What to Do If You Have Recurring Nightmares

A single nightmare is scary enough, but when you keep having nightmares — maybe even the same one over and over — you may dread going to sleep. Fortunately there are ways to deal with nightmares, and even a term for what you might be going through: nightmare disorder.

What is nightmare disorder?

We all have bad dreams, but a nightmare is something more intense. You’re not just stressed out about having to get to the final exam that you haven’t studied for, you’re fighting for your life in a scenario that feels vivid and real. You may wake up sweating and with your heart racing, clearly recall disturbing details, and have trouble getting back to sleep.

Nightmares are worth seeing a mental health professional about if they interfere with your ability to function in the daytime, or if they interfere with your ability to get enough sleep. In people with nightmare disorder, the nightmares may happen frequently, and cause extreme anxiety or fear.

Nightmare disorder often occurs as part of another mental health issue, which makes it even more important that you seek help, since the problem may be bigger than just nightmares. Post-traumatic stress disorder (PTSD) often involves recurring nightmares, but other conditions can occur with nightmares as well, like anxiety and depression.

How rewriting your nightmares may help

While therapy and medication can help, one of the best-supported treatments for recurring nightmares is known as image rehearsal therapy, or IRT. (If you’re curious, the American Academy of Sleep Medicine has a position paper here about which treatments they recommend; image rehearsal therapy is at the top of the list.)

In IRT, you basically rewrite your nightmare to put yourself in control of the ending. If you have trauma surrounding the subject of the nightmare, it’s best to do this with a professional guiding you.

The four steps of the therapy, according to this guide for patients and clinicians, are:

1. As soon as you wake up from the nightmare, make some notes to yourself about what happened in the dream. To allow yourself to get back to sleep afterward, the guide advises against typing it on your phone; make notes on paper with a book light or record a voice memo.
2. Later, write down the dream as a story, but change the ending. It’s up to you how to do this: It can be realistic, or you can gain super powers, whatever makes sense to you. The whole idea is that you’re putting yourself in control again.
3. Before you go to bed, go over your script. Tell yourself that if you have this dream again, it will have the ending you intend.
4. After you have the dream — whether the rewriting worked or not — revisit the process and either celebrate your success or repeat the process of rewriting the dream.

IRT is considered a type of cognitive behavioural therapy. While you may be able to attempt it by yourself for milder cases of recurring nightmares, it can be helpful to do it with a professional guiding you. IRT by itself may not be the only treatment you need, so be open to discussing the options of other types of therapy and possibly medication, if that’s what you need.