Can You Have Too Many Nightmares?

Anyone who's had a truly vivid nightmare knows that its effects can be long-lasting. From the initial sleep disturbance (like waking in a cold sweat) to a lingering sense of unease the following day, nightmares have the annoying ability to feel real, even though they're not. There's a reason Wes Craven's "A Nightmare on Elm Street" franchise continues to slay as the pop culture phenomenon that it is. People can relate!

Of course, everyone has nightmares from time to time. These upsetting mental images usually evoke fear or extreme anxiety to the point that they wake a person up and cause a racing heart and other physiological side effects. Nightmares can run the gamut from something upsetting, but relatively harmless (you're naked in public) to being pursued by a murderous psycho. Nightmares don't necessarily always involve crippling fear or anxiety, however. Other common themes are rage, disgust, anger, or anything else that makes a person feel generally lousy. Children most commonly experience nightmares beginning between ages three to six, says Mayo Clinic, but anyone can have them. And there is definitely a point when you may be having too many nightmares and should seek help.

Somewhere between 50% and 85% of adults have nightmares occasionally, says the AASM. This is more common among women, but men can certainly have nightmares, too. Of those, 2% to 8% of people experience sleep problems because of their nightmares, which is a big deal because sleep quality is a major factor in overall health and wellness. If sleep is being consistently disrupted by nightmares, it's likely to throw a person's well-being completely out of whack and will cause trouble at home and at work.

It's difficult to pinpoint an exact threshold for how many nightmares are too many, but if they become overly prevalent (multiple nightmares per week, even per night) it's probably time to consult a doctor for treatment because there could be an emotional or physical cause bubbling under the surface. This is especially true for adults, as nightmares are supposed to lessen in frequency and severity as we age, not the opposite.

Blessedly for those of us who cherish our zzz's, true nightmare disorder is a pretty rare phenomenon. Severe nightmare disorder is characterized by nightmares every night, while moderate disorder sufferers have them once or more per week. 

Then, of course, there's the duration of the problem. People with chronic nightmare disorder experience it for six months or more, which is a living nightmare in itself. Acute nightmare disorder is characterized by bad dreams for one month or less, while subacute nightmare disorder splits the difference between the two. It's not enough to have nightmares to be diagnosed with the disorder, though. People with true nightmare disorder experience sleep disruptions as a result (can't get to sleep at night in fear or get back to sleep after a nightmare), experience emotional distress because of the nightmares, and/or have trouble functioning during the day because of subpar sleep quality.

Most people know that rapid eye movement (REM) sleep is critical to health. Lack of quality REM sleep is associated with the inability to focus, crankiness, and generally lower quality of life. Unfortunately, nightmares usually happen during REM sleep, which is why people often remember nightmares and not the other useless stuff they dream about the rest of the night.

Excessive nightmares can also be symptomatic of bigger underlying problems. People who have frequent nightmares are more likely to suffer from anxiety or depression, for example. Left unchecked, both of these can quickly spiral and cause major problems. Nightmares can also exacerbate these problems by ramping up fear and anxiety, spilling over into the daytime. Other mental health issues that could be triggering the nightmares include bipolar disorder, post-traumatic stress disorder (PTSD), and schizophrenia. Then, there are physical health concerns, such as sleep apnea or even certain medications, which can cause more frequent nightmares.

Most health concerns have some sort of home assessment that can be done easily enough to determine if a visit to the doctor is warranted — nightmares are no exception. First, start to track how often these nightmares occur. Keep a sleep journal next to your bed, and every morning note if you had any nightmares, and if so, how many? Add notes as to the theme/content of the nightmares, and if they were scary, anxiety-riddled, or rage-filled. Note whether or not you were able to get back to sleep quickly, as well as what time of night the dream occurred if you know.

It also doesn't hurt to reflect on the events of the previous day when a nightmare has occurred. Did you watch a particularly disturbing show on television? Have an argument with a loved one? Stress over finances or something else? Any of these could contribute to disturbed sleep every once in a while. If the nightmares are happening frequently and haphazardly, however, it could be time to consult a professional.

If you're not ready to seek professional help yet, there are plenty of things to try at home to minimize nightmare impact. Improve your sleep hygiene by avoiding substances late in the day that are known to disrupt sleep, like alcohol, cigarettes, and caffeine. Also, establish some healthy habits that will let your body know when it's time to get and stay asleep. For example, wake up and go to bed at the same time, no matter what day of the week it is. Also, get some sort of exercise at least a few hours before bedtime.

The atmosphere in which you sleep is also critical to quality. Many people stare at phones or television screens until the moment they close their eyes, but this can actually keep you awake. Also, the room's temperature should be comfortable, and devoid of bright lights. A calming activity like reading a book or taking a warm bath before bed will also help to facilitate the process, improving the process of getting to sleep and the quality of the REM cycle.

If your best efforts have failed to get nightmares under control it's likely time to seek professional help. Take your sleep diary to the first appointment to help the physician or therapist get a clear picture of the frequency and severity of your nightmares. Also, make sure to have a list of all of your medications, medical history, and any other problematic symptoms that could be related. The doctor may end up diagnosing you with some type of sleep or mental health disorder, treatable with a combination of medication and therapy.

A full sleep study may be required to make a diagnosis. Among other things, the sleep study could diagnose sleep apnea, which most people refer to as snoring. Sleep apnea is related to nightmares because the former causes the body to be periodically deprived of oxygen — this upsets the body, which stresses out the brain, leading to terrifying or anxiety-filled dreams. Often, solving the sleep apnea issue will resolve excessive nightmares.

If the underlying cause of nightmares is determined to not be something medical, the next step is to seek some sort of behavioral therapy to correct the issue. A lot of people balk at the idea of therapy, but frequent nightmares are symptomatic that something else is going on, and can often be effectively treated by a licensed professional.

First, the therapist will work to identify the potential causes of the nightmares. Sometimes this is pretty obvious, as in cases where a patient has PTSD from a specific event. Other times, it takes a little more digging to figure it out. Once identified, the therapist can help the patient work through the feelings so that they're not bubbling up in the overnight hours. Many therapists also teach people to manage their stress better. This can lower anxiety, helping sleep to be a more seamless process.

Occasionally, nightmares are about a specific fear. Some therapists will practice systematic desensitization, which exposes the person to their fear in gradual steps. So, the person who's having recurring nightmares about growling dogs might be exposed to pictures, then videos, then actual dogs until they can become more comfortable around canines. This is all done while practicing helpful relaxation techniques.

Or, the therapist can walk the patient through alternative endings to their dreams. Known as "imagery rehearsal therapy," this method seeks to reprogram the bad dreams, rather than wipe them out altogether. The patient writes down the details of the nightmare, then rewrites the ending to give it a more positive spin. The patient is then directed to act out the alternate ending (verbally or in their mind) before bedtime. This reprogramming has been shown to be effective in lessening the severity of nightmares, as well as how often they happen. A dream come true, indeed!