Nightmares and sleep

Can you change a recurring nightmare?

A recurring nightmare can often be changed (Gieselmann et al., 2019). The best-supported method is imagery rehearsal therapy: while awake, you rewrite the nightmare into a new version and rehearse it for 10 to 20 minutes a day (Lancee et al., 2021; Morgenthaler et al., 2018). The American Academy of Sleep Medicine (AASM, 2018) recommends it for nightmare disorder. If the nightmare replays a trauma, start with a doctor or therapist (AASM, 2020).

Last updated: 2026-10-13.

Why does the same nightmare keep returning?

One review describes a model in which a recurring nightmare becomes a learned script, replaying even after the stress that first set it off has faded (Gieselmann et al., 2019). It notes that some treatments therefore aim to unlearn the pattern rather than decode what the nightmare means, and imagery rehearsal therapy (IRT) is one of them. For recurring dreams that aren’t nightmares, see why dreams repeat.

What is imagery rehearsal therapy?

Imagery rehearsal therapy (also called image rehearsal therapy) is a way of changing a nightmare while you’re awake (Morgenthaler et al., 2018). You turn the nightmare into a new set of positive images. Then you rehearse the new version for 10 to 20 minutes a day.

The original instruction was simply to change the nightmare any way you wish (Gieselmann et al., 2019). Other versions aim for an ending that is triumphant, satisfying, or more neutral or even pleasant. The new story is then rehearsed in the mind a couple of times a day. IRT is recommended both for nightmare disorder and for nightmares linked with post-traumatic stress disorder, or PTSD (Morgenthaler et al., 2018).

How do you try imagery rehearsal, step by step?

You can try imagery rehearsal by following the steps researchers have described and tested (Gehrman, 2026; Gieselmann et al., 2019; Morgenthaler et al., 2018). If the nightmare replays something that really happened, talk to a doctor or therapist before you begin (American Academy of Sleep Medicine [AASM], 2020). The AASM notes that nightmares caused by a trauma may need more intensive counseling.

1. Choose one nightmare that keeps coming back and doesn’t replay a trauma.
2. Change it in any way you like, so that it becomes less intense or distressing. The new ending can be triumphant, satisfying, or simply more neutral.
3. Write the new version down, and keep it short. You may not need to go back over the old nightmare in detail: some researchers argue that IRT works with little focus on the original (Gieselmann et al., 2019).
4. Rehearse the new version in your imagination for 10 to 20 minutes a day, while you’re awake.
5. Keep a simple dream journal of your nights and nightmares. In one trial, a nightmare diary on its own helped a little (Lancee et al., 2010).

In trials, people practiced over a few weeks, and results were checked months later (Krakow et al., 2001; Lancee et al., 2021).

How well does rewriting a nightmare work?

Rewriting has reduced nightmares for many people in trials, though not in every group (Morgenthaler et al., 2018). One trial with 168 women in New Mexico tested three sessions of IRT against a wait list (Krakow et al., 2001). Nearly all had moderate to severe PTSD (95%) and had survived rape or other sexual assault (97%). With IRT, they had fewer nights with nightmares, fewer nightmares a week, better sleep and milder PTSD symptoms, and the gains held from 3 to 6 months.

A 2013 meta-analysis found large drops in how often nightmares came after IRT, according to a later review (Gieselmann et al., 2019). Morgenthaler et al. (2018), writing for the AASM, rate IRT as “recommended” for nightmare disorder, a grade that means clearly useful for most patients.

Can you do imagery rehearsal on your own, or do you need a therapist?

Self-help versions have worked in trials (Burgess et al., 1998; Lancee et al., 2010), but some people should begin with a professional. Nightmare treatment has worked in a single session, as self-help books sent by mail and as online self-help, yet many people live with their nightmares, often because they don’t know there’s another option (Gieselmann et al., 2019).

Talk to a doctor or therapist if:

• the nightmare replays something that really happened, or you have PTSD, since nightmares caused by a traumatic event may need more intensive counseling (AASM, 2020)
• rehearsing brings up upsetting images or makes your nightmares worse, as it did for a few people in trials (Morgenthaler et al., 2018)
• nightmares come often, keep you from restful sleep or make you fear going to sleep. These can be signs of nightmare disorder (AASM, 2020), and a doctor may refer you to an accredited sleep center (AASM, 2018).

What if the nightmare replays a trauma?

If a nightmare replays a trauma, start with a doctor or therapist: more intensive counseling may be needed (AASM, 2020). Two recent studies tested imagery rehearsal together with treatments for PTSD and insomnia (Gehrman, 2026). The evidence in veterans is mixed (Morgenthaler et al., 2018). In two trials, imagery rehearsal did no better than the treatment it was compared with (Cook et al., 2010; Harb et al., 2019).

