Nightmares in Adults: Causes, Symptoms, and Coping
Sleep is supposed to be a time when we rest and recover. It’s when our bodies and minds can finally relax and let go. But for some of us, nighttime is when our minds become the loudest. Nightmares can turn rest into something we dread, leaving us anxious to close our eyes again.
Images that feel too real, fear that’s too sharp, and a heart that continues to pound long after waking. Occasional bad dreams are part of being human. But when we experience recurring nightmares that are impacting our rest, they might be trying to tell us there’s something more going on beneath the surface.
If nightmares are beginning to take a toll on your sleep or sense of safety, you’re not alone. A mental health professional can help you uncover the root causes and finally find restful relief.
This page can also help you better understand nightmares in adults by discussing:
- What nightmares are and how they can affect adults
- Causes of nightmares and their connection to mental health issues
- Symptoms and when to seek help
- Sleep support for adults
- Answers to commonly asked questions about nightmares in adults
What Are Nightmares and How Do They Affect Adults
Nightmares are vivid and disturbing dreams that cause us to wake up feeling upset or distressed. They tend to occur when we’re in REM (rapid eye movement) sleep – the stage where our brains are most active and processing memories.1
Plus, nightmares often feel so real that it can take a few minutes after waking up to realize they’re “just a dream.” In fact, nightmares can be a sign that our minds are trying to wrestle with unprocessed experiences or emotions.
While having the odd or random nightmare is normal, when they become frequent or recurring, they can disrupt our body’s natural rhythm of rest and repair. Every time a nightmare jolts us awake, our heart rate increases and adrenaline surges. Nightmares can even alter our nervous systems, keeping the body in a state of fight-or-flight after we wake up.2 Over time, this pattern can lead to fragmented sleep, daytime fatigue, irritability, and increased anxiety or depression.
Causes of Nightmares in Adults
There are many possible causes of nightmares in adults. From medical conditions and sleep disorders to accidents and mental health conditions, here are some of the common causes for why adults experience nightmares:
Stress and Nightmares
Being stressed is already associated with poor sleep. When we live in a constant state of tension or overthinking, the nervous system struggles to fully relax, even during sleep. The body remains on alert, and the mind often mirrors this feeling of danger through vivid or distressing dreams. This ongoing cycle can leave adults feeling both emotionally drained and physically exhausted, as nighttime stress bleeds into daytime fatigue and irritability.
Anxiety-Related Nightmares
For people with anxiety, nightmares can emerge when daytime fears or worries are left unresolved. For instance, anxiety-related nightmares might reflect common anxious themes or thoughts, such as helplessness, embarrassment, or specific phobias. Because anxiety heightens the body’s fight-or-flight response, the brain continues to process this state of alarm during REM sleep, often making the dreams more intense and emotional.
PTSD and Nightmares
Nightmares are a common symptom of PTSD, with about 88% of those with PTSD experiencing nightmares.3 For survivors of trauma, nightmares tend to replay parts of the event itself or are ways of expressing fear, guilt, or grief connected to the event.
These bad dreams aren’t simply “memories” but the brain’s attempt to process experiences that were too overwhelming to integrate when they happened. Left unaddressed, they can lead to chronic sleep disturbances, hypervigilance, and emotional exhaustion.
Medical Conditions
Certain health issues can also trigger or worsen nightmares. For example, conditions like sleep apnea or parasomnias can disrupt sleep cycles and increase the likelihood of experiencing vivid and distressing dreams. Further, some neurological conditions, like epilepsy and Parkinson’s Disease, can also increase the chances of experiencing nightmares.
Nightmares may feel random or uncontrollable, but they’re often rooted in patterns that can be understood and addressed. Whether they stem from stress, anxiety, or trauma, effective treatment can help restore balance – turning sleep from something you fear into something that truly restores.
Symptoms of Nightmares and When to Seek Help
Nightmares have a tendency to follow us, even into the day. Without proper rest, our bodies are unable to rest and recover, making it harder to get through the day. Therefore, a poor night’s sleep can leave us feeling foggy, tense, or emotionally raw.
