Nightmares and Insomnia: What Treatments Exist?

All of us have bad dreams from time to time, especially in times of stress. While they may disrupt our sleep for a night, they’re not usually enough to cause insomnia. Nightmares, on the other hand, can have a big impact on sleep.

Nightmares vs bad dreams

Nightmares are typically more intense than your average bad dream. Nightmares can be recurrent (the same dream replaying itself night after night). They often wake the dreamer from sleep and cause a great deal of anxiety and distress. That distress can persist through the day, leading to daytime anxiety and worry about having another nightmare.

Nightmares and insomnia

The distress caused by nightmares can be so strong that the dreamer starts to dread going to sleep. As bedtime approaches, they become more anxious and tense, making it harder to fall asleep. And if a nightmare does wake them up in the night, it may be difficult to fall back to sleep afterward. Over time, nightmares can become a perpetuating factor for insomnia.

Treating nightmares and insomnia

Whereas we have a good understanding of what causes insomnia, researchers and clinicians are still learning about nightmares and what causes them. There are outstanding questions about why some people have recurrent nightmares and whether nightmares that follow a trauma are different than other types of nightmares.

This also means that there is not a one-size-fits-all treatment for nightmares, but several options exist and are worth exploring.

Nightmare-focused psychotherapist

Two brief therapies exist to address nightmares: Exposure, Relaxation, and Rescripting Therapy (ERRT) and Imagery Rehearsal Therapy (IRT).¹

Both of these treatments can be delivered individually and in group settings. Both encourage the patient to think about their most distressing nightmare(s) and “rescript” the events or the themes of the dream. The new script is read daily, especially before bed. While each of these treatments approaches nightmares in a slightly different way, both rely on the idea that dreams are open to modification and that what we think about during the day has a direct impact on what we dream.

Prazosin

Prazosin (Minipress^®) is a drug typically used to treat high blood pressure. However, it has shown promise for some patients who experience recurrent nightmares, especially those linked to a trauma. Initial research on prasozin’s effects on nightmares was very strong, but more recent studies are less conclusive. Therefore, many doctors currently neither recommend for or against the use of prazosin for nightmares.²

Cognitive behavioral therapy for insomnia (CBTI)

The benefits of CBTI on insomnia are well documented. But there is also some evidence to suggest that CBTI can improve nightmares. In fact, in one study CBTI reduced the frequency and intensity of nightmares as much as IRT did. Researchers think that improving the quantity and quality of sleep has an effect on how frequently we have nightmares and how likely we are to be awoken by them when they do occur.³

Choosing a treatment

While we can’t predict which treatment will work best for whom, you have options you can explore. Some treatments, like CBTI, are more widely available than others, such as ERRT and IRT, so ask your doctor which options are available to you. And if you’ve tried these options, let us know how they’ve worked for you.

Have any of these treatment worked for you? What else would you add to this list? Share from your experience in the forums!