Writing for the National Center for PTSD, Gehrman (2026) notes that IRT, also called nightmare re-scripting, has had positive trials in civilians. He also says that studies suggest cognitive behavioral therapy for insomnia improves both insomnia and nightmares in PTSD, and that it’s unclear whether IRT adds any benefit. Start with a doctor or therapist, and do any nightmare work as part of that care (AASM, 2020). Don’t try to relive a trauma on your own to rewrite it.

What else can help a nightmare that keeps coming back?

Several other approaches may help, though the evidence for them is less clear (Morgenthaler et al., 2018). They list options that may be used for nightmare disorder, among them:

• cognitive behavioral therapy
• exposure, relaxation and rescripting therapy
• hypnosis
• lucid dreaming therapy
• progressive deep muscle relaxation
• self-exposure therapy
• systematic desensitization

Lucid dreaming therapy works from inside the dream: you learn to notice that you’re dreaming and change what happens (Gieselmann et al., 2019). Not everyone manages lucid dreaming. In one study the review describes, only 6 of 16 patients became lucid in a nightmare, though they benefited either way.

Sources

1. American Academy of Sleep Medicine. (2018, June 25). Treating nightmare disorder in adults. Sleep Education. sleepeducation.org/treating-nightmare-disorder-adults/
2. American Academy of Sleep Medicine. (2020, October). Nightmares. Sleep Education. sleepeducation.org/sleep-disorders/nightmares/
3. Burgess, M., Marks, I. M., & Gill, M. (1998). Postal self-exposure treatment of recurrent nightmares: Randomised controlled trial. The British Journal of Psychiatry, 172(3), 257–262. doi.org/10.1192/bjp.172.3.257
4. Cook, J. M., Harb, G. C., Gehrman, P. R., Cary, M. S., Gamble, G. M., Forbes, D., & Ross, R. J. (2010). Imagery rehearsal for posttraumatic nightmares: A randomized controlled trial. Journal of Traumatic Stress, 23(5), 553–563. doi.org/10.1002/jts.20569
5. Gehrman, P. (2026, April 15). Sleep problems in veterans with PTSD. National Center for PTSD, U.S. Department of Veterans Affairs. ptsd.va.gov/professional/treat/cooccurring/sleep_problems_vets.asp
6. Gieselmann, A., Ait Aoudia, M., Carr, M., Germain, A., Gorzka, R., Holzinger, B., Kleim, B., Krakow, B., Kunze, A. E., Lancee, J., Nadorff, M. R., Nielsen, T., Riemann, D., Sandahl, H., Schlarb, A. A., Schmid, C., Schredl, M., Spoormaker, V. I., Steil, R., … Pietrowsky, R. (2019). Aetiology and treatment of nightmare disorder: State of the art and future perspectives. Journal of Sleep Research, 28(4), e12820. doi.org/10.1111/jsr.12820
7. Harb, G. C., Cook, J. M., Phelps, A. J., Gehrman, P. R., Forbes, D., Localio, R., Harpaz-Rotem, I., Gur, R. C., & Ross, R. J. (2019). Randomized controlled trial of imagery rehearsal for posttraumatic nightmares in combat veterans. Journal of Clinical Sleep Medicine, 15(5), 757–767. doi.org/10.5664/jcsm.7770
8. Krakow, B., Hollifield, M., Johnston, L., Koss, M., Schrader, R., Warner, T. D., Tandberg, D., Lauriello, J., McBride, L., Cutchen, L., Cheng, D., Emmons, S., Germain, A., Melendrez, D., Sandoval, D., & Prince, H. (2001). Imagery rehearsal therapy for chronic nightmares in sexual assault survivors with posttraumatic stress disorder: A randomized controlled trial. JAMA, 286(5), 537–545. doi.org/10.1001/jama.286.5.537
9. Lancee, J., Effting, M., & Kunze, A. E. (2021). Telephone-guided imagery rehearsal therapy for nightmares: Efficacy and mediator of change. Journal of Sleep Research, 30(3), e13123. doi.org/10.1111/jsr.13123
10. Lancee, J., Spoormaker, V. I., & van den Bout, J. (2010). Cognitive-behavioral self-help treatment for nightmares: A randomized controlled trial. Psychotherapy and Psychosomatics, 79(6), 371–377. doi.org/10.1159/000320894
11. Morgenthaler, T. I., Auerbach, S., Casey, K. R., Kristo, D., Maganti, R., Ramar, K., Zak, R., & Kartje, R. (2018). Position paper for the treatment of nightmare disorder in adults: An American Academy of Sleep Medicine position paper. Journal of Clinical Sleep Medicine, 14(6), 1041–1055. doi.org/10.5664/jcsm.7178