Be Our Partner! Book a Free Consultation Now! Become a Member > Get Involved >
Health Conditions > Health Articles > Find a Practitioner > Events >

Home  /  Health Conditions  /  Bad Dreams & Nightmares

Bad Dreams & Nightmares

Almost everyone has a nightmare now and then, and they are a normal part of childhood. When frightening dreams keep coming back and spoil your sleep, there is real help — including a well-studied talk therapy.

If nightmares come with thoughts of suicide or of not wanting to go on, call or text 988 to reach the 988 Suicide & Crisis Lifeline, or chat online. It is free, confidential and open 24/7 (988 Lifeline). Veterans can call 988 and press 1, or text 838255, for the Veterans Crisis Line (VA National Center for PTSD). If a life is in immediate danger, call 911 or go to the nearest emergency room (NIMH). Long-lasting nightmare disorder that goes untreated is linked with a higher risk of suicide attempts, so frequent nightmares deserve to be taken seriously (Cleveland Clinic).

Acting out dreams is a reason to see a doctor. Punching, kicking, shouting or leaping out of bed while still asleep — often noticed first by a bed partner — can be a sign of REM sleep behavior disorder. It can injure you or the person beside you and needs medical attention; it is most common in men over 50 (American Academy of Sleep Medicine).

Loud snoring, snorting or choking in your sleep can point to sleep apnea, in which breathing stops or turns very shallow again and again during the night (MedlinePlus). Repeated nightmares can themselves be a sign of sleep apnea (MedlinePlus). Ask your doctor about it.

What is a nightmare?

A nightmare is a bad dream that brings up strong fear, terror, distress or anxiety (MedlinePlus). Sleep doctors draw a simple line: a nightmare wakes you up, while a disturbing dream that doesn’t wake you is “just” a bad dream. Nightmares tend to feel vivid and real, often involve danger, and are usually easy to remember once you’re awake. They mostly happen during REM (dreaming) sleep, so they are most likely in the last third of the night; nightmares after trauma can come earlier (AASM).

How common are they?

What can bring them on?

Often nobody knows exactly why a nightmare happens (AASM). Common triggers include:

Nightmares that keep coming back can also be a sign of something else that is treatable, such as sleep apnea, PTSD, an anxiety disorder, depression or narcolepsy (MedlinePlus).

When nightmares become a sleep disorder

When nightmares happen often and keep you from getting restful sleep, doctors call it nightmare disorder. People with it may dread going to bed, struggle to fall back asleep and feel sleepy during the day (AASM). It can also affect mood, concentration, and work or school (Cleveland Clinic). Estimates of how many people have it range from about 2% to 8% (AASM), and the AASM puts it at about 4% of adults (AASM position paper, 2018).

Having nightmare disorder doesn’t mean something is wrong with your mind — it is classed as a sleep disorder (a parasomnia), not a psychiatric illness. For some people it fades on its own; for others it can last for years without help. The good news is that it is treatable (Cleveland Clinic).

Nightmares after trauma

Nightmares and trouble sleeping are both symptoms of post-traumatic stress disorder (PTSD). Trauma nightmares are often a replay of the event, can make it hard to fall back asleep, and can make bedtime itself feel unsafe (VA National Center for PTSD). Up to 80% of people with PTSD report nightmares (AASM position paper, 2018). PTSD is treatable, and several talk therapies work well (VA National Center for PTSD). If your nightmares started after something frightening happened to you, please mention that to your provider.

Nightmare or night terror? (children)

What helps: after a nightmare, go to your child quickly, reassure them you are there, let them talk about the dream, remind them dreams aren’t real, and leave a light on if that helps. During a night terror, stay calm and simply keep your child safe — they are still asleep and will usually settle on their own (AAP).

When to talk with a provider: if you have nightmares more than once a week, if they disrupt your sleep or daily life for a long time, or if they started soon after a new medicine (MedlinePlus). For a child, talk with the pediatrician if recurring nightmares greatly disturb them (AASM), or if night terrors happen often, regularly disrupt sleep, or cause (or nearly cause) injuries (MedlinePlus).

