Overview

You've likely jumped awake from a bad dream at least once - heart pounding, soaked in sweat, and trying hard to clear those scary images from your thoughts. For many, bad dreams hit now and then and are not fun at all. But what if they keep happening so much that they mess up your sleep or even impact your day? This is when we talk about nightmare disorders.

Clinically, nightmares are seen as clear, upsetting dreams that usually pull you out of sleep, often from the stage called REM (rapid eye movement) sleep. These dreams are often full of fear, worry, or distress.  And unlike night terrors, you’re often able to remember the details when you wake.

When nightmares become frequent and start to interfere with your sleep quality, mood, or ability to function during the day, doctors may diagnose you with a nightmare disorder. In simple terms, it’s not just the occasional bad dream, it’s when those unsettling nights start to take a real toll on your wellbeing.

In this article, we’ll explore why nightmares happen, when they’re considered a problem, and what you can do if they’re affecting your life.

What is nightmare disorder?

A nightmare is a scary or upsetting dream that can wake you up feeling anxious or afraid. They're pretty common, especially for kids, but anyone can have them at any age. If they only happen once in a while, they’re usually nothing to worry about.

Children typically begin having nightmares between the ages of three and six, and they may extend throughout the lifespan.¹ Around 1 in 5 children say they get nightmares often, and about half of all kids have had at least one at some point.² For adults, most people (about 85%) have a nightmare at least once a year.² A smaller number, around 2 to 6 out of every 100 adults, say they have nightmares pretty often, even as much as once a week.² Girls are more likely than boys to experience nightmares during their teenage years and the early stages of adulthood.³

While having nightmares now and then is normal, nightmare disorder is something more serious. This is when someone has bad dreams often, and those dreams start to cause problems. They might mess with sleep, cause stress during the day, or even make a person afraid to go to bed.

How is it different from other nightmares?

It’s important to know the difference between the occasional bad dream and something more serious. A typical nightmare is just a one-off, scary dream that might wake you up, but doesn’t cause much trouble beyond that. Nightmare disorder (ND), on the other hand, is a real sleep problem. It means having nightmares often, so often that they mess with your sleep and even affect how you feel or function during the day. The key differences between both are:

What are the causes of nightmare disorder?

No one knows for sure what causes nightmares or nightmare disorder, but researchers have a few ideas and theories about why they happen. They've discovered a lot about dreams and nightmares, but there’s still plenty they don’t fully understand. However, they’re linked to mental health issues like PTSD or depression, or they might be triggered by medication and other sleeping disorders. Common causes of nightmare disorder include: 

Mental health conditions

• Post Traumatic Stress Disorder: People with PTSD report nightmares in 80% of cases of nightmare⁴
• Depression & Anxiety: Because of the strong feelings and high levels of stress, these conditions can cause more nightmares. A stressful life event or the death of a loved one may cause this⁵
• Other Mental Illnesses: Disorders like schizophrenia or borderline personality disorder can also bring on negative dreams

Traumatic experiences

• Trauma: Bad experiences like accidents or abuse can cause recurring nightmares, especially with PTSD, serving either as a coping mechanism or as a manifestation of unresolved emotions⁴
• Childhood Trauma: Tough experiences early in life can make nightmares more likely later on

Sleep disorders

• Sleep Apnea & Breathing Problems: Sleep-disordered breathing (including sleep apnea) is more common in individuals with PTSD and may contribute to awakenings and nightmares⁶
• Insomnia: Nightmare disorder has high comorbidity rates with insomnia (~18%). Insomnia and nightmares can also perpetuate each other, particularly in mood disorders⁷

Medications and substances

• Medications: Some medicines, like antidepressants, blood pressure pills, or Parkinson’s drugs, can impact sleeping behaviours⁴
• Alcohol and Drugs: Alcohol withdrawal often causes REM rebound and vivid dreams, potentially including nightmares
• Stopping Certain Medications: When you stop medicines that normally block dream sleep (like some antidepressants), you might get a "rebound" effect with more vivid and intense nightmares

Other factors

• Scary Content: Children's nightmares tend to have more real, age-appropriate themes, like villains, ghosts, or creatures, than those of adults. These nightmares' content usually mirrors the anxieties and fears tied to development that's typical at this age
• Poor Sleep Habits: Irregular sleep schedules or not getting enough sleep can increase nightmares

Impact on daily functioning and work life

Sleep problems, including frequent nightmares, can seriously affect your daily life and work. People with recurrent nightmares commonly report poorer sleep quality and daytime tiredness, which then translates into mood changes and trouble thinking clearly.^7,8

Being tired during the day, having mood swings, and struggling to think clearly make it harder to focus, remember things, and get tasks done. Experimental and review studies of sleep deprivation show declines in reaction time, working memory, decision-making and higher-order cognitive skills that directly impair everyday performance.⁸

At work, this can lead to mistakes, poor concentration, and lower productivity. Large occupational studies link insomnia and other sleep disturbances with both presenteeism (being at work but working suboptimally) and increased absenteeism, so sleep problems commonly translate into measurable losses in work performance.^7,9 In children, their behaviour, emotional health, and academic achievement can all be affected by such episodes.¹⁰

