Nightmares and sleep

Why do you have nightmares, and when should you get help?

Most adults have an occasional nightmare, and most nightmares need no treatment (AASM, 2020). They become more likely with stress, an irregular sleep schedule, being overtired, some medicines, alcohol withdrawal and trauma (AASM, 2020; Cleveland Clinic, 2022). See a doctor when nightmares often wake you, keep you from getting back to sleep or affect your daily life (NHS, 2025). Nightmares that cause problems can be treated (AASM, 2018).

Last updated: 2026-10-13.

How common are nightmares, and what counts as one?

Nightmares are very common: an estimated 50% to 85% of adults have an occasional nightmare (American Academy of Sleep Medicine [AASM], 2020). Frequent ones are much rarer: weekly nightmares occur in about 4% to 10% of people (Levin & Nielsen, 2007), and in a Hong Kong study of 8,558 adults, 5.1% had nightmares at least once a week (Li et al., 2010).

Across eight Finnish surveys held between 1972 and 2007, with 69,813 adults in all, 3.5% of men and 4.8% of women said they had nightmares “often” in the past 30 days (Sandman et al., 2013). The question didn’t define a nightmare, so some bad dreams were likely counted too.

A nightmare wakes you, and you usually remember it clearly (AASM, 2020). A disturbing dream that doesn’t wake you is a bad dream. The AASM adds that nightmares tend to come during REM (rapid eye movement) sleep and are most likely in the last third of the night, though nightmares after trauma may come earlier.

What makes nightmares more likely?

Several everyday things, and some medical ones. The AASM (2020) lists stress, anxiety, an irregular sleep routine and being overtired. The NHS (2025) adds being unwell, sudden noises, needing to pee in the night, and something that frightened you, such as a scary film.

Trauma is a strong one: up to 80% of patients with post-traumatic stress disorder (PTSD) report nightmares (Morgenthaler et al., 2018).

Some medicines and substances can bring nightmares on (AASM, 2020; Cleveland Clinic, 2022). Sources name antidepressants, medicines for high blood pressure (beta-blockers among them) and medicines for Parkinson’s disease, as well as nicotine and withdrawal from alcohol. If nightmares started with a new medicine, talk to your prescriber, and don’t stop it or change the dose on your own (MedlinePlus, 2026). The guide to vivid dreams covers medicines in more detail.

Other sleep problems, such as sleep apnea or restless legs, can also lie behind nightmares (NHS, 2025).

Does a nightmare mean something is wrong with you?

A nightmare on its own doesn’t mean something is wrong with you (AASM, 2020). Most adults have one now and then. Frequent nightmares are linked with PTSD, anxiety and depression, but nightmares are not considered a psychiatric illness (Cleveland Clinic, 2022). They count as a sleep disorder when they come often and keep you from getting restful sleep (AASM, 2020).

A nightmare isn’t a verdict on you, and it has no fixed meaning. A dream draws on your own life (Domhoff, 2017), so reading it is your call, as the guide to whether dreams mean anything explains.

What is nightmare disorder?

Nightmare disorder is the name doctors use when nightmares come again and again and cause real distress or trouble in daily life (Gieselmann et al., 2019). About 4% of adults in the US have it (Morgenthaler et al., 2018), and an estimated 2% to 8% of people have nightmares that cause sleep problems (AASM, 2020).

Doctors grade it by how often nightmares come (Cleveland Clinic, 2022). Mild means less than one a week on average, moderate means one or more a week but not every night, and severe means every night. They also note how long it has lasted: a month or less, one to six months, or six months or more.

Many researchers conclude that how much nightmares upset you matters more for your mental health than how often they come (Gieselmann et al., 2019). One of their reasons: distress about nightmares is more strongly tied to anxiety, depression and other mental health complaints than frequency is.

When should you see a doctor about nightmares?

See a doctor when nightmares affect your sleep or your days, or when one of the signs below applies (NHS, 2025). These are reasons to talk to someone, not a test you can pass or fail.

A sleep doctor may ask you to keep a sleep diary for two weeks (AASM, 2020). Most people troubled by nightmares don’t seek professional help (Gieselmann et al., 2019). In the studies the authors reviewed, fewer than a third believed their nightmares could be treated, and only 38% had told a healthcare provider about them.

What helps with nightmares?

Most nightmares need no treatment (AASM, 2020). For a bad run, the NHS (2025) suggests a relaxing bedtime routine, a sleep diary to spot what sets them off, and dealing with stress. It adds that cognitive behavioral therapy (CBT) can help both adults and children with frequent nightmares.

For nightmare disorder, the AASM recommends image rehearsal therapy (Morgenthaler et al., 2018). In it, you rewrite a nightmare’s story while you’re awake, then rehearse the new version (AASM, 2018); the guide to changing a recurring nightmare explains the steps. If your nightmares follow a trauma, start with your doctor: more intensive counseling may be needed (AASM, 2020). If you’re struggling with nightmares, a doctor may refer you to an accredited sleep center (AASM, 2018).

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. American Academy of Sleep Medicine. (2021a, January). REM sleep behavior disorder. Sleep Education. sleepeducation.org/sleep-disorders/rem-sleep-behavior-disorder/
4. American Academy of Sleep Medicine. (2021b, January). Sleep terrors. Sleep Education. sleepeducation.org/sleep-disorders/sleep-terrors/
5. Cleveland Clinic. (2022, November 21). Nightmare disorder. my.clevelandclinic.org/health/diseases/24464-nightmare-disorder
6. Domhoff, G. W. (2017). The invasion of the concept snatchers: The origins, distortions, and future of the continuity hypothesis. Dreaming, 27(1), 14–39. doi.org/10.1037/drm0000047
7. 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
8. Levin, R., & Nielsen, T. A. (2007). Disturbed dreaming, posttraumatic stress disorder, and affect distress: A review and neurocognitive model. Psychological Bulletin, 133(3), 482–528. doi.org/10.1037/0033-2909.133.3.482
9. Li, S. X., Zhang, B., Li, A. M., & Wing, Y. K. (2010). Prevalence and correlates of frequent nightmares: A community-based 2-phase study. Sleep, 33(6), 774–780. doi.org/10.1093/sleep/33.6.774
10. MedlinePlus. (2025, January 1). Alcohol withdrawal. U.S. National Library of Medicine. medlineplus.gov/ency/article/000764.htm
11. MedlinePlus. (2026, January 14). Taking medicines: What to ask your provider. U.S. National Library of Medicine. medlineplus.gov/ency/patientinstructions/000535.htm
12. 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
13. NHS. (2025, November 24). Night terrors and nightmares. nhs.uk/conditions/night-terrors/
14. Sandman, N., Valli, K., Kronholm, E., Ollila, H. M., Revonsuo, A., Laatikainen, T., & Paunio, T. (2013). Nightmares: Prevalence among the Finnish general adult population and war veterans during 1972–2007. Sleep, 36(7), 1041–1050. doi.org/10.5665/sleep.2806