Nightmares

A nightmare is a disturbing dream that usually occurs late in sleep, during the rapid eye movement (REM) sleep phase. Upon wakening, the person will quickly orientate and vividly remember the nightmare, which can cause distress. Nightmares are common (particularly in children) and most often, are a normal part of life, not requiring treatment. However, if nightmares are recurrent and cause significant distress or functional impairment, further investigation is required.

Recurrent nightmares featuring a repeated story are commonly associated with posttraumatic stress disorder (PTSD)—see here for PTSD diagnosis and management, including management of nightmares.

Some drugs (eg beta blockers, selective serotonin reuptake inhibitors, benzodiazepines, dopamine agonists) can cause vivid dreams or nightmares. If a drug is suspected to be the cause of ongoing nightmares, consider adjusting the time of administration, reducing the dose or stopping the drug—often nightmares will then resolve. Conversely, withdrawing or stopping drugs that suppress REM sleep (eg alcohol, antidepressants, some hypnotics) can precipitate nightmares.

If recurrent nightmares appear to have no clear cause, consider psychological therapies (eg imagery rehearsal therapy, cognitive behavioural therapy). If these therapies are not effective or unavailable, seek specialist advice for further treatment options.