Journal of Sleep Research
January 29, 2019
Annika Gieselmann, Malik Ait Aoudia, Michelle Carr et al.
192 citations
Chronic nightmares arise from an interaction between elevated hyperarousal and impaired fear extinction, facilitated by trait affect distress from traumatic experiences, early childhood adversity, trait susceptibility, elevated thought suppression, and potentially sleep-disordered breathing. Treatment options target nightmare meaning, chronic repetition, or maladaptive beliefs. The paper reviews epidemiological findings, aetiology models for traumatized and non-traumatized individuals, and evidence-based interventions, noting gaps in healthcare provider knowledge and delivery. Future perspectives for nightmare treatment and aetiology research are outlined.
Behavioral Sleep Medicine
January 15, 2025
Kristi E. Pruiksma, Katherine E Miller, Joanne L. Davis et al.
16 citations
An expert consensus panel reviewed treatment manuals for cognitive behavioral therapies for nightmares (CBT-N) tested in randomized clinical trials with adults. The panel developed guidelines for standardized implementation and terminology of CBT-N, addressing patient symptom presentations appropriate for treatment and components such as session length, relaxation training, stimulus control, sleep efficiency training, sleep hygiene, nightmare exposure, nightmare rescripting, and imagery rehearsal of rescripted dreams. The recommendations aim to clarify confusion caused by unstandardized nomenclature and implementation nuances, and are intended to be revised as new research evidence emerges.
Journal of Sleep Research
June 1, 2025
Jennifer M Mundt, Kristi E. Pruiksma, Karen R Konkoly et al.
7 citations
A small trial tested cognitive behavioral therapy for nightmares (CBT-N), adapted for people with narcolepsy, with or without targeted lucidity reactivation (TLR) to enhance lucid dreaming. Six adults who had frequent nightmares (at least 3 per week) received seven treatment sessions. Nightmare frequency dropped from an average of 8.38 per week to 2.25 per week, a large improvement. Nightmare severity and symptoms such as sleep paralysis, hallucinations, and dream enactment also improved. The three participants who received TLR all recalled dreams related to their rescripted nightmare. Participants reported reduced shame and anxiety about sleep and nightmares. The findings offer preliminary evidence that CBT-N and TLR may help manage narcolepsy-related nightmares.
Journal of Sleep Research
April 1, 2026
Severin Ableidinger, Luigi De Gennaro, Sérgio Mota-Rolim et al.
During the COVID-19 pandemic, about 30% of people frequently knew they were dreaming (lucid dreaming), and roughly half of those (17%) could influence their dreams (lucid dreaming with agency). Female gender and anxiety symptoms were linked to less ability to influence dreams, while dream recall, nightmares, insomnia, dream enactment behavior, sleep vocalization, short and long COVID, and PTSD were linked to more ability. Older age, dream recall, nightmares, and anxiety were linked to lucid dreaming without agency, while short sleep, being an evening type, and short COVID were linked to less of it. The different patterns suggest lucid dreaming with and without agency may be distinct sleep states, and this is the first study showing COVID-19 and long COVID are associated with lucid dreaming.
Journal of Sleep Research
February 1, 2026
Courtney J Bolstad, Bjørn Bjorvatn, Ngan Yin Chan et al.
In a large multi-country survey of 15,854 adults, frequent dream recall (at least weekly) was reported by 54.0% of participants in 2021 and 51.1% in 2019. Frequent nightmares rose from 6.9% in 2019 to 11.0% in 2021, suggesting an increase during the COVID-19 pandemic. Dream recall showed a linear relationship with sleep duration, while nightmare frequency had a quadratic relationship. Prevalence rates varied by age, gender, and country. This is the first multi-continent study to provide these prevalence estimates across 16 countries, including some never studied before.
Journal of Sleep Research
October 1, 2024
Courtney J Bolstad, Brigitte Holzinger, Serena Scarpelli et al.
During the COVID-19 pandemic, suicidal ideation was 2% lower overall than before, while nightmare frequency increased by 4.50%. Data from 9328 individuals across 16 countries showed that suicidal ideation decreased significantly in Austria, Sweden, and Bulgaria but rose non-significantly in Italy and Portugal. Participants with long-COVID reported higher rates of suicidal ideation (21.10%) than those with short-COVID (12.40%), though ideation did not differ by COVID-19 history alone. Nightmare frequency was higher in those with prior COVID-19 (14.50% vs. 10.70%), during active infection (23.00% vs. 8.10%), and in long-COVID (18.00% vs. 8.50%). Frequent nightmares during the pandemic increased the odds of suicidal ideation (OR = 1.
