What to do about repeated nightmares: bad dreams, recurring dreams and sleep
The few seconds after waking from a nightmare, your heart pounding, sleep far away. Nightmares are common and mostly no great matter, but some situations deserve to be taken seriously.
Why nightmares come
Nightmares often come in the second half of the night, when REM sleep is longest and the emotional parts of the brain are most active. Stress, irregular sleep, late nights, alcohol and some medicines can all bring more of them. After a frightening experience or trauma they can also return again and again.
For most people an occasional nightmare is feeling being sorted out, not a bad omen, and nothing needs "breaking".
Night terrors: like a nightmare, but not
Something often mistaken for a nightmare: soon after falling asleep, the person suddenly sits up screaming, drenched in sweat, heart racing, cannot be woken, and remembers nothing next day. This is a night terror, which comes in the deep sleep of the first half of the night and is commoner in children than adults.
The difference from a nightmare is that nightmares come in REM sleep in the second half of the night and the content is remembered on waking, while a night terror comes in deep sleep, usually with no story and no memory. During one, do not force a wake-up or shake them; just see that they are safe and wait for them to settle. Most children grow out of it.
If they are very frequent, or there is sleepwalking or a risk of injury, see a doctor.
What a recurring dream is saying
When one scene comes again and again, it often matches something not yet dealt with or a long-standing feeling. The details change slowly with your state, so noting what is different each time is valuable: did you turn round this time? Did you get away? Did anyone come to help? These changes often reflect a change in your relation to the matter.
A method with scientific support: imagery rehearsal
Sleep medicine has a common method called imagery rehearsal. While awake, write the nightmare down, then rewrite it freely into an ending you want, odd if you like as long as it feels safe; spend about ten minutes a day running through the new version in your mind.
Studies show it reduces nightmares for many people. It works because it turns a helpless dream into a story in which you have a choice.
A few small things before bed
Keep to regular times for going to bed and getting up; look at less stimulating material in the hour or two before bed; write down what is on your mind so it stays on the paper; do not use alcohol to get to sleep, because it breaks up sleep in the second half of the night. If you wake frightened, put on the light, drink some water, tell yourself "it was a dream", and breathe slowly a few times.
The first ten minutes after a fright
Woken by a nightmare, the body is still in "fight or flight": racing heart, damp palms. What helps most then is not to replay the dream, but first to bring the body back to the present.
You can: switch on the light and say aloud where you are, what time it is and what day it is; breathe in for four beats and out for six, a few rounds; touch something near you and feel its texture; drink a little water and, if needed, get up and walk about. When the heart slows, decide whether to write the dream down.
Do not lie there forcing yourself to recall and turn over the pictures, and do not reach for the phone at once. If you really cannot sleep, get up and do something quiet, and go back to bed when sleepy.
When a child has nightmares
Nightmares are common in pre-school and primary-school children. When a child wakes frightened, hold them first and say in a calm voice "you are safe, we are here", without pressing for details and without saying "what is there to be afraid of".
By day, if the child is willing, let them draw what was in the dream and then give it a funny ending together: the monster shut in a box, or turned into a puppy. It is the same idea as imagery rehearsal for adults. Fewer frightening stories and videos before bed and a small night light also help.
If the nightmares go on for weeks, or the child becomes anxious by day or unwilling to go to school, talk to a paediatrician or a child psychologist.
When to see a doctor
If nightmares come several times a week for over a month, make you afraid to sleep, leave you clearly worn out by day, or began after a trauma, please see a doctor, a sleep clinic or a mental-health clinic. This can be helped; you do not need to tough it out.
If you are in a very hard moment, please reach someone you trust, or a local support line. In mainland China you can call the national mental-health hotline 12356.
Questions people ask
Are nightmares and sleep paralysis the same thing?
No. A nightmare is waking in fright from a bad dream; sleep paralysis is waking with a clear mind while the body cannot move for a few seconds to a few minutes, usually harmless but very frightening. If it happens often, see a sleep clinic.
Does it help to tell the nightmare?
Yes. Putting it into words turns something shapeless into something with shape, and that alone makes it less frightening. Writing it down here is one way.
Are medicines and alcohol connected with nightmares?
Yes. Some medicines (for example certain blood-pressure drugs and antidepressants) can make dreams more frequent and vivid; and stopping alcohol suddenly after long drinking, or stopping certain sleeping pills, can bring more nightmares. If your nightmares began after you started a medicine or stopped one, tell the doctor the timing, and do not stop or change the dose yourself.