Nightmare Treatments.

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.


Nightmares maintain depression and PTSD.
Photo courtesy of Pixabay

What are the top Nightmare treatments?

Many people have an occasional “bad dream.” But some people, and you know this if you are one of them, have frequent recurrent nightmares. An occasional episode of a bad dream is probably no big deal, though if you just had one last night it may be very disturbing today.

Technically we think there are differences between bad dreams, nightmares and night terrors. Night Terrors are when you wake up in a panic and possibly screaming but can’t remember what was happening just before. A “bad dream” is when you do not wake up till morning but you remember the disturbing dream. Nightmares are the worst for most people. This is when the dream wakes you up and you remember what it was about. Not everyone uses the same meanings for this which makes reading articles on negative dreams confusing.

What caused the Nightmare?

Treatment for nightmares partially depends on what is causing them, or more specifically what the content of the nightmare is about. Is there a specific trigger for your dream?

Children can begin to have nightmares after watching a particularly scary movie. This I think of as “contamination.” You see or hear about something that happened somewhere else to someone else and your mind begins to process this. Avoiding things that trigger you can help.

Sometimes we are going through a difficult time at work or school. If your department is being reorganized and you are having scary dreams, nightmares even, about being laid off, fired or transferred, then we can work on these in a very specific way.

The most difficult nightmares to have and to treat are dreams about real-life trauma that has happened to you. Nightmares about past trauma can perpetuate your mental health issues. Nightmares play a role in keeping you depressed or in maintaining your Posttraumatic Stress Disorder (PTSD.)

Rule out medical causes of nightmares.

Medical issues, especially breathing problems during sleep, can be a cause of bad dreams and nightmares. It pays to talk with your medical doctor and be sure that there are no underlying medical problems that are causing or worsening your nightmares. This “medical rule out” is a good idea for all mental illnesses.

The talk approach to reducing nightmares.

This is the starting point for most treatment. In this system, you work on remembering your dreams, good and bad. Often people keep a diary or pad of paper by the bed and upon awakening then write down anything they can remember about the dreams they have been having that night. If you get up and do things before writing you will lose most of the content of the dreams. Write a few things down and you have a better chance of recalling more details of the dream.

This dream record then can become the basis of your discussion with your counselor. For simple non-threatening dream work, you may want to work with a friend or group and do mutual discussion of your dreams.

What you want to avoid here is repeatedly talking about dreams based on real trauma. Going over and over the story of your rape or abuse will reinforce it not reduce it. For dreams that are maintaining PTSD or complex trauma, you need to work with a more specialized professional.

Medication for nightmares.

Medication has its place in managing Nightmares. If you are currently under stress you may need medication to sleep. Say you are having to testify in a case involving a crime you witnessed or that happened to you. You need to be able to sleep to get through this. Seeing your doctor is a good idea.

Soldiers in a combat zone may need medication so they sleep and are alert the next day. Not sleeping the night before can get you or someone else killing in this kind of situation. You may be able to talk with a comrade but even that is difficult. The middle of combat is no time for any lengthy therapy.

Medications have one disadvantage. They suppress dreaming but they do not eliminate the need to dream. In dreaming our minds process the events of the dream. Your dream and the memory waits in line to be worked on. When you stop the meds the memories can come back and they have had time to bulk up and become scarier than before.

Image rehearsal therapy.

This method has some good research to back it up and has worked across a range of different types of nightmares from children with scary monster dreams to victims of abuse and violence. In working with a counselor to use this method you focus more on learning the skill of imagery rehearsal than on discussing the specifics of your nightmare. Here is the basic process. I recommend that you try doing this with a professional to avoid creating other problems while working on the nightmare.

You keep track of your nightmare. A written journal helps but if you can remember it well you can do it that way.  Ask yourself what would need to happen for the dream to be less scary.

Say in your nightmare an ex breaks into the house and beats you up. This is based on a history of the ex. stalking you and trying to harm you. You imagine putting a metal door on your house. You imagine installing a deadbolt and an alarm that automatically calls the police if someone tries to break in. Imagine the ex tries to break in and the police are called and they catch and arrest him.

If you practice this new less scary dream each night before you fall asleep many people will discover that they have the new less scary dream. If you can imagine the new ending and can learn to recognize that you are dreaming, a process called lucid dreaming, you can in effect rewrite the dream and over time it will get processed and become less of a problem.

Scheduled Awakenings.

This is a new method. I have not read a lot about it and can’t tell you if it really works. People who have tried everything else without success have reported this one helped them.

In sleep, we cycle through deep and shallow sleep about every 90 minutes. As we age you may find yourself waking up every 90 minutes or so. It is in these cycles that dreaming occurs. So if you set an alarm clock to wake you up every 90 minutes or so it could stop the dream cycle before the dream gets really scary.

The goal here is to wake up to the alarm before the nightmare, set the alarm and go back to sleep. This will result in choppy sleep.  You may need more time in bed but you can theoretically get a full 8 hours of sleep and that without nightmares. Over time the nightmares should reduce. If any of you have tried this let me know how it worked.

Have you used any of these methods and how did they work for you? Has anything else helped you to reduce nightmares?

You might also want to take a look at other sleep and dream related posts that have been published here on .

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

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For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at Him


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