The following are some of the common symptoms you might experience from nightmares as an adult:
- Vivid, distressing dreams that leave behind fear, sadness, or panic upon waking
- Physical reactions, such as sweating, rapid heartbeat, or trembling after the dream
- Difficulty falling back asleep, or lying awake to avoid another nightmare
- Dreading or worrying about going to bed at night
- Feeling tired or irritable during the day because of disrupted sleep
- Feeling more anxious, withdrawn, or on edge from not getting enough sleep
When nightmares occur repeatedly (several times a week or across months) they can take a real toll on mental health. Chronic poor sleep can also affect our physical health, causing problems with the immune system and a higher risk of diabetes, heart disease, high blood pressure, and stroke.4
When Nightmares Become a Clinical Concern
While the occasional nightmare is normal, consistent and distressing dreams may meet the criteria for nightmare disorder. Nightmare disorder is a type of parasomnia recognized in the DSM-5, affecting 2% to 5% of the adult population.5
It may be time to seek help if:
- Nightmares cause you to wake frequently and leave lingering emotional distress
- You feel intense feelings of fear, guilt, or helplessness from the nightmares
- You experience sudden changes in mood that are related to poor sleep
- The nightmares are linked to trauma, anxiety, or depression
- You’ve tried adjusting lifestyle habits, but the nightmares continue
Professional treatment can help identify any potential underlying factors and provide strategies that restore both rest and emotional balance.
Therapy for Nightmares
Nightmares can make sleep feel unpredictable and unsafe, but the good news is that they are highly treatable. Coping with nightmares and finding the right approach depends on what’s driving them, whether this is stress, trauma, or an underlying sleep disturbance. Regardless of the treatment approach, the goal is to help you feel safe in your own mind again.
The following are some evidence-based nightmare treatment options:
Cognitive Behavioral Therapy for Nightmares (CBT-N)
One of the most effective and well-researched treatments for nightmares is cognitive behavioral therapy for nightmares (CBT-N).6 This form of therapy helps us identify the thoughts, emotions, and physical responses that happen around sleep and dreaming.
A key part of this approach is Imagery Rehearsal Therapy (IRT), which teaches us to rewrite the ending of our nightmare while awake and mentally rehearse the new version.7 Over time, this can retrain the brain to associate the dream with safety rather than fear, reducing both intensity and frequency.
Exposure, Relaxation, and Rescripting Therapy (ERRT)
ERRT combines exposure and relaxation techniques to gradually reduce the emotional charge attached to nightmares. This approach involves overcoming frequent nightmares by revisiting the dream in a safe, structured environment and learning coping tools such as grounding and deep breathing to relax your body. ERRT can not only lessen nightmare-related distress but may also improve overall sleep quality and daytime functioning.8
EMDR and Trauma-Focused Therapies
Eye movement desensitization and reprocessing (EMDR) and other trauma-focused therapies can be particularly effective in helping the brain process traumatic memories that remain “stuck,” allowing you to start healing.9 As the brain integrates these experiences more fully, trauma-related nightmares often decrease in both frequency and emotional intensity.
Medication Support When Needed
In some cases, medication can support the therapeutic process. Prazosin, for example, has shown promise in reducing PTSD-related nightmares by lowering the body’s stress response during REM sleep.10 However, medication is most effective when paired with therapy, as the goal isn’t to suppress dreams but to create a sense of safety within them.
Nightmares may feel uncontrollable, but therapy can help you take back power step by step. Whether through imagery rehearsal, trauma processing, or mindfulness, each approach aims to restore your body’s ability to rest and recover.
Mission Connection: Professional Treatment for Nightmares and Sleep Disturbance in Adults
Recurring nightmares can leave you feeling tense, fatigued, and disconnected from the rest your body needs. At Mission Connection, we understand that these experiences often point to underlying emotional, psychological, or physiological stress.
Treatment often combines cognitive behavioral therapy to manage emotional stress and sleep, as well as EMDR and trauma-focused care to process painful memories that may resurface in dreams. Mindfulness techniques that calm the nervous system before rest can also be incorporated into your plan.
Contact Mission Connection today so you can move beyond restless nights toward deep, restorative rest.