Sleep medicine clinics
March 1, 2024
Victoria R Garriques, Deepali M Dhruve, Michael R Nadorff
Nightmare disorder is a prevalent condition with significant psychosocial impacts. This review describes its diagnosis using established assessment tools and evaluates both psychological and pharmacologic treatments, noting their efficacy and side effects. It discusses optimizing therapy by weighing medication against psychotherapy, addressing co-morbidities, cultural factors, and the roles of technology and service animals. The review concludes with recommendations for effective clinical care.
Nature and Science of Sleep
January 1, 2022
Serena Scarpelli, Michael R Nadorff, Bjørn Bjorvatn et al.
People reported more dream activity during the pandemic than before it. Those who had COVID-19 reported significantly more nightmares during the pandemic than matched controls who had not had COVID-19, while dream recall frequency did not differ between the groups. COVID-19 participants also had higher anxiety, depression, and PTSD symptom scores, and lower quality of life and well-being scores than controls. Nightmare frequency was predicted by dream recall frequency, PTSD, anxiety, insomnia, COVID-19 severity, sleep duration, and age. The findings suggest that the more severely people were affected by COVID-19, the greater the impact on dream activity and quality of life.
Dreaming (New York, N.Y.)
September 1, 2021
Christina Pierpaoli-Parker, Courtney J Bolstad, E. Szkody et al.
Imagery rehearsal therapy (IRT) reduced nightmares and, according to the patient and her husband, decreased dream enactment in a person with both nightmare disorder and REM sleep behavior disorder (RBD). Five sessions of IRT over five months led to fewer nightmares and less dream enactment. The authors suggest that lowering the emotional intensity of dream content may make dream enactment less likely, and that IRT could serve as a helpful addition to medication for RBD.
Nature and Science of Sleep
January 1, 2021
Eirin Fränkl, Serena Scarpelli, Michael R Nadorff et al.
Dream recall frequency increased during the COVID-19 pandemic compared to pre-pandemic levels across four continents. In a cross-sectional web survey of 19,355 individuals from 14 countries, high dream recall (three or more nights per week) was associated with female gender, nightmares, sleep talking, sleep maintenance problems, symptoms of REM sleep behavior disorder, and repeated disturbing thoughts indicative of PTSD. Older adults aged 55-64 reported less high dream recall than younger participants. While unadjusted analyses showed associations between depression, anxiety, and dream recall, adjusted analyses revealed negative associations: depression and anxiety were linked to lower odds of high dream recall. The findings suggest that the pandemic's emotional intensity is reflected in dreams.
Behavioral Sleep Medicine
January 1, 2019
Thomas E Ellis, Katrina A Rufino, Michael R Nadorff
Imagery Rehearsal Therapy (IRT) reduced nightmare frequency and intensity and improved sleep and other symptoms, including suicidal ideation, in 20 adult psychiatric inpatients with multiple treatment-resistant conditions. No adverse reactions occurred. Because the study was an open trial without a control group, it cannot conclude that IRT specifically caused these improvements; larger controlled trials are needed.
Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine
July 15, 2015
Michael R Nadorff, Danielle K Nadorff, Anne Germain
Nightmares are a strong and changeable predictor of higher suicide risk and poor mental health outcomes, yet they are rarely screened for or treated, even in sleep clinics. In two U.S. surveys, only 37.8% of people with clinically significant nightmares in one sample and 11.1% in another had discussed them with a healthcare provider. Among those with significant nightmares, fewer than one-third believed nightmares were treatable. Greater nightmare severity made people more likely to report them but also less likely to believe they could be treated. The findings indicate that nightmares are seldom reported to healthcare providers, which may explain why effective treatments are underused, and support routine nightmare screening.
International review of psychiatry (Abingdon, England)
April 1, 2014
Michael R Nadorff, Karen K Lambdin, Anne Germain
Nightmare disorder is clinically significant and linked to post-traumatic stress disorder, other psychiatric conditions, and suicidality. Imagery rehearsal therapy and prazosin are leading treatments. The paper proposes using these treatments as first-line interventions for PTSD and as adjunctive therapy to reduce suicide risk in individuals with nightmares.