Nightmares and what to do about them

We all dream (some of us daydream more than others 😉). Some of us remember those dreams, while others do not. Some dreams are pleasant while others are unpleasant nightmares. Dreams have been a topic of interest since the inception of psychology, and they continue to be the focus of prominent research today. 

Disturbing, distressing, or disruptive dreams are often called nightmares. Most people experience nightmares at some point in their life, with a varying level of frequency. There are several factors that may increase the chance that someone will experience nightmares more frequently. These include; anxiety, stress, irregular or disrupted sleep, medications, post-traumatic stress disorder, and other health conditions. 

It is important to note that most people experience nightmares to some degree. However, if nightmares are a concern for you  there are healthy habits we can include in our day to day lives to reduce their frequency. 

What can I do myself to help reduce nightmares and get better quality sleep? 

Most strategies or suggestions to help improve sleep quality are covered under the topic of ‘sleep hygiene’. These strategies typically include modifying or adapting our routine before bed and during the night. 

Suggestions include: 

• Setting up regular sleep/wake times each day. Consistency is key to maintaining our circadian rhythm or body clock. Being consistent with your sleep/wake times helps your body’s natural processes make it easier for you to get reliable and good quality sleep. 

• Have a regular wind-down routine before bed, e.g. shower, cleaning teeth, a good book to read. 

• Avoiding snacks or food intake within an hour or so before bed. 

• Similarly avoiding caffeine and alcohol before bed. While we might be able to sleep, the quality of sleep can be negatively influenced by alcohol consumption before sleep. 

• Reducing screen use before bed (this includes avoiding blue light, as well as stimulating content that may ‘wake us up’ while we prepare for sleep). 

• Ensure the bedroom space is quiet and comfortable, and is setup to help ensure you’re better able to sleep. 

• Breathing, relaxation or mindfulness exercises to help relax and slow the body ready for sleep.

• Regular exercise each day can also help with sleep, while best avoided an hour before bed as this can wake the body up, and take longer for us to fall asleep. 

What if I have tried healthy sleep habits and I’m still having nightmares?

Reduce stress and anxiety

Other than the routine before bed, finding ways to reduce overall stress and relax during the day can help improve sleep at night. Anxiety and stress can make us more susceptible to having nightmares. Using strategies to reduce stress and anxiety in day-to-day activities can go a long way in improving sleep quality and reducing the frequency of nightmares. Existing mental health conditions may create further negative influences on sleep quality and the frequency of nightmares. 

Manage distress upon waking from a nightmare

Often the disruption from waking in the middle of the night and not being able to fall back asleep can be frustrating, and one of the key reasons someone might seek help with recurrent nightmares.  Particularly since when we wake or become aware of a nightmare,  we often experience stress, anxiety and related symptoms (e.g. increased heart rate, sweating upon waking).  We may not always recall the content of our nightmares, but thankfully we can focus on calming down, and relaxing ourselves in an attempt to return to sleep after waking from one. An effective way to try and get back to sleep upon waking from a nightmare is to use progressive muscle relaxation. A helpful guide to walk through progressive muscle relaxation has been created by the Centre of Clinical Interventions here. 

Seek professional support

If problems with nightmares persist, it may be worth seeking professional assistance. One technique that clinical psychologists use to address recurrent nightmares is called imagery rescripting or image rehearsal therapy. Imagery rescripting has shown promising results as an approach used to help desensitise and habituate to unpleasant imagery, and reduce the frequency of nightmares. The process of imagery rescripting often involves recounting the unpleasant situation or nightmare, and reframing the imagery and situation into something more positive and less distressing. This may involve imagining the situation changing to something different and often less distressing, having help from your future self, or rethinking the situation completely. The type of imagery rescripting or imagery rehearsal considered varies from person-to-person based on an assessment of what could be causing their nightmares. 

As such, it is important to consider each individual and their circumstances, and investigate potential medical or personal factors that may be contributing to the experience of nightmares. These may include experiencing previous trauma, a change in medications, an underlying or related medical condition (e.g. sleep apnoea), or any number of other factors that may be unique to you that could be contributing to recurrent nightmares. If you are struggling with ongoing nightmares, it may be worth having a conversation with a clinical psychologist or sleep physician to address your concerns.

Written by Dr Ben Pearcy, Clinical Psychologist.