Why Do I Have Recurring Nightmares?

When we think of nightmares, we often associate these bad dreams with kids who fear monsters under the bed or things that lurk in the dark. But adults often have nightmares too. And sometimes they are recurring.

A recurring nightmare is defined as an unpleasant dream that is repeated over and over again across a long period of time.

Perhaps you dream about being assaulted once a week. Or maybe your nightmare involves a loved one getting into an accident, and you experience it every time you fall asleep.

Why Do People Have Recurring Nightmares?

While dreams have long fascinated people, little is still known about why we dream. And there’s little consensus about whether dreams have deeper meanings.

Even less is known about nightmares. While some researchers think nightmares may stem from chemical imbalances in the brain, others believe they stem from deep-rooted issues or traumatic experiences. And still, some believe nightmares are simply a sign of vivid imagination.

So why would someone have a recurring nightmare? There are a few potential reasons.

Unmet Psychological Needs

Some researchers believe that recurrent nightmares stem from unmet psychological needs, such as autonomy, competence, and relatedness. These unmet needs can lead to recurring dreams, and in some cases recurring nightmares as an effort at processing and integrating these experiences.

Substances and Medications

Medication, drugs, and alcohol may interfere with brain chemicals and increase the likelihood of nightmares. Studies have found that sedatives, beta-blockers, and amphetamines are especially likely to cause nightmares. In some cases, withdrawing from substances can also lead to recurring nightmares.

PTSD

Nightmares are one of the most common symptoms of PTSD. They often involve re-experiencing the same trauma that was endured in real life (although they may also seem unrelated to a specific real-life trauma as well).

Borderline Personality Disorder

Borderline personality disorder (BPD) is a mental health disorder that is characterized by self-image issues, difficulty managing emotions and behavior, and a pattern of unstable relationships. There is a high prevalence of both sleep disturbances and nightmares in people with BPD.

Nightmare Disorder

Some individuals with recurring nightmares may qualify for a diagnosis of nightmare disorder. Nightmare disorder is a mental health condition that is characterized by:

• Recurrent episodes of well-remembered dreams that typically involve efforts to avoid threats to survival or physical integrity
• Rapid alertness upon waking from the nightmare
• Significant distress or impairment in social, occupational, or other areas of functioning
  

Common Recurring Nightmare Themes

While nightmares can be about anything, researchers have found that there are some common themes to nightmares.

A 2018 study examined common nightmares in children. The researchers discovered that children’s nightmares often involved being chased, physical aggression, or the death or injury of a loved one.

The researchers noted that fear is not always part of nightmares. Sadness, confusion, guilt, and disgust were often present. 

The Toll Recurring Nightmares Can Have on You

Someone who has never had recurring nightmares might think, "It's just a bad dream. So what?" But anyone who has experienced recurring nightmares knows that they can take a serious toll on your emotional, physical, occupational, and social well-being.

These are just a few difficulties you might experience as a result of recurrent nightmares. Here’s what the research says about recurring nightmares and the toll they can take:

Sleep Deprivation

What distinguishes nightmares from bad dreams is the fact that nightmares tend to wake people up. They also tend to make it hard to fall back asleep, leading to sleep deprivation.

You might also be tired at work because you woke up several times the night before from nightmares. Consequently, your productivity could be affected.

Low Mood

Nightmares have also been associated with depression, anxiety, and other mood disturbances.  You may have more difficulty managing your emotions or even your appetite when you’re sleep-deprived as well.

Link to Suicide

A 2017 study found a link between recurring nightmares and suicide in war veterans. Another 2017 study found that recurring nightmares are associated with non-suicidal self-injury among college students.

Treatments for Recurring Nightmares

If you’re experiencing recurring nightmares, talk to your physician. Your doctor may want to conduct a complete physical to rule out any potential medical reasons for the nightmares. Your physician may also recommend referral to a therapist who can assist in improving your sleep, address any underlying mental health issues, and reduce your nightmares.

Lifestyle Changes

The treatment for recurring nightmares depends on the cause. Sometimes, a few lifestyle changes can reduce them. Some strategies that may help reduce nightmares include:

• Using effective stress management techniques
• Getting regular exercise
• Creating a comfortable sleep environment
• Practicing good sleep habits

Medication

At other times, medication changes may be necessary. A physician might be able to prescribe a medication that can decrease nightmares or change one that is contributing to them.

Medications that may be prescribed to treat nightmares in adults include:

• Prazosin
• Hydroxyzine
• Clonazepam
• Cyproheptadine
• Nabilone
• Doxazosin

Therapy

Therapy can also be helpful. Therapists often use exposure therapy to treat PTSD, and this could decrease recurring nightmares.

Different types of psychotherapy may be effective in reducing recurring nightmares as well, even when the cause of the nightmares isn’t known. Therapists might ask individuals to write down their dreams, associate to different aspects of them, or they may ask them to look for alternative endings to their nightmares.

Types of therapy that may be helpful include:

• Cognitive-behavioral therapy (CBT)
• Exposure, relaxation, and rescripting therapy (ERRT)
• Imagery rehearsal therapy (IRT)
  

Both ERRT and IRT involve keeping a sleep log, tracking nightmare frequency and severity, and psychoeducation. People also practice skills that help them better manage thoughts, emotions, and imagery related to their nightmares. Both of these types of therapy are recommended by the American Academy of Sleep Medicine in the treatment of nightmares.

Keep in Mind

If you’re struggling with a recurring nightmare, don’t be afraid to ask for help. Talking to your physician or a therapist could be key to helping you get better rest. A few simple changes in your life or working through a specific issue might help you overcome a nightmare once and for all.