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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). In one study of military primary care patients, having nightmares at least weekly (along with clinical insomnia) predicted later suicide attempts, so frequent nightmares deserve to be taken seriously (PubMed).

Acting out dreams is a reason to see a doctor. Punching, kicking, shouting or leaping out of bed while still asleep can be a sign of REM sleep behavior disorder, in which dreams are physically acted out, sometimes with aggressive or complex movements. It mostly affects older men, and it can be linked to conditions such as Parkinson’s disease, so it needs medical attention (PubMed, PubMed Central).

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). Sleep apnea is also among the sleep conditions that can bring on nightmares (NHS). Ask your doctor about it.

What is a nightmare?

A nightmare is a bad dream that wakes you up with strong feelings of fear, and you can usually remember it afterward (NHS). Researchers describe nightmares as distressing dreams with intense negative emotions such as fear, anxiety or sadness that can linger after you wake; they happen mostly during REM (dreaming) sleep, and they tend to come later in the night (PubMed Central, NHS). Nightmares are different from night terrors and from acting out dreams, both covered below.

How common are they?

What can bring them on?

Common triggers include:

  • Stress, worry and big life events — such as something frightening, a traumatic event, or a time of worry (NHS). Stressful life changes such as job loss, moving or a loss in the family can also bring on intense dreams (PubMed Central). If worry is a big part of the picture, our Anxiety guide may help too.
  • Medicines: the NHS lists certain medicines, such as antidepressants, as a possible cause (NHS). A review of drug-induced nightmares most often linked them to sedative or sleeping medicines, beta-blockers, amphetamines and dopamine-acting medicines, while noting that it is hard to prove a medicine is the cause (PubMed). Don’t stop a prescribed medicine on your own — talk with your provider first.
  • Alcohol and other substances: alcohol and nicotine can disrupt sleep in general (NHS), and using alcohol or drugs to get to sleep can harm sleep quality over time (VA National Center for PTSD).
  • Other things: being very tired or unwell, or something that has frightened you, such as a scary film (NHS).

Nightmares that keep coming back can also be a sign of something else that is treatable, such as another sleep condition (sleep apnea, for example), an anxiety disorder (NHS) or PTSD (VA National Center for PTSD).

When nightmares become a sleep disorder

When nightmares happen often and keep you from getting restful sleep, doctors call it nightmare disorder. It can lead to insomnia because people dread falling asleep (PubMed), and it can significantly impair quality of life (AASM position paper, 2018). Frequent nightmares can also cause daytime sleepiness and trouble with concentration at work or school (PubMed Central). The American Academy of Sleep Medicine (AASM) puts nightmare disorder at about 4% of adults (AASM position paper, 2018).

Nightmare disorder is classed as a REM parasomnia, a type of sleep disorder (PubMed). For most people, though, nightmares get better on their own (NHS). The good news is that nightmare disorder is treatable — the AASM recommends imagery rehearsal therapy for it (AASM position paper, 2018).

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). Among people diagnosed with PTSD, nightmares are common (VA National Center for PTSD). 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)

  • A nightmare usually comes later in the night. Your child wakes up scared and can usually remember the dream and tell you about it (NHS). Nightmares may follow something frightening, such as a scary film (NHS).
  • A night terror happens in the early part of the night. A child may scream, shout, thrash about or even jump out of bed with their eyes open but still asleep, may not recognize you, and usually won’t remember it (NHS). Night terrors are most common between ages 3 and 8, and most children grow out of them (NHS).

What helps: a relaxing bedtime routine, a sleep diary to help spot causes, and dealing with anything that may be causing stress or worry (NHS). A consistent bedtime routine can help a child feel more secure, and parents can help by letting children talk through their bad dreams and fears calmly during the day (PubMed Central). During a night terror, stay calm and wait for it to pass; don’t try to wake your child, and step in only to keep them from getting hurt (NHS).

When to talk with a provider: if you have regular nightmares that are affecting your sleep and everyday life, or if you think a medicine may be behind them (the NHS lists some medicines as a cause) (NHS). The NHS also advises seeing a doctor if a child is still having nightmares after age 6, has frequent nightmares or ones that follow an upsetting event, still has night terrors after age 12, or starts having night terrors after age 5 (NHS).

