Nightmares are dreams that are upsetting or disturbing. According to the American Academy of Sleep Medicine, over 50 percent of adults report having occasional nightmares. However, some people have nightmares that occur more frequently. These are called recurring nightmares. Recurring nightmares tend to happen more often in children than adults.

Not all recurring nightmares are the same each night. Many nightmares follow similar themes and tropes but may differ in content. Regardless, these nightmares often cause similar emotions once you wake up, including:

  • anger
  • sadness
  • guilt
  • anxiety

These thoughts and feelings can make it hard to get back to sleep again.

Recurring nightmares often have an underlying cause. In this article, we’ll explore the common causes for recurring nightmares, as well as treatment options for some of the underlying conditions.

Nightmares can occur for a number of reasons, but here are five of the most common.

1. Stress, anxiety, or depression

Stress is one of the emotions that many people have trouble channeling in a productive manner. Because of this, dreams may be one of the only opportunities for the body to work through those feelings.

One hypothesized that stress and trauma from childhood can cause recurring nightmares later in life. Anxiety and depression can cause nightmares, as well. These nightmares may include situations related to self-worth, disease relapse, and for some, even panic attacks.

2. PTSD

of people with post-traumatic stress disorder (PTSD) experience nightmares. PTSD is one of the primary causes of recurring nightmares in adults.

One of the most common symptoms of PTSD is “re-experiencing,” or having flashbacks to traumatic event or events. Sometimes these flashbacks can manifest as nightmares. For people with PTSD, recurring nightmares can have a variety of negative effects, including:

  • contributing to or worsening PTSD symptoms
  • contributing to or worsening depression
  • reducing sleep quality

The content of these nightmares can vary from person to person. For some people, these dreams are replicative nightmares in which the original trauma is replayed over and over again. For others, the nightmares are symbolic to the emotions and feelings of the original trauma.

3. Underlying medical conditions

Certain sleep disorders can lead to recurring nightmares. Sleep apnea is a condition characterized by interrupted breathing during sleep. Narcolepsy is a disorder of the nervous system that causes severe daytime drowsiness, hallucinations, and sleep paralysis. Conditions such as these can affect the quality of sleep and may be an underlying cause of recurring nightmares.

4. Medications

Certain medications, such as antidepressants, blood pressure medications, and other drugs used to treat specific conditions, can cause nightmares. One from 1998 found that the most common nightmare-causing drugs included sedative and hypnotic drugs, beta blockers, and amphetamines.

5. Substance abuse

There are many symptoms of withdrawal that occur from substance abuse, including nightmares. These nightmares may be more intense at the onset of withdrawal but usually taper off within a few weeks of sobriety. Alcohol withdrawal most commonly causes nightmares.

Although nightmares and night terrors may seem similar, they’re quite different experiences. Nightmares are scary, vivid dreams that usually cause the person to awaken immediately. These dreams are often easily remembered.

Night terrors are hard to wake up from. A person may experience extreme agitation, such as flailing about, screaming, or even sleepwalking. Despite these physical reactions, people who experience night terrors usually sleep through them.

Night terrors and nightmares happen during different stages of sleep. When you doze off, you’ll typically move through four stages of sleep. In stages one and two, you’re in a light state of sleep. In stages three and four, you slip into a deeper sleep.

Roughly every 90 minutes, you enter what is often referred to as the fifth stage of sleep, which is rapid eye movement (REM) sleep. Night terrors generally happen when you’re in non-REM sleep, while nightmares occur during REM sleep.

In many cases, treating recurring nightmares involves treating the underlying condition.

Depression and anxiety

Treating conditions such as depression and anxiety, can help to resolve the thoughts and feelings that may be leading to nightmares. Some of the treatment options for these conditions may include:

  • psychotherapy, especially cognitive behavioral therapy (CBT)
  • medications, such as selective serotonin reuptake inhibitors (SSRIs)
  • support groups
  • relaxation techniques, such as yoga, meditation, and deep breathing
  • regular exercise

Sleep conditions

Treatment for sleep conditions, such as sleep apnea and narcolepsy, may differ. Sleep apnea is generally treated with breathing machines, medications, lifestyle changes, and in some cases, even surgery.

