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Treating nightmare disorder in adults

Filed in
  • Treatments
  • nightmares

By Corinne Lederhouse  |  Jun 25, 2018
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While nightmares occur frequently in children, they can be a problem for adults too. It’s common to have nightmares every once in a while, but if you suffer from nightmare disorder, you may have repeated occurrences of nightmares that cause distress or impairment. 

Approximately 4 percent of adults have nightmare disorder, either by itself or as part of other disorders such as post-traumatic stress disorder (PTSD). Nightmare disorder can significantly disturb your sleep and impair your quality of life. It also can worsen an underlying mental illness, such as depression or anxiety. 

Fortunately, there are treatments for nightmare disorder in adults. A position paper from the American Academy of Sleep Medicine (AASM) outlining treatments was published in the June 15 issue of the Journal of Clinical Sleep Medicine.

The position paper reports that image rehearsal therapy is useful for the treatment of nightmare disorder and nightmares associated with PTSD. Image rehearsal therapy is a technique that involves altering the content of a nightmare by creating a new set of positive images and rehearsing the rewritten dream scenario while awake. 
The AASM task force found that various methods may be used for treating nightmare disorders, including cognitive behavioral therapy, hypnosis, and some prescription medications. However, the task force concluded that the anti-anxiety medication clonazepam and the antidepressant venlafaxine are not recommended for the treatment of nightmare disorder. 
For more information about these recommendations, read the full paper, “Position Paper for the Treatment of Nightmare Disorder in Adults: An American Academy of Sleep Medicine Position Paper.” 
If you are struggling with nightmares, talk with a doctor, who may refer you to an accredited sleep center. Effectively treating nightmare disorder can improve your sleep quality and help you feel more alert and less sleepy.


