You’ve probably had a nightmare before and told yourself, “Just go back to sleep. It’s not real.” But what if those nightmares weren’t just once in a while, and you had one almost every night? You wake up in a panic, heart racing, and no matter how hard you try, you can’t stop replaying the terrifying images in your mind. Falling back asleep feels impossible, and you’re scared to close your eyes again because you can’t handle seeing those images one more time. By the time morning rolls around, anxiety and dread have taken over, making it difficult to get your day started.
If you share a similar experience, you may feel like you’re supposed to accept these constant nightmares and deal with the effects as if there isn’t a problem. However, it’s important to realize that while an occasional nightmare is normal, if you are experiencing them on a regular basis and they cause anxiety and disrupt your sleep patterns, you might have a nightmare disorder. This disorder can affect anyone, but it is more common for individuals that live with mental illness.
What is nightmare disorder?
Nightmare disorder is one of many parasomnias, which are behavioral sleep abnormalities. Some other common forms of parasomnia are sleep paralysis, night terrors, and sleepwalking. Nightmare disorder specifically can be defined as experiencing repeated agitated dreams that affect the quality of your sleep patterns and daily life. Nightmare disorder can range from mild to severe. A mild nightmare disorder equates to less than one nightmare a week, while a severe nightmare disorder equates to nightmares every night. People with this disorder may experience symptoms for varying lengths of time. Some have the symptoms for a week, others for a month, and others deal with nightmare disorder chronically.
If you feel like you may be experiencing nightmare disorder, getting a professional diagnosis can be very helpful to help guide and treat your thought patterns. While some parasomnias have specific medical tests for diagnosis, nightmare disorder does not. Your provider will instead use your history of nightmares to form their diagnosis. They will also ask about your mental health history because certain mental illnesses are more likely to be connected to the disorder.
We spoke with Tracie Zinman-Ibrahim, LMFT, CST, and Chief Compliance Officer at NOCD to better understand the relationship between nightmares and mental health. Zinman-Ibrahim, who has personally dealt with mental illness and nightmares for much of her life, explains that mental health conditions such as obsessive compulsive disorder (OCD), anxiety, depression, and post traumatic stress disorder (PTSD) can invoke nightmares. “It does tend to happen with people who are having more heavy emotional type things going on,” she says. Additionally, certain medications and sleep aids—like SSRIs, antihistamines and melatonin—are prone to causing nightmares and can possibly have a hand in the formation of the disorder itself.
What causes nightmares?
Nightmares are dreams that invoke fear, distress, and anxiety, causing the dreamer to wake up and disturb their sleep patterns. Dreamers typically remember their nightmares, something that sets this phenomenon apart from a parasomnia called night terrors, which are sometimes mistaken for nightmare disorder.
Because nightmares usually occur during the rapid eye movement (REM) phase of sleep, the time when our brain’s activities resemble that of an awakened state, people are usually able to remember specific details and feelings of their dreams. The distressing themes of nightmares are usually associated with past trauma, stress, or fears.
Zinman-Ibrahim describes the dreams you experience while having nightmare disorder specifically, “You wake feeling like you were just there and then you remember it,” Zinman-Ibrahim explained. She went on to say that remembering dreams is one of the big things that differentiates nightmare disorder from just having a bad dream. “When people are like, I had a terrible dream, I don’t remember it. That’s not a nightmare disorder, actually.”
Lifestyle factors that can cause nightmares:
Stress: Stress that comes with a major life change, or anxiety around an upcoming event can alter your typical dream patterns and cause nightmares.
Medication: Certain medications are known to cause nightmares as a side effect. These medications are typically antidepressants, blood pressure drugs, beta blockers, and those used for Parkinson’s disease and smoking cessation.
Lack of sleep: Not getting enough sleep can make you more prone to having nightmares. Common factors include changes in the amount of sleep you receive, as well as changes in sleep quality (e.g., waking up more often throughout the night).
Substance use: Nightmares can be triggered by using alcohol and recreational drugs, as well as the effects of withdrawal from these substances.
Mental health conditions that can cause nightmares
Having certain mental health conditions can also make you more prone to nightmares because they can cause a change in healthy sleep cycles. Let’s get into some of the specific conditions that nightmares are associated with.
Post-Traumatic Stress Disorder (PTSD)
- According to the DSM-5, a manual used to diagnose mental illnesses, nightmares are considered to be one of the hallmark symptoms of PTSD.
- PTSD and nightmares are linked by changes in activity within the same areas of the brain, highlighting their connection.
- “One of the things that happens with that disorder is recurrent nightmares, sometimes reliving the event or things similar to the event.” Zinman-Ibrahim explains. People with PTSD often experience “…seeing really terrible things over and over, waking up crying and yelling, thrashing. They can be sweaty, or they could not move at all, and they wake up just really feeling like they were just there.”
- This can cause an increase in anxiety when the individual awakens and can make daily tasks harder to accomplish due to the mind being fixated with the nightmare.
Obsessive-Compulsive Disorder (OCD)
- OCD can affect sleep through creating disturbances in sleep patterns that lead to nightmares.
- Nightmares can increase your compulsions if you have OCD, or increase the desire or feeling to perform compulsions.
- Sometimes, people with OCD experience their triggers in their dreams. Zinman-Ibrahim explains, “If you have OCD and you ruminate a lot about something, just because you went to sleep doesn’t mean that that’s necessarily going to shut off.”
- Individuals with OCD may feel stressed and drained throughout the day after dealing with their compulsions.
- OCD can create a struggle with falling asleep due to nighttime intrusive thoughts.These intrusive thoughts and compulsions can then cause intrusive dreams.