Narcolepsy is most often treated with long-term medications, such as stimulants and certain antidepressants.

PTSD

If nightmares are caused by PTSD, it’s important to seek professional treatment. There are specific treatments that can be used for PTSD nightmares, such as imagery rehearsal therapy and visual-kinesthetic dissociation.

Imagery rehearsal therapy involves recalling the nightmare (or nightmares) when awake and changing the ending so that the dream is no longer threatening. Visual-kinesthetic dissociation therapy is another technique used to help rewrite traumatic memories into a new memory that is less traumatizing.

In addition to treating anxiety and depression, cognitive behavior therapy (CBT) may also be used for treating nightmares caused by PTSD.

In one , researchers investigated whether using CBT for PTSD would also help to alleviate trauma-induced recurring nightmares. Participants of the study received CBT for 20 weeks. The researchers found that after 20 weeks of CBT, 77 percent of participants no longer experienced recurring nightmares related to their PTSD.

In the case of nightmares caused by PTSD, medication may be used as part of a treatment protocol for the overall disorder. However, outside of PTSD, it’s rare for medication to be used in the treatment of recurring nightmares.

One of the ways you can reduce recurring nightmares is to create healthy sleep habits by improving your bedtime routine.

  1. Create a sleep schedule. A sleep schedule can help to make sure that you’re getting enough sleep throughout the night. It can also provide some routine stability if you’re experiencing recurring nightmares due to stress or anxiety.
  2. Ditch the electronics. A huge part of getting better sleep is making sure that your body is ready to sleep. The blue light from electronics is known to suppress melatonin, the sleep hormone, making it harder to fall and stay asleep.
  3. Avoid stimulants. Taking stimulants before bed can make it more difficult to fall asleep. According to the National Sleep Foundation, alcohol, cigarettes, and caffeine can all negatively affect your sleep.
  4. Set the stage. You should make sure that your bed, pillows, and blankets are comfortable. In addition, decorating your bedroom with familiar, comforting items can help create a safe space to fall asleep.

When you experience recurring nightmares, you may find it difficult to fall back asleep again. Here are a few methods you can use to calm yourself down after waking up from a nightmare.

  • Practice deep breathing. If you wake up scared or anxious, deep breathing, also called diaphragmatic breathing, can help to slow your heart rate and lower your blood pressure.
  • Discuss the dream. Sometimes, discussing the dream with a partner or friend can help to alleviate some of the anxiety it may have caused. It can also be a good way to reflect on the fact that it’s only a dream, and nothing more.
  • Rewrite the dream. Part of CBT involves rewriting your thoughts and feelings. If you can rewrite the nightmare into something that’s less scary or disturbing, you may find yourself able to fall back asleep again.

If recurring nightmares are impacting your ability to get good sleep or causing you increased anxiety or depression throughout the day, seek help.

If your nightmares are related to stress, anxiety, or depression, make an appointment with a health professional for treatment and support. The American Psychiatric Association, American Psychological Association, and Anxiety and Depression Association of America all have resources that you can use to find a mental health professional near you.

If your nightmares are related to an underlying sleep condition, your healthcare provider may want to order a sleep study. A sleep study is a test that’s commonly performed at an overnight testing facility. The results of the test can help your doctor determine if you have a sleep disorder that may be leading to your recurring nightmares.

Recurring nightmares usually have an underlying cause. Sometimes, this cause can be related to stress or anxiety, medication use, or even substance abuse.

If you feel that recurring nightmares are affecting your quality of life, reach out to a doctor or mental health professional. Once you treat the cause of the recurring nightmares, you may be able to reduce or eliminate them for good.