  1. 1 Kym Ramsay 20 Feb
    I have had nightmares every night for years. They occur throughout the entire night. It's not unusual that I will end up sitting up in the middle of the night for a half hour to an hour. Or wake up very early and stay awake for the day. My nightmare themes are generally the same night after night: post-apocalyptic scenarios, or violence. I am writing this at 6 am because I had dreams that I was part of a captured task force trying to rescue children and pets from being murdered. I slit one of the bad guys throat with a steak knife I found trying to rescue one of my teammates, but I had to keep slicing because a steak knife is not an effective tool for that purpose. Yup, that's my every night.
  2. 2 Joxelyn 05 Feb
    My husband have a terrible nightmares this Feb. 05 , I so very scared and sad for what happened my daughters see her that was his very terrible scare and shouting said go away go away then I shout back to calm his.I'm so very worried but like what I read now may be it's cause of over fatigue and sometimes they hard to sleep well because our neighbour always make noisy for his to hard to sleep .thank you
  3. 3 Denise 24 Jan
    I have had chronic severe nightmares over 18 years. My nightmares can be about a thing!!! My nightmares brings in people from my past and present and even a conversation with a stranger and my jobs both old and new. I am always the main characters and I remember the whole nightmare in the morning and play it over and over in my mind!!! I believe I will never be free of them!!! I once went to a hospital for 2 weeks that specializes in sleep disorder. For 2 whole whole weeks I slept for the first time ever without nightmares!!! I am past exhausted!!! I don’t feel I will ever be well!!!! I have a therapist and take medicines for anxiety and to sleep at night. 
  4. 4 Marilyn 23 Jan
    Ive been having extreme nightmares every night . With that Im also having internal tremors. Almost all the time. Ive seen 4 Drs and most say its anxiety  . But 2 say I need an MRI   . What do you think? 
  5. 5 Tawna 04 Dec
    I dream and have nightmares every night 365 days a year..I'm up and down all night long because of them. The next day I feel like I haven't slept at all. I suffer from Anxiety, major manic depression/bipolar, insomnia and PTSD. I however do not take any meds for any of my disorders. I'm 48 years old and a complete mess and have no idea where to turn..
  6. 6 American Academy of Sleep Medicine 20 Jul
    Joshua, if you are experiencing severe sleep disturbances or daytime sleepiness, we recommend contacting an accredited sleep center near you.
  7. 7 Joshua 19 Jul
    I keep having very vivid dreams of me or people I love dying. This has been happening since I was a little kid, I'm now 21. Should I call my doctor? It's at the point I'm crying out of fear each night and wake up numerous times a night sweating and seeing that I've been thrashing around. My roommate thinks I game seizures at night and l even though it's just dreams. I can't afford much, so what can I do that costs little to help myself? And do I talk to my doctor about this.
  8. 8 Chris 29 Jun
    It seems I have suffered from this for years. Although, I would not call them nightmares, I have extremely vivid dreams that pose issues in my life because i have trouble differentiating between my daytime memories and my dreams, as if my dreams were simply other memories.
    It has caused problems in my marriage, at work, and my personal life due to thinking something has happened or needed attention when in reality neither may be true.
    I have found that marijuana has been helpful due to the lack of dreams, although this has created other problems as well
  9. 9 Nikole L Hansford 15 May
    I have severe chronic persistent  nightmare disorder ...... I have the most painful and scary nightmares every night and I don't get any sleep at all....I wish it would go away health is deteriorating rapidly .....I wish I could just have a sound sleep everynight....does anyone one know of any kind of medications that would work? Email me
  10. 10 isadora 06 Apr
    I have only learned of this disorder after suffering from it for a decade. It should be ridiculous to get bothered by dreams, however, it's inevitable when they happen at least 3x a week, sometimes 3x a day, and they're so intense that you don't feel like you where there, you WERE there. They started in childhood, I knew it wasn't normal but no one could even relate.
    What slowly stopped them was journaling about the most novel ones. At first it felt counterintuitive to write down what I wanted erased but ignoring didn't help either. Turning them into stories must have had the same effect of doing imagery rehearsal. The dreams got more elaborate and I more powerful in them, when before I could only run and hide, though they persisted still.
    I noticed that they were all about my current life no matter what I did. For example, school nightmares exploded in frequency as the 1st day of school approached, even though I wasn't thinking about it at all. My humor is stable and mostly happy and still I always have had the worst dreams. I tried see to them as a joke and do my best to not dwell on the mental pictures after writing them down. If you're suffering, writing will transfer the burden to the paper, and staying positive and treating the dreams lightly will definitely help. I'd just love to know what causes them.
  11. 11 American Academy of Sleep Medicine 17 Feb
    Hi Nazy, our recommendation is to speak with a physician or a sleep center near you. In addition to the position paper about the treatment of nightmare disorder in adults, we have some additional information about nightmare disorder here.
  12. 12 Nazy 14 Feb
    Hi, I have  extreme nightmare disorder.  A lot has happened to me, generally feeling unsafe might be the underlying cause of mine. But am not in a country with such imagery rehearsal treatment.. So what can I do to help myself.. Cos Mine gets worse every night.  Pls  email any response.
  13. 13 Shristi Patni 20 Aug
    Hi, Above blog is inresting. Nightmares may be caused by  stress. Thanks for sharing.
  14. 14 ben wise 01 Aug
    i am get more bad dreams there in my head is still there i see i see them in my sleep i was there to see it i see it when i'm in my dreams i need help i been crying about it myself this more tramua 
  15. 15 Royce Barber 21 Feb
    I love this website because it's helping me cope with over a month of insomnia and only a few hours of sleep in that time. I'd like this Nightmare page to be expanded a lot, and perhaps not have a visual from a scary movie at the top of the page. Just a picture of a empty bed, would be fine.
  16. 16 Shirley Albert 09 Feb
    Nightmares may be caused due to anxiety and stress. These can be really dangerous sometimes. Can you mention some of the reasons behind these dreams?
  17. 17 ben wise 21 Oct
    my name is ben i been seeing thing's in my mind
  18. 18 Parijatak Ayurveda 17 Oct
    Excellent post. The information you provided is useful to all of us. Keep on posting like this. Thanks for sharing.

  19. 19 mary walker 16 Oct
    I do have nightmares .
  20. 20 No name 19 Sep
    They get it because of real bad stress and anxiety or a tramua sexual abuse can sometimes cause it so that’s your answer corey
  21. 21 corey 18 Sep
    how and why do people get nightmare disorder