Many people have nightmares, but not everyone has a nightmare disorder. In some cases, this condition requires specialized treatment from mental health professionals.

For almost everyone, nightmares are an unpleasant but normal part of life. For people with nightmare disorder, nightmares are frequent, long in duration and highly distressing. When a person has nightmare disorder, sleep becomes a stressful activity rather than an opportunity for rest and recuperation. Without proper sleep, physical and mental health can quickly deteriorate which makes nightmare disorder treatment a necessity to those with the condition. Fortunately, there are many well-researched treatments available that can improve the symptoms of nightmare disorder and help those affected.

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is used in many settings to treat a variety of mental health and substance abuse conditions. CBT is rooted in the notion that a person’s thoughts, feelings and behaviors are all connected. By addressing self-defeating thoughts, the individual can better cope with their emotions and avoid counterproductive actions.

Several nightmare disorder treatments draw from CBT principles including:

  • Image rehearsal therapy (IRT)
  • Relaxation skills training
  • Exposure and systematic desensitization

Image Rehearsal Therapy

Image rehearsal therapy uses CBT techniques to track the content and images of unwanted dreams. The person with nightmare disorder then works with a therapist to analyze and edit the content of the dream. The person then spends about 20 minutes each day thinking about the edited dream. By rewriting the end of the dream to be more hopeful and positive, the individual gains a sense of control over their dreams. Studies show that image rehearsal therapy is quite effective in treating nightmare disorder.  

Relaxation Skills Training

Relaxation skills are essential in helping people manage the symptoms of nightmare disorder. These skills help the individual calm their body and mind and manage the stress of nightmares.

There are many useful relaxation skills a therapist can teach someone in need, including:

  • Deep breathing
  • Guided imagery
  • Progressive muscle relaxation
  • Body awareness
  • Mindfulness

Relaxation skills may seem uncomfortable or awkward at first, but with patience and practice, these skills can make daytime and nighttime less stressful.

Exposure and Systematic Desensitization

Exposure and systematic desensitization involve encouraging the individual to face, rather than avoid, the content of their nightmares. Unlike other commonly feared stimuli, like spiders or tall buildings, counselors can’t directly expose the individual to their nightmare. Instead, the counselor exposes the individual to the content of their nightmare through mental imagery.

Systematic desensitization is a version of exposure where the person is exposed to stressful thoughts gradually instead of all at once. Because the individual can slowly acclimate to stressful thoughts, they experience their stress in a more gradual, controlled way.


While therapy may be enough to manage unwanted symptoms of nightmare disorder effectively, some cases may require medication. Some effective drugs for nightmare disorder symptoms include:

  • Nitrazepam: This benzodiazepine sedative is best used for short-term anxiety and insomnia treatment
  • Triazolam: Another benzodiazepine, this drug is specifically used to improve insomnia
  • Prazosin: Unlike nitrazepam and triazolam, this drug works by reducing communication in the central nervous system and allowing people to achieve longer periods of sleep

Prescribers may recommend other medications used to address nightmares related to post-traumatic stress disorder, but these may not be helpful for nightmare disorder. Along the same lines, certain prescription drugs can make nightmares worse. Some medications that individuals with nightmare disorder should avoid are clonazepam and venlafaxine.

Alternative Treatments and Lifestyle Changes for Nightmare Disorder

If medications and therapy are not enough to relieve the symptoms of nightmare disorder, someone might consider alternative treatments or lifestyle changes for nightmare disorder, including hypnosis and improved sleep hygiene.


Hypnosis may be a useful alternative treatment for nightmare disorder for those who do not respond well to therapy or medication options. Working with a professional hypnotherapist can help the person with nightmare disorder enter a state of relaxation and deep concentration that leaves the individual more open to confronting the fears that surface in their nightmares.

Sleep Hygiene

Sleep hygiene is not a treatment; It’s a lifestyle change aimed toward making sleep more restorative. Sleep hygiene works to change one’s habits and routines around bedtime to improve the quality and quantity of sleep.

Examples of good sleep hygiene practices include:

  • Going to bed at the same time each day
  • Creating a comfortable and calm bedroom environment
  • Avoiding caffeine, alcohol and large meals before bedtime
  • Eliminating electronic and TV use for a few hours before going to bed

Treating Nightmare Disorder and Co-Occurring Conditions

Like other mental health issues, nightmare disorder may present with co-occurring conditions. Many people may experience symptoms of nightmare disorder while withdrawing from alcohol and other drugs, which can make an uncomfortable experience even more distressing.

There is help available for yourself or a loved one dealing with symptoms of nightmare disorder and substance abuse. These conditions require specialized care to improve symptoms without risking the physical or mental well-being of the individual.

The Recovery Village has treatment centers across the country able to help manage co-occurring nightmare and substance use disorders. Call today to recapture your life and start the path towards effective treatment.

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Editor – Megan Hull
Megan Hull is a content specialist who edits, writes and ideates content to help people find recovery. Read more
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Medically Reviewed By – Eric Patterson, LPC
Eric Patterson is a licensed professional counselor in the Pittsburgh area who is dedicated to helping children, adults, and families meet their treatment goals. Read more

American Academy of Sleep Medicine. “New Position Paper Recommends Treatment […]e Disorder in Adults.” June 14, 2018. Accessed on April 6, 2019.

American Psychiatric Association. “Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition.” 2013.

Aurora R.N., Zak R.S., Auerbach S.H., et al. “Best Practice Guide for the Treatment of[…]e Disorder in Adults.” Journal of Clinical Sleep Medicine. August 15, 2010. Accessed on April 6, 2019.

Cline, J. “Treating Nightmare Disorder.” Psychology Today. December 31, 2018. Accessed on April 6, 2019.

National Center for Biotechnology Information. “Best Practice Guide for the Treatment of[…]e Disorder in Adults.” August 15, 2010. Accessed April 15, 2019.

Medical Disclaimer

The Recovery Village aims to improve the quality of life for people struggling with substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare providers.