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. Federally funded community health centers charge on a sliding fee scale based on income. Most people need no sleep test; when one is needed, a home sleep apnea test is advertised online at about $99 to $189, while an overnight lab sleep study at a hospital runs about $1,000 to over $6,000 at published discounted cash rates (The Pricer, updated October 2026). Medicare Part B covers sleep studies for suspected sleep apnea. Many nightmares get better on their own. For nightmare disorder, imagery rehearsal therapy is the treatment the sleep-medicine academy recommends; medicines such as prazosin are listed only as options that “may be used,” meaning the evidence is less clear.
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 $70–$90 a month for a membership at one national chain (Massage Envy), which includes one 60-minute session a month; each franchise sets its own rates. 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)

For most people, nightmares get better on their own (NHS). 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

Treatment for nightmares depends on what may be causing them (NHS). A sleep diary — noting how long you sleep, how long it takes you to fall asleep and how you feel the next day — can help identify causes (NHS). Medicines, other sleep conditions and mental health conditions can all play a part, so it helps to tell your provider about any medicines and any alcohol or drug use. If you have a condition that affects your sleep, treatment usually involves managing that condition better, and nightmares caused by a traumatic event may call for counseling or other psychological treatment (NHS). Most people don’t need a sleep study, but one can diagnose sleep apnea if it is suspected (VA National Center for PTSD).

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-associated nightmares (AASM position paper, 2018). In IRT, you picture a more positive or less frightening ending to a nightmare while you are awake, which can change your emotional response to the nightmare and reduce how often it comes back (PubMed Central). A systematic review of 69 studies found strong evidence that exposure and image rehearsal treatments reduce how often nightmares happen, how severe they are and how distressing they feel, in civilians, military members and people with PTSD; treatments worked best when they directly targeted the nightmare content or the person’s emotional response to it (PubMed).

3. Other nightmare-focused therapies

  • CBT-based approaches such as exposure, relaxation and rescripting therapy, systematic desensitization (gradually facing the dream content) and progressive deep muscle relaxation. The AASM lists these as options that “may be used” for nightmare disorder, meaning the evidence or expert consensus is less clear than for IRT (AASM position paper, 2018).
  • Cognitive behavioral therapy for insomnia (CBT-I) has been shown to reduce how many nightmares people have and how upsetting they are, alongside improving sleep (VA National Center for PTSD). VA experts note that a variety of cognitive behavioral nightmare treatments show promise and can also ease insomnia, PTSD and depression (VA National Center for PTSD).
  • Mindfulness and relaxation techniques can reduce anxiety and improve sleep quality, and group or peer support can help people cope with nightmare-related distress (PubMed Central).

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 among the medicines the AASM says “may be used” for both PTSD-associated nightmares and nightmare disorder, which means the evidence or expert consensus is less clear than for IRT (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). Medicines for nightmares often come with side effects and may not address the underlying causes (PubMed Central), so talk through the pros and cons with your provider.
  • Sleeping pills are generally meant for short-term use and can carry risks such as dependence, falls and confusion (VA National Center for PTSD), so ask your provider before using them for more than a short time.

What it costs

  • Therapy without insurance: federally funded community health centers charge on a sliding fee scale based on your ability to pay, with a full discount or a nominal fee at or below the federal poverty level and partial discounts up to twice that level (HRSA, HRSA compliance manual). Ask whether the center you choose offers counseling, and ask any private therapist whether they offer a self-pay or sliding-scale rate.
  • Sleep studies aren’t needed for most nightmares. When one is, the cost depends on the test and your insurance (cost estimate being researched).
  • 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

Many nightmares ease on their own (NHS). For nightmare disorder, nonmedication treatment, especially imagery rehearsal therapy, is described as particularly effective (PubMed). The AASM lists many other options, so if one treatment doesn’t help, ask about others (AASM position paper, 2018).

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 some medicines can themselves bring on nightmares (PubMed).

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

One national chain, Massage Envy, charges about $70–$90 a month for a 12-month membership that includes one 60-minute session a month (about 50 minutes of hands-on time); each franchise sets its own rates, so prices elsewhere vary (The Pricer). Independent therapists: cost estimate being researched.

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

  • Keep a regular bedtime and wake time (NHS). Being very tired can bring on nightmares (NHS), and a relaxing bedtime routine is one of the things the NHS suggests trying.
  • Sleep in a quiet, cool, dark room, spend time outdoors each day, and avoid caffeine, nicotine, alcohol, large meals and bright screens (TV, computer or phone) close to bedtime (NCCIH).
  • Regular physical activity can help you sleep better; if exercising close to bedtime affects your sleep, try being active earlier in the day (NHS).

Alcohol and caffeine

Caffeine can keep you more awake, and alcohol and nicotine can disrupt sleep, so try to avoid them in the hour or two before bed (NHS). 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

  • Mindfulness and relaxation exercises can reduce anxiety and improve sleep quality, which may make nightmares easier to cope with (PubMed Central).
  • 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 to someone you trust or writing down your worries can help, and so can calming activities such as reading, meditation or listening to calming music (NHS).

A sleep and nightmare diary

Jotting down how long you sleep, how long it takes you to fall asleep and how you feel the next day can help identify what may be behind nightmares (NHS), and it gives your doctor useful clues. If you are in imagery rehearsal therapy, a coach can cheer you on as you practice the “new dream” your therapist helps you write (PubMed Central).

Comforting routines for children

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.

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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.

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