PA: Elsevier; 2022:chap 61.