What do disturbing dreams mean about you? It is important they are not a definition of you or your character. Melanie Dideriksen, LPC, CAADC explains, “Here’s the important thing to understand: the dream is just an expression of their biggest fear. The dream does not represent a wish or a desire. It’s not the dream that’s the problem; it’s the meaning that a person attaches to the intrusive dreams that becomes an issue.”
We can help you tackle your intrusive thoughts, no matter what they are
Anxiety Disorder
- Having anxiety about sleep and being unable to easily fall asleep is more common in individuals that are diagnosed with an anxiety disorder.
- Having racing thoughts before bed can disrupt sleep patterns, leading to less sleep and causing nightmares.
- Nightmares are common after experiencing life events that create anxiety, such as accidents, injuries, and other forms of trauma.
- Zinman-Ibrahim states that anxiety, or the subject of one’s anxiety, can often manifest itself into dreams because it “doesn’t just stop” when we go to sleep.
- Waking up from a nightmare can cause increased anxiety throughout the day if the individual is left with the negative feelings they experienced in the dream.
Depression
- People with major depressive disorders often have more nightmares than those without these conditions.
- Zinman-Ibrahim shares that nightmares “can also increase depressive symptoms, because with nightmare disorder, one of the things about it is you tend to be extremely depressed. You tend to be either dysphoric or sad.”
- Individuals with depression that experience regular nightmares tend to have a higher rate of suicidal thoughts.
- Depression can often cause insomnia, which increases the risk of nightmares.
Borderline Personality Disorder (BPD)
- Individuals with BPD have more nightmares than most people. Their dreams often include trauma, conflicts with others, and fears of being left alone.
- Studies show that nightmares and borderline personality traits affect each other through things like emotional ups and downs, bad sleep, anxiety from nightmares, increased stress, and worsened self-control.
Sleep Paralysis
- Regular nightmares are a common symptom of sleep paralysis
- Sleep paralysis happens when you wake up or fall asleep, and is most common during the switch between REM sleep and waking up or during unclear REM sleep, which is also when nightmares occur.
- Nightmares can turn into moments of sleep paralysis when you awaken.
Will my nightmares go away on their own?
When someone experiences a nightmare, forgetting and moving forward is the typical approach for dealing with the phenomenon. Zinman-Ibrahim explains that whether nightmares go away on their own really depends on each individual situation and whether or not you have a sleep disorder.
If you believe you have a nightmare disorder, working with a healthcare provider can be very helpful. Zinman-Ibrahim recommends seeking professional help if you’ve been experiencing on-going nightmares for more than six months. She also emphasizes that the first step should be to see your primary care provider and potentially a sleep specialist to make sure there isn’t an underlying medical cause. From there, a mental health specialist can help with catered forms of therapy to help with the nightmares.
How can I get rid of my nightmares?
“I want peace. I want tranquility,” says NOCD community member avirgofrombrklyn, speaking about her struggle with constant nightmares. And while it might seem impossible due to the consuming nature of nightmare disorder, peace and tranquility are definitely achievable.
When addressing the broader causes of nightmares, healthy sleep habits are key. “Good sleep hygiene. That’s one thing that helps everybody’s mental health,” says Zinman-Ibrahim. By adopting good sleep hygiene, “you’re setting up your psychological situation for something nicer. It doesn’t mean you’re not going to have a nightmare, but it could help.” Calming your mind before bed is a key way to ensure you don’t lie awake with intrusive thoughts and worries that can lead to nightmares.
Tips for establishing good sleep hygiene:
- Do something calming before bed—take a warm bath, light a candle, read a book
- Keep your environment dark to promote sleep
- Go to bed earlier and wake up early (aim for the same time every day)
- Explore meditation and mindfulness to manage anxiety
- Exercise during the day
- Establish a sleep-friendly environment
- If you have a racing mind before bed, try journaling to relax and clear your head
Treatment for mental health conditions
If you believe your nightmare disorder is linked to an underlying mental health condition, a professional can help guide you towards the best form of treatment. Zinman-Ibrahim explains that mental health conditions and nightmare disorders are typically treated alongside each other, but not necessarily together through the same form of treatment.
Prolonged exposure therapy, a form of cognitive behavioral therapy, is the recommended treatment for PTSD. Behavioral activation is recommended for depression, a form of treatment which encourages individuals to participate in positive activities, even when they may not feel motivated to do so.
For an individual with OCD, exposure and response prevention (ERP) therapy is the best way to address the issue and work towards remission. Extensive research has shown that ERP is successful for treating all forms of OCD. ERP works by gradually exposing you to your triggers, and teaching you response prevention strategies to cope with your distress.
Waking up from an OCD-related trigger nightmare can be particularly distressing. Zinman-Ibrahim tells patients, “If you’re having a nightmare, you’re going to have a nightmare. You have to remember not to wake up and start compulsing.” This means not trying to figure out why you had a specific dream, or if it means something about you and your thoughts. “You wake up and you go, yep, that was a dream. You have to get out of bed and you have to go on with your day,” she says. The key is to remember that dreams are not reality.
Take the first steps
Whether your sleep issues are tied to a mental health condition or a result of stress, having a nightmare disorder is manageable with the right tools. It is important to remember that you don’t have control over the content of your dreams, and therefore, your nightmares do not define you.
Working with a healthcare provider is the best way to reduce the frequency and severity of your nightmares. Better sleep hygiene, like sticking to a regular sleep schedule and creating a relaxing bedtime routine can also make a big difference. Practices like meditation and journaling before bed can help calm your mind and set the stage for better sleep with less nightmares. With time and effort, you can regain control of your nights and wake up feeling more rested and less worried about nightmares.