Sleep is meant to be restful and restorative. PTSD nightmares can make it terrifying and exhausting. Around 80% of people with PTSD struggle with nightmares, according to some research.

PTSD nightmares are different than your run-of-the-mill bad dreams. They’re intrusive and cause severe anxiety. PTSD nightmares interfere with daytime functioning and may occur several times a week. The clinical diagnosis for this condition is nightmare disorder or dream anxiety disorder. While research is still relatively new, there are many promising PTSD nightmare treatments.

Types of PTSD Nightmare Treatments

Some PTSD nightmare treatments draw on the same approaches used to treat trauma. They address the underlying issues behind PTSD. Getting to the root causes of symptoms often causes the nightmares to stop or become less frequent. Other PTSD nightmare treatments are more symptom-focused. A combination of both approaches is ideal.

Common PTSD nightmare treatments include:

Cognitive Behavioral Therapy (CBT) / Imagery Rehearsal Therapy (IRT)

People with trauma often develop strong associations and responses to situations that trigger PTSD. Cognitive behavioral therapy helps change these associations and responses. Cognitive behavioral therapy encourages you to explore the relationship between your thoughts, emotions and behaviors. You learn to recognize unhealthy thoughts and beliefs and replace them with productive ones.

A cognitive behavioral approach called imagery rehearsal therapy (IRT) is a PTSD nightmare treatment that research shows can reduce PTSD nighttime symptoms. It’s especially effective when combined with CBT. This nightmare-focused therapy encourages you to discuss the traumatic event, nightmares and reminders that trigger PTSD symptoms. You change the storyline by rehearsing a different outcome in your mind. The therapist makes sure this takes place in a safe, controlled environment in a way that doesn’t re-traumatize you. The goal of IRT is to build self-confidence and a sense of safety and control.

Eye Movement Desensitization and Reprocessing (EMDR)

EMDR uses bilateral stimulation of your eyes to work through internal associations with trauma. EMDR works on the same biological processes as rapid eye movement (REM) sleep. There are several phases of EMDR treatment. An EMDR therapist will usually have you track a light or their hand as it moves back and forth. They may have you recall the traumatic memory or a related situation. EMDR can help you process the memory and transform it in a way that it loosens its hold on you. It can help you have healthier thoughts and beliefs around the event.

Sleep Dynamic Therapy (SDT)

Sleep dynamic therapy focuses on the physical and psychological factors contributing to poor sleep quality. SDT specialists help you understand why you’re experiencing poor sleep quality. They help you see the importance of making necessary changes to correct this. Sleep dynamic theory doesn’t have a specific set of treatment protocols. It’s a very personalized approach to treating nightmare disorders. The SDT professional may prescribe a number of different treatments or practices based on your medical and emotional needs.

Hypnosis

Even if you don’t get “hypnotized,” hypnosis can lead to an extremely relaxed state conducive to sleep. A trained hypnotist can help you put aside ruminations that are interrupting sleep. Hypnosis techniques that may help you sleep and reduce nightmares include:

  • Guided imagery
  • Focused attention
  • Symptom control

For many people hypnotherapy is most beneficial in combination with other approaches like cognitive behavioral therapy.

Medication

Sometimes medications are helpful PTSD nightmare treatments. Medications are most effective in combination with behavioral therapy. Prazosin is a drug originally prescribed for high blood pressure. It’s been shown to have “off-label” benefits for PTSD related nightmares. Clinicians may prescribe some of the following medications for PTSD nightmare treatment, though there is less data to back up their effectiveness:

  • Tricyclic antidepressants
  • Clonidine
  • Topiramate
  • Phenelzine
  • Trazodone
  • Cyproheptadine
  • Gabapentin
  • Low dose cortisol
  • Fluvoxamine
  • Atypical antipsychotics
  • Nitrazepam
  • Triazolam

Exposure, Relaxation and Rescripting Therapy (ERRT)

ERRT typically takes place over 3-5 sessions. It draws on cognitive behavioral approaches to help alleviate nightmares. ERRT usually involves:

  • Educating you about trauma and how it feeds nightmares
  • Teaching you how to modify sleep habits and improve sleep hygiene
  • Training you on relaxation techniques
  • Having you talk and write about the nightmare
  • “Rewriting” the nightmare in a way that feels empowering and safe
  • “Rehearsing” the revised dream each night before bed

Moving Beyond PTSD Nightmares

PTSD nightmares are part of a bigger problem. They’re symptoms of PTSD. Left untreated, PTSD can also lead to symptoms like substance abuse, mental health disorders and medical issues. Addressing the root causes of trauma can help alleviate these intrusive PTSD symptoms. The good news is that research shows it’s possible to experience long-term PTSD symptom reduction with the appropriate treatment.

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Krisi Herron

Medically Reviewed by

Krisi Herron, LCDC

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