Is There a Way to Cure or Prevent Nightmares?

Is There a Way to Cure or Prevent Nightmares?
Illustration: Elena Scotti (Photos: Getty Images, Shutterstock)

Are you spending your sleeping hours getting chased down endless hallways by men with enormous claws for hands? Shrieking in pain as wolves chomp your legs? Re-experiencing various traumatic incidents from your childhood from the vantage point of a ghost, forced to watch the same disasters play out over and over again with no ability to affect their outcome? If so, this week’s

Antonio Zadra

Professor of Psychology and Head of the Zadra Dream Lab at the Université de Montréal

It’s important to note, first, that there are many different kinds of nightmares. Some people have had the same nightmares since they were little kids; others start having them following stressful or traumatic events; some occur after people develop medical conditions, or start taking particular medications.

The good thing is that, almost regardless of what kind of nightmare a person is experiencing, there are indeed things they can do to decrease their frequency or get rid of them altogether.

One of the most studied and effective techniques is called Imagery Rehearsal Therapy. This involves taking out a sheet of paper and actually writing out your recurring nightmare, changing whatever feels right to you. Some people might change the beginning; some might change the end; some might change the whole thing; some choose to focus on just a minor detail of the dream. This exercise is typically done when the person wakes up from the nightmare, and tends to be effective in over 80% of clinical nightmare sufferers. This is true whether these people are suffering from what we call idiopathic nightmares — for which we don’t know of a clear cause — or if they’re war veterans or victims of sexual abuse or people who have been caught in natural disasters. Most clinicians familiar with this area of study will recommend this, because it’s fairly straightforward, can be easily practiced at home, and tends to give positive results.

Other methods are trickier to recommend. Some people try autosuggestion — telling themselves they won’t have a nightmare before going to bed — but there is very little evidence for the effectiveness of this method. Some try to develop the ability to lucid dream — to become aware that they’re dreaming while the dream is ongoing, and to use this awareness to change how the nightmare unfolds. But here, too, the evidence tends to be mixed, and it can also happen that people become aware that they’re dreaming but are unable to alter anything in the nightmare, which can actually make the nightmare worse than it might otherwise be.

Lisa DeMarni Cromer

Associate Professor of Psychology and Director of the SPARTA Lab at the University of Tulsa

The difference between a nightmare and a bad dream is that a nightmare wakes you up. In my lab, we’re looking at not just nightmare frequency but also the levels of distress they generate. When you wake up, is your heart beating fast? Are you sweating? Are you panicked? Are you afraid to go back to sleep?

When we treat people with chronic nightmares, one of the first things we do is try to improve their sleep hygiene. We advise people to not drink alcohol before bed, to stop using screens at least an hour before bed, to avoid eating or heavy exercising before bed. We want them to turn down the lights and allow the natural melatonin in their brains to be released, to prime them for a good night’s sleep.

If that doesn’t solve the problem, we have them re-script their nightmare. They write out the nightmare in detail, in the present-tense, with as much detail as possible, and then they change whatever’s really bothering them, no matter how fantastical. If they have a nightmare about being trapped on the subway underground, they might alter it so that the subway starts rolling really fast and sprouts wings and starts sailing through the clouds. This gives them some element of control. What I’ve seen in my research is that what really helps is the realisation that you can change your nightmare, that you have control over your subconscious, even when you’re sleeping. With some of the kids I work with, just the hope and belief that they can make that change really makes a difference.

T.W.C. Stoneham

Professor, Philosophy, University of York, who has conducted research on nightmares

According to our research, what triggers dreaming — including nightmares — is largely perception and interoception during sleep. Nightmares seem most strongly associated with interoception: our awareness of our own bodies and physiological processes. To reduce nightmares you need to remove these triggers, so make sure the light, temperature, and noise levels in your bedroom are comfortable and constant; avoid foods and drink you find hard to digest (including alcohol); find comfortable sleeping positions; and maybe take a small dose of a painkiller such as ibuprofen.

If your nightmares are associated with trauma and you are seeing a psychotherapist, make sure they are trauma-aware and use therapeutic interventions which are designed for dealing with nightmares and parasomnias, such as Systemic Experiential Embodied Reprocessing (SEER).

Rachel Salas

Associate Professor, Neurology, Johns Hopkins University

Anyone can experience nightmares, especially during something like a pandemic. But when it becomes a problem — when it starts disrupting your sleep, or leading to insomnia, or causing extreme anxiety — it’s probably time to seek evaluation.

When we treat nightmares, we utilise our sleep behavioural psychologist who does cognitive behavioural therapy. We may have them do mindfulness exercises; we might have them write down the nightmare they had earlier in the day, so that at night, if they start worrying that they’ll have it again, they can tell themselves: ‘well, I already wrote that stuff down, I thought about it earlier.’ It kind of puts them in a different mindset. Hypnotherapy and meditation can also be useful here. Weighted blankets have worked for some patients, given the extra security they provide. We also look to see if there are any medications that could be contributing to the nightmares.

Another thing that’s helpful is to take away any triggers in the sleep environment. Often, people dream about people who have passed away, and so reminders in your bedroom may not be a good idea, especially if you’re having recurring nightmares about them.

But then there’s REM behavioural sleep disorder, which is more serious. Usually, with this disorder, people have violent dreams, typically involving fights with someone or something. What happens is that they end up either hurting themselves or whoever’s in the bed with them, to the point of needing stitches. One of my patients dove out of his bed and broke his clavicle. Many of these people also go on to develop Parkinson’s disease, so we identify them early and assess them for early signs or symptoms they may not even be aware of.