FAQs About Nightmares in Adults
While we hope that the information on this page helped you better understand nightmares in adults, we understand that you may still have some pressing concerns. For this reason, we’ve provided some responses to FAQs about nightmares.
1. Can Nightmares Be a Sign of Mental Health Problems?
Not always. Sometimes nightmares just happen, and we’re not sure why. But when we experience chronic nightmares, this might be related to a mental health condition like anxiety or trauma. When nightmares cause significant fear, exhaustion, or mood changes, it may help to explore them with a mental health professional.
2. What Are Common Nightmares in Adults?
Common nightmares in adults usually involve the themes of being chased, falling, losing control, or experiencing harm to oneself or loved ones. These dreams can sometimes reflect feelings of fear, guilt, or anxiety that we might be holding on to. For some people, nightmares replay stressful events or unresolved trauma, while for others, they appear during periods of major life change or uncertainty.
3. What’s the Connection Between PTSD and Nightmares?
Nightmares are one of the most common symptoms of post-traumatic stress disorder (PTSD). If you have PTSD, you may be likely to replay aspects of the traumatic event through nightmares. This is often a way for the brain to try to process these traumatic events or situations.
4. How Does Mission Connection Treat Nightmares and Sleep Disturbances?
Mission Connection treats nightmares and sleep disturbances by using a combination of evidence-based approaches like CBT and EMDR, along with practices that focus on relaxation, such as mindfulness. Our goal is to help you restore calm and improve your sleep quality by uncovering the roots of what might be driving the nightmares.
References
- Levine, H. (2024, September 9). REM sleep: What is it, why is it important, and how can you get more of it? Harvard Health. https://www.health.harvard.edu/staying-healthy/rem-sleep-what-is-it-why-is-it-important-and-how-can-you-get-more-of-it
- Tomacsek, V., Blaskovich, B., Király, A., Reichardt, R., & Simor, P. (2023). Altered parasympathetic activity during sleep and emotionally arousing wakefulness in frequent nightmare recallers. European Archives of Psychiatry and Clinical Neuroscience, 274(2), 265–277. https://doi.org/10.1007/s00406-023-01573-2
- El-Solh, A. A. (2018). Management of nightmares in patients with posttraumatic stress disorder: current perspectives. Nature and Science of Sleep, Volume 10, 409–420. https://doi.org/10.2147/nss.s166089
- Colten, H. R., & Altevogt, B. M. (2006). Extent and health consequences of chronic sleep loss and sleep disorders. Sleep Disorders and Sleep Deprivation – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK19961/
- Weir, K. (2024, October 1). Nightmares in adults: symptoms, causes, and innovative, science-backed therapies. American Psychiatric Association (APA). https://www.apa.org/monitor/2024/10/science-of-nightmares
- Lancee, J., Spoormaker, V. I., Krakow, B., & van den Bout, J. (2008). A systematic review of cognitive-behavioral treatment for nightmares: Toward a well-established treatment. Journal of Clinical Sleep Medicine, 4(5), 475–480. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2576316/
- Albanese, M., Liotti, M., Cornacchia, L., & Mancini, F. (2022). Nightmare Rescripting: Using imagery techniques to treat sleep disturbances in post-traumatic stress disorder. Frontiers in Psychiatry, 13. https://doi.org/10.3389/fpsyt.2022.866144
- Davis, J. L., & Wright, D. C. (2006). Exposure, relaxation, and rescripting treatment for Trauma-Related Nightmares. Journal of Trauma & Dissociation, 7(1), 5–18. https://doi.org/10.1300/j229v07n01_02
- Shapiro, F. (2014). The Role of Eye Movement Desensitization and Reprocessing (EMDR) Therapy in Medicine: Addressing the Psychological and Physical Symptoms Stemming from Adverse Life Experiences. The Permanente Journal, 18(1), 71–77. https://doi.org/10.7812/tpp/13-098
- Hudson, S. M., Whiteside, T. E., Lorenz, R. A., & Wargo, K. A. (2012). Prazosin for the treatment of nightmares related to posttraumatic stress disorder. The Primary Care Companion for CNS Disorders. https://doi.org/10.4088/pcc.11r01222