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) A check of medicines, alcohol and other sleep problems, then nightmare-focused talk therapy — especially imagery rehearsal therapy — plus treatment of any underlying PTSD or sleep apnea. Medicine is sometimes added. Therapy commonly runs about $80–$200 a session at market rates; nonprofit sliding-scale sessions are $40–$70. Most people need no sleep test; when one is needed, a cost guide puts home tests at about $150–$1,000 and lab studies at $1,000 or more. Medicare Part B covers sleep studies for suspected sleep apnea. Occasional nightmares usually need no treatment. For nightmare disorder, imagery rehearsal therapy is the treatment sleep specialists recommend; the evidence for medicines such as prazosin is mixed.
Chiropractic Being researched — coming soon.
Acupuncture Needle sessions for relaxation and sleep, alongside — not instead of — proven care. About $125–$230 for a first private visit and $90–$185 for follow-ups; community clinics about $50–$90. No good studies on nightmares. Evidence for insomnia is small and low quality. Relatively few complications are reported.
Herbal medicine No herb has been shown to prevent nightmares. Melatonin and valerian are sold for sleep in general. Cost estimate being researched. Evidence for sleep is limited or inconsistent, and valerian can itself cause vivid dreams. Check with your doctor or pharmacist first, especially for children.
Massage therapy Relaxing hands-on bodywork as a complement to care. About $50–$90 for 45–60 minutes at clinics and spas; $60–$120 with an independent therapist. Can feel calming, but there are no studies on nightmares and little evidence it improves sleep. Low risk with a trained therapist.
MBHA Wellness Coach A steady sleep schedule, a calm wind-down routine, less alcohol and caffeine, screens off before bed, relaxation skills, a sleep and nightmare diary, and comforting routines for children. Cost estimate being researched. Less stress and steadier sleep may ease nightmares for some people, but habits don’t replace therapy for nightmare disorder, PTSD or sleep apnea.

Approach 1 of 6

Conventional medicine (AMA)

Most occasional nightmares need no treatment at all (AASM). When nightmares are frequent and disturbing, care focuses on finding anything that is feeding them and on talk therapy that targets the nightmares themselves.

1. Getting checked

Your provider will ask when the nightmares began, how often they come and what they are about, along with your health history, medicines, alcohol or drug use, and any other sleep problems. You may be asked to keep a sleep diary for two weeks. Most people don’t need any tests, but a sleep study may be suggested if your sleep is badly disturbed or another problem is suspected (AASM). Next steps might include changing a medicine or a referral to a mental health provider (MedlinePlus).

2. Imagery rehearsal therapy (IRT)

In its 2018 position paper, the American Academy of Sleep Medicine named imagery rehearsal therapy as the one treatment it recommends for both nightmare disorder and PTSD-related nightmares (AASM position paper, 2018). With a therapist, you rewrite a recurring nightmare so it has a different, less frightening storyline, then rehearse the new version while awake (AASM position paper, 2018). The idea is that nightmares behave like a learned habit that practice can change (Cleveland Clinic). Treatment usually also includes keeping a sleep and nightmare log and learning about how nightmares work (Cleveland Clinic).

3. Other nightmare-focused therapies

4. Treating what lies underneath

5. Medicines — an honest look

We name medicines here only to explain the evidence; your prescriber chooses whether any medicine fits you, and the dose.

  • Prazosin is the best-known medicine for nightmares, and the AASM still lists it as one that “may be used.” But after a large trial of 304 people with PTSD at VA medical centers found no difference between prazosin and a placebo, the AASM task force downgraded its recommendation — while noting that many patients do respond well and that it remains the first-choice medicine for nightmares (AASM position paper, 2018). In other words, the experts are still debating who benefits.
  • The AASM lists several other medicines as possible options and advises against two (clonazepam and venlafaxine) for nightmare disorder (AASM position paper, 2018). All medicines have possible side effects, so talk through the pros and cons with your provider (Cleveland Clinic).
  • Sleeping pills are generally meant for short-term use and can carry risks such as dependence, falls and confusion (VA National Center for PTSD); avoid long-term use of sleep medicines and tranquilizers unless your provider advises it (MedlinePlus).

