Nightmares: taking back your nights

This guide is psychoeducational content. It does not replace a consultation. If you are thinking about dying, if your nights come with dark thoughts, talk about it the same day to your doctor, to someone close to you or to a suicide prevention line; in immediate danger, call the emergency services in your country. See someone promptly, too, if your nightmares began after a serious event and come with memories that intrude during the day, startle reactions or avoidance; if they appeared with a new medicine, a change of dose or the stopping of a treatment (never change a prescribed treatment on your own); if you thrash about in your sleep to the point of hurting yourself or someone else; or if you snore loudly, with pauses in your breathing and sleepiness during the day. Allow fifty-five minutes to read.

1. Before you begin

It is 3.40 a.m. You are sitting up in bed, heart pounding, T-shirt stuck to your back. It was the corridor again, the door that will not open, the footsteps coming closer. You knew from the very first second that it was a dream, and it made no difference: your body was there. You go to the kitchen for a glass of water, you get back into bed, and you lie there with your eyes open until five. Partly because sleep will not come back. Mostly because you have no wish at all to go back there.

The next evening, you stay up in front of a screen until one in the morning, and you pour yourself a drink to "sleep straight through". You tell no one, because saying "I have nightmares" at forty sounds like a child's confession.

Three things, straight away.

Nightmares that have kept coming back for months can be treated. The best-supported method is practised awake, during the day, for about ten minutes a day, and several controlled trials show that it clearly reduces how often they occur.

You do not need to relive the nightmare to get rid of it. The work is on a new version, which you invent and then rehearse. The old one you barely look at, just long enough to know what to change in it. Section 9 explains why.

A nightmare is neither a prophecy nor a sign of madness. It foretells nothing, and it does not hide a message that you would have to decipher in order to get better. When it keeps coming back for months, it behaves above all like a sleep habit, and a habit can be unlearned.

Who this guide is for

For you if you have had frequent nightmares for weeks or months, with no obvious cause, and your nights are suffering for it.

For you if your nightmares began after a serious event (an accident, an assault, violence, a disaster, the sudden death of someone close) and they keep coming back.

For you if you share a bed with someone who wakes up screaming, and you want to understand and to help.

For you if your child has nightmares or wakes up terrified: section 19 is devoted to you.

2. Nightmare, bad dream, nightmare disorder

What makes a nightmare

A nightmare is a very unpleasant dream, often long and built like a story, which wakes you up and which you remember precisely. Most often it stages a threat: being chased, attacked, trapped, losing someone, arriving too late. When you wake, you are clear-headed at once, and the emotion takes a long time to subside.

Fear is not the only thing at stake. In a study in which volunteers kept a dream diary for four weeks, about one nightmare in three was dominated by an emotion other than fear (Zadra et al., 2006): anger, sadness, shame or disgust can take the lead role. Waking up in tears from a dream in which you lost your child in a crowd is just as much a nightmare as being chased.

A bad dream, by contrast, does not wake you: it leaves a sense of unease in the morning that clings to the day a little. For our purposes, the two are treated in the same way.

When is it called a disorder?

The international classifications speak of nightmare disorder when repeated nightmares, with a rapid and clear-headed awakening, cause distress or difficulties during the day: fatigue, low mood, fear of going to bed, trouble concentrating (American Academy of Sleep Medicine, 2023). So it is not a number that makes the disorder, it is what the nightmares cost you. The American Academy of Sleep Medicine estimates that it affects about 4% of adults.

And nightmares are underestimated: asked about the past year, people report markedly fewer nightmares than a diary kept every morning reveals (Zadra and Donderi, 2000).

Two broad families

Post-traumatic nightmares appear after a serious event. Some replay the scene almost exactly; others transpose it, with a different setting and different characters, but the same emotion. They are among the most frequent features of post-traumatic stress: according to the American Academy of Sleep Medicine, up to 80% of people who suffer from it report nightmares (Morgenthaler et al., 2018).

Nightmares with no clear traumatic cause may go back to childhood, appear during a stressful period, or set in for no identifiable reason. They are no less legitimate, and they respond to the same treatment.

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