Strain on personal and romantic relationships

Mood swings and emotional withdrawal are other effects of the condition that affect relationships with loved ones. Relationship maintenance can be challenging due to conflict and misunderstandings caused by depression, anxiety, and irritability. Communication breakdowns may result from people feeling ashamed to discuss their sleep issues, which can lead to misunderstandings and emotional detachment.^7,11

Intimacy and trust may be impacted over time by these sleep problems. The relationship can be weakened by avoidance behaviours, such as not sharing a bed, and emotional detachment, which lessen affection and intimacy. Research has shown that couples dealing with disrupted sleep often report lower relationship satisfaction, more frequent arguments, and reduced ability to manage conflict constructively.^7,11

The strain is not only emotional but practical. Partners may feel exhausted themselves due to disrupted sleep, leading to resentment or frustration. Over time, this shared sleep disturbance can create a cycle in which both individuals feel disconnected and unsupported.¹²

Nightmares can also trigger strong emotional reactions such as fear, shame, or anger, which may carry over into waking life and affect how partners interact. In some cases, people may avoid discussing their nightmares altogether, either to protect their partner or to avoid feelings of vulnerability. This silence, however, can foster distance and prevent the couple from working together to address the problem.¹²

Ultimately, when sleep problems persist, the relationship risks becoming another casualty of the disorder. Trust, communication, and intimacy may all erode, leaving both partners feeling isolated. Recognising and addressing the role of nightmares and sleep disruption in relationship health is therefore essential, not only for the individual, but for the wellbeing of the partnership as a whole.

Mental health consequences

Because sleep deprivation exacerbates mental health issues, psychological disorders brought on by such conditions can raise the risk of suicidal thoughts and self-harm. Research shows that people with insomnia or frequent nightmares are almost twice as likely to report suicidal thoughts or behaviours compared to those who sleep normally.¹³

A vicious cycle may result from the fear of sleeping. You might start to fear going to sleep, which makes you more anxious and restless. That anxiety then fuels insomnia, which increases stress, and the stress itself triggers even more nightmares. A sense of helplessness and emotional instability during the day can result from this cycle, which can make it seem like there is no way out.

Social isolation can also be experienced by those who struggle with sleep issues. They may avoid social situations due to fatigue and mood swings, and they may be ashamed or afraid of being judged if they talk about their difficulties.^11,14

How do you treat nightmare disorder?

To treat ND, the doctor might suggest a mix of treatments, such as medication and psychotherapy (talk therapy). There are numerous types of talk therapy that may help reduce nightmares:^11,15

• Imagery Rehearsal Therapy (IRT): you rewrite your nightmare to a less frightening version and rehearse it daily; it's effective in both PTSD-related and idiopathic nightmares
• Exposure, Relaxation, and Rescripting Therapy (ERRT): this combines IRT with exposure and relaxation techniques and has empirical support for trauma-related nightmares
• Lucid Dreaming Therapy: training to become aware and control your dream; some studies show reduced nightmare frequency, though evidence is still emerging
• Exposure and Desensitisation Therapies (systematic desensitisation): gradually confronting intensifying nightmare elements paired with relaxation techniques
• Progressive Deep Muscle Relaxation: used in variants of ERRT and desensitisation approaches to reduce arousal and empower control over nightmare content
• Cognitive-Behavioral Therapy for Insomnia (CBT-I): targets sleep habits and sleepless thoughts; shown effective for general insomnia and reduces nightmares, particularly in PTSD populations

Changes to sleep hygiene, such as daily routines and habits that promote regular sleep, are often part of talk therapy recommendations. These therapies help patients develop healthier sleeping habits by minimizing the severity and frequency of nightmares.

Different types of prescription medications can also be recommended to help manage nightmares, especially when they are linked to underlying mental health conditions:^11,15

• Antidepressants: which may help indirectly by addressing underlying mood or anxiety disorders, though not necessarily effective for nightmares themselves
• Antipsychotics and anxiety medications: these have been used off-label for nightmares with some positive case reports, but high-quality evidence is limited and side effects significant
• Antihypertensives: are shown to be effective in many PTSD-related nightmares. Though evidence is mixed, it is still considered a first-line pharmacological option

How do you stop nightmares and get better sleep?

There are many simple ways to follow good sleep hygiene. Some of the most crucial ones are as follows: 

• Stick to a regular sleep routine
• Find ways to relax before bed
• Cut down on caffeine and alcohol in the evening
• Turn off screens before bedtime
• Make your bedroom cozy and peaceful

Summary

While we all get nightmares sometimes, if they’re happening often and making you tired, anxious, or stressed during the day, it might be time to get help. Nightmare disorder can have a serious impact beyond just sleep. It can strain personal and other relationships, creating emotional distance, tension, and misunderstandings. But the good news is that nightmare disorder can be treated. With therapy, medication, better sleep habits, and support, you can reduce how often nightmares happen and take back control of your sleep. A calm bedtime routine, a relaxing sleep environment, and talking to a mental health professional can all make a big difference. You don’t have to deal with it alone, better sleep is possible.