What it costs

  • Therapy without insurance: the nonprofit Open Path Collective puts typical U.S. market rates at about $80–$200 a session. Its network offers sliding-scale sessions of $40–$70 after a one-time $65 membership fee, for people without insurance or adequate mental health coverage (Open Path Collective).
  • Sleep studies aren’t needed for most nightmares. When one is, a sleep-study cost guide puts home tests at about $150 to $1,000 and in-lab studies at about $1,000 to more than $10,000, depending on the test and insurance (Sleep Foundation cost guide).
  • Medicare Part B covers sleep studies ordered by your provider when you have signs and symptoms of sleep apnea; you pay 20% of the approved amount after the deductible (Medicare.gov).
  • The 988 Lifeline is free (988 Lifeline). Prescription medicines: MBHA cost estimate being researched.

How well it works — what to expect

People whose nightmares are treated successfully report better sleep, fewer insomnia symptoms and less daytime tiredness (AASM position paper, 2018). Imagery rehearsal therapy takes practice at home between sessions (Cleveland Clinic). If one treatment doesn’t help, ask about others (Cleveland Clinic).

Find a medical doctor in our directory

Approach 3 of 6

Acupuncture

We couldn’t find any controlled studies of acupuncture for nightmares — only reports about single patients, which can’t tell us whether it works. What research there is looks at sleep more generally.

What the research says

  • A 2021 review of 11 small studies suggested acupuncture may help insomnia, but the studies were judged low quality (NCCIH).
  • A 2019 VA/Department of Defense guideline found too little evidence to recommend for or against acupuncture for insomnia, apart from a weak recommendation for acupuncture on points of the outer ear (NCCIH).

If you try it, use it alongside — not instead of — care for frequent nightmares.

Safety

Relatively few complications have been reported. Problems have come from non-sterile needles and poor technique. The FDA requires acupuncture needles to be sterile and single-use, and most states license acupuncturists (NCCIH).

What it costs

Private sessions run about $125–$230 for a first visit and $90–$185 for follow-ups; community clinics charge about $50–$90 (The Pricer).

Find an acupuncturist in our directory

Approach 4 of 6

Herbal medicine

No herb or supplement has been shown to prevent nightmares. Products sold “for sleep” have limited or mixed evidence even for ordinary sleep problems, and some sleep aids can make dreams worse rather than better. We don’t list doses here.

Melatonin

Melatonin supplements may help with jet lag and some other timing-related sleep problems, but sleep-medicine guidelines advise against using them for long-term insomnia (NCCIH, NCCIH). Short-term use appears safe for most people, though long-term safety is unknown, and many products don’t contain what the label says (NCCIH). For children, talk with a health care provider first and store melatonin — especially gummies — out of reach; accidental swallowing by young children has led to thousands of emergency visits (NCCIH).

Valerian

The evidence on valerian for sleep is inconsistent, and the AASM advises against it for chronic insomnia. Notably, its possible side effects include vivid dreams, as well as headache and stomach upset. Don’t combine it with alcohol or sedatives (NCCIH).

Others

For other complementary products, the evidence on sleep is too limited or inconsistent to draw conclusions. Kava has been linked to severe liver damage, and L-tryptophan can cause dangerous reactions with some medicines (NCCIH).

Before you try any herb or supplement, talk with your doctor or pharmacist, especially if you take other medicines — some herbs and medicines interact in harmful ways (NCCIH). Keep in mind that over-the-counter sleep aids, and stopping sleeping pills, can themselves trigger nightmares (MedlinePlus).

Approach 5 of 6

Massage therapy

Many people find massage relaxing, and it is low-risk. We found no studies of massage for nightmares, and the evidence that it improves sleep is thin: a review in people with fibromyalgia found that massage helped pain, anxiety and depression but not sleep disturbance (NCCIH). Think of it as a way to unwind, not a treatment for nightmares.