Often people won’t seek treatment for their nightmares, either out of embarrassment or because they think everyone deals with them and it’s not something they need medical help for. But if you’re having recurring nightmares about choking or drowning, that could be a red flag that you might have undiagnosed, untreated sleep apnea. Nightmares can indicate not only sleep disorders but other underlying problems. So it’s probably best to talk to your doctor about them.

Deirdre Leigh Barrett

Professor of Psychology at Harvard University whose research focuses on dreams, and the author of Pandemic Dreams

This is a question I’ve been seeing a lot lately in my survey on covid-19 dreams!

First, there are two distinct types of nightmares. First is the garden variety one which, like other dreams, usually happens during Rapid Eye Movement Sleep, and is just basically a dream with terrifying affect. The imagery is bizarre and “dreamlike.” Some people are distressed by these, while others describe them as “interesting” or “exciting like a horror film.” The second type, post-traumatic nightmares, re-enact a trauma the dreamer has experienced in waking life. Events may unfold just as they did in reality or they may go one step further so that something that was only feared as about to happen awake actually happens in the nightmare. Post-traumatic nightmares may also introduce bizarre, dreamlike distortions. The trauma-related nightmare occurs equally across all sleep stages — not just REM sleep. They’re always extremely distressing to the dreamer.

The technique that is most effective for eliminating traumatic nightmares is scripting an alternate, positive outcome or “mastery dream.” In my 1996 edited book, Trauma and Dreams, therapists described techniques that involved telling survivors about mastery dreams and asking them to think of an alternate ending for their own nightmare. Sleep physician Barry Krakow consolidated these techniques into a three session group treatment which his research demonstrated significantly reduced traumatic nightmares. People can try this on their own, but it’s more typically done with a therapist.

The most effective technique for decreasing ordinary nightmares is simply to focus on what dreams you would enjoy. Perhaps there’s a loved one you can’t be with right now who you’d like to visit with in your dreams? Or a favourite vacation spot? Many people enjoy flying dreams. Maybe you have one all-time favourite dream you’d like to revisit? With what we call “dream incubation,” you can suggest to yourself what you would like to dream as you fall asleep.

Dreams are extremely visual, so an image is especially likely to get through to your dreaming mind. Picture that favourite person, place, or yourself soaring above it all. Or replay that favourite dream in detailed scenes. If images don’t come easily to you, place a photo or other objects related to the topic on your night table as the last thing to view before turning off the light. Repeat to yourself what you want to dream about as you drift off to sleep. My research has shown that incubating a particular dream topic is effective about 50% of the time. The technique also makes for a pleasant experience as you’re falling asleep in a time when many have been anxious at bedtime.

Courtney Bolstad

Graduate Student, Psychology, Mississippi State University, who has studied nightmares

We can prevent, or at least reduce, the likelihood of experiencing nightmares by reducing stress, anxiety, and exposure to traumatic events — or managing symptoms that arise after a trauma has occurred. Strategies that may help reduce stress and anxiety include relaxation exercises (e.g., deep breathing, progressive muscle relaxation, and meditations), exercising, journaling, and other self-care activities. Further, eliminating or reducing sources of stress can also be beneficial. Currently, this may include limiting time spent watching the news or avoiding ruminating over concerns with friends and family. These strategies may also reduce exposure to the collective trauma of covid-19 that the world is currently facing.

Now, if you already have nightmares, there is a research-backed approach to reduce the frequency of nightmares and change the dream content itself. This technique is called Imagery Rehearsal Therapy. Essentially, the treatment involves identifying details of the target nightmare, rescripting the dream to be not distressing, and mentally practicing the new dream to replace the nightmare. First, start by writing out details of the target nightmare. This is often a recurring nightmare, or if the nightmares are not always the same, try to identify a common theme between nightmares and write about that. Next, change the storyline or content of the dream to be emotionally neutral, or even positive, using any way you see fit. Since it’s a dream, we can use our imaginations and add content that is not realistic (e.g., the ability to fly or turn invisible). Next, use visual imagery to mentally rehearse the new dream at least twice a day for at least five minutes each time. This may be difficult at first, but just like any new skill, repeated practice will make it easier eventually. It’s also recommended that these practice sessions occur during the daytime, not just right before bedtime. Generally, people who follow this technique see improvements in the content of their dreams and reductions in nightmare frequency in a few weeks. Typically, if you are experiencing nightmares as a result of a traumatic experience, this technique is not used until a month after the event, as nightmares that occur in the first weeks after a traumatic experience can be helpful for processing the trauma in the long run. However, if the nightmares persist for longer than a month after the traumatic event, imagery rehearsal therapy may be useful.

Imagery Rehearsal Therapy is a research-backed approach to reduce the frequency of nightmares and change the dream content itself. Other techniques to improve sleep quality and reduce nightmares fall under the umbrella of “sleep hygiene.” These recommendations include setting a consistent sleep/wake schedule, limiting time in bed to only when you are asleep or engaged in sexual intimacy, getting enough sleep to feel refreshed (but not oversleeping) — typically between 7 and 9 hours per night for adults, avoiding naps, exercising regularly, limiting consumption of substances that impact sleep (e.g., nicotine, caffeine, alcohol), limiting fluids before bedtime, and not going to bed hungry.

If you continue to have nightmares or difficulty sleeping after making these changes, I recommend visiting with a behavioural sleep specialist or mental health professional that provides cognitive-behavioural therapy or imagery rehearsal therapy in order to receive individualized treatment for your sleep problems.

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