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Managing Nightmares

Not every dream is pleasant; many are disconcerting or even terrifying. Unpleasant dreams—particularly those that are frightening or deeply upsetting—are referred to as “nightmares,” and are experienced by most people from time to time. Certain mental health disorders, as well as traumatic life events, may make someone more likely to experience more frequent nightmares.

Having scary dreams night after night can severely disrupt sleep and ultimately decrease quality of life. Luckily, many cases of persistent nightmares appear to respond to treatment, improving sleep quality and mental well-being for many with trauma, depression, or other challenges.

Understanding Nightmares

Nightmares, though upsetting, are a normal (if infrequent) occurrence for the vast majority of people. Like dreams, nightmares often involve people, places, or other elements from an individual’s real life that are made distorted, frightening, or otherwise unpleasant; also like dreams, they are theorized to help humans process memories or come to terms with difficult feelings from their waking life.

Nightmares may be more likely to occur when an individual is stressed, anxious, or struggling with other difficult emotions in daily life; they may also occur seemingly randomly. In some cases, they may be triggered (or exacerbated) by mental health disorders.

What causes nightmares?

According to the DSM, nightmares are generally thought to be caused by anxiety or stress; trauma or an upsetting event; sleep disorders; a fluctuating sleep schedule; or medication or drug use. (For more on the causes of nightmares, see our Diagnosis Dictionary.)

Are nightmares related to mental illness?

In some cases, yes. Chronic nightmares have been associated with depression, schizophrenia, PTSD, and some personality disorders, like borderline personality disorder. Some researchers believe that assessing the frequency and content of nightmares may help clinicians determine the progression and severity of mental health disorders; more frequent dreams of death, for instance, may reveal the presence of suicidal thoughts.

Common Nightmares

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Nightmares often feel like one-of-a-kind horror shows to the individual experiencing them. But in reality, like dreams, there actually exist myriad “universal” nightmare themes that have been reported across cultures, genders, and ages.

In general, nightmares of any kind are thought to be related to stress, sadness, or anxiety. Some people believe that particular nightmare themes are indicative of particular real-world problems, dilemmas, or fears, but these exact connections have not tended to hold up consistently in research. Knowing that an upsetting nightmare theme is not uncommon, though, may help someone deal with any anxiety, shame, or sadness that the nightmare triggers.

What are some of the most common themes in nightmares?

Common nightmare themes include physical aggression, interpersonal conflicts, or experiences in which the dreamer feels helpless or unable to escape a particular situation, according to one large study that analyzed approximately 10,000 dreams. Nightmares may also feature large-scale calamities like war or natural disasters. Fear, guilt, sadness, and disgust are emotions that often characterize nightmares.

What does it mean if I dream that my teeth are falling out?

Dreams involving teeth falling out, rotting, or breaking are common around the world. Some evidence suggests that they may be related to real-life dental irritation, though this relationship is inconclusive. Other researchers hypothesize that such dreams are triggered by psychological distress like anxiety or nervousness, though this has also not been definitively proven. Ultimately, the nightmare may not mean anything; many neurologists argue that dreams are merely random collections of images generated by the human brain.

Treating Nightmares

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Nightmares that occur only occasionally are often not cause for concern. But persistent nightmares could be indicative of a larger problem—like depression or trauma—or may themselves interfere with well-being by disrupting sleep or triggering daytime anxiety.

Fortunately, there are several options for treating nightmares; strategies range from self-help (i.e. practicing relaxation techniques before bed) to improved sleep hygiene to formal therapy. If frequent nightmares came on suddenly with no discernible psychological trigger, it may be best to talk to a doctor; certain medications or physical disorders like sleep apnea may be causing persistent nightmares.

How do I stop having nightmares?

The best place to start is by improving sleep hygiene; sticking to a more consistent sleep schedule, engaging in a relaxing bedtime routine, limiting caffeine and alcohol, and exercising consistently may help curb nightmares in many cases. The next step may be to explore the issue with a doctor to determine if the nightmares have any medical causes.

How do I know when to seek professional help for nightmares?

If no medical causes are found, certain types of psychotherapy—including cognitive behavioral therapy and image reversal therapy—have been found to be effective at reducing the frequency of nightmares by helping an individual navigate the stress, anxiety, or trauma that may be responsible for the bad dreams. (For more on treating nightmares, visit our Diagnosis Dictionary.)

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