Safety

The risk of harm appears low, though rare serious problems have been reported, sometimes with vigorous deep-tissue massage or in frail older adults. Most states license or certify massage therapists (NCCIH).

What it costs

About $50–$90 for 45–60 minutes at gyms, clinics and spas, $60–$120 with an independent therapist, and $30–$40 an hour at massage schools (CostHelper).

Find a massage therapist in our directory

Approach 6 of 6

MBHA Wellness Coach

An MBHA Wellness Coach can help you build the everyday habits that support calmer nights, keep track of what helps, and get connected to a therapist if nightmares keep coming back. These habits support — but don’t replace — treatment for nightmare disorder, PTSD or sleep apnea.

A steady sleep routine

Alcohol and caffeine

Limit both (MedlinePlus). Heavy drinking and suddenly stopping after heavy use can both trigger nightmares (MedlinePlus), and using alcohol or drugs to get to sleep can harm sleep quality over time (VA National Center for PTSD). If cutting back is hard, a coach can help you ask your provider for support.

Winding down and easing stress

  • Managing stress, including relaxation training, can help you manage nightmares and get back to sleep after one (AASM).
  • Slow, deep breathing, progressive muscle relaxation and guided imagery are easy to learn (NCCIH). They are generally safe, but occasionally bring up anxiety or intrusive thoughts, and rarely can worsen symptoms in people with a history of trauma — so go gently and tell your provider if that happens (NCCIH).
  • Talking about worries with friends and family, making time for hobbies, and practices such as music, yoga or meditation can all help (MedlinePlus).

A sleep and nightmare diary

Jotting down when you sleep, when nightmares happen and how upsetting they are gives your doctor useful clues (AASM), and logs like this are part of nightmare therapy too (Cleveland Clinic). If you are in imagery rehearsal therapy, a coach can cheer you on as you practice the “new dream” your therapist helps you write.

Comforting routines for children

  • After a nightmare, go to your child quickly, reassure them, let them tell you about the dream, remind them dreams aren’t real, and leave a light on if it helps (AAP).
  • A favorite blanket or stuffed animal and a dim nightlight can help the bedroom feel safe. Talk about nightmares openly during the day, and let your child know that children and adults all have them sometimes (AASM).
  • Scary movies or TV shows can feed nightmares, so keep bedtime viewing gentle (MedlinePlus).

Still being researched: Chiropractic. We add each approach once its costs and results are sourced. Are you a practitioner with experience treating Bad Dreams & Nightmares? Tell us.

Member stories

Living with Bad Dreams & Nightmares? Share your experience

Real experiences help others choose. Tell us what you tried — conventional medicine, chiropractic, acupuncture, herbs, massage or coaching — what it cost and what changed.

No stories have been published for this condition yet. Yours could be the first.

Which approaches have you tried?

What did you try, what did it cost, and what changed for you? Please leave out anything you’d rather keep private.

We read every story before it’s published and may shorten it. Stories describe one person’s experience; results vary. See our Privacy Policy.

Sources

This page is for education only and is not medical advice. Costs are typical U.S. ranges and estimates; yours will depend on your provider, location and insurance. Talk with your doctor before starting, stopping or combining any treatment. In an emergency, call 911. See our disclaimer.

Find the right practitioner

Search MBHA’s Health Directory for doctors, chiropractors, acupuncturists and massage therapists across the Monterey Bay.

Search the Directory All Health Conditions

The Monterey Bay Holistic Alliance is a charitable, independent registered nonprofit 501(c)(3) organization and does not endorse any particular products or practices. Claims and statements herein are for informational purposes only and have not been evaluated by the Food and Drug Administration. We strongly recommend that you seek out your trusted medical doctor or practitioner for diagnosis and treatment of any existing health condition. MBHA provides administrative support, education and navigation — not medical, legal or tax advice — and cannot guarantee claim, billing or fundraising outcomes. MBHA is not an emergency service: in an emergency, call 911 or go to the nearest emergency room.