Tips On Managing Nightmares

Tips On Managing Nightmares - With Love from Dr. G

Now, onto Nightmares! It may surprise some of you to know that treatment can actually target nightmares even though we are asleep when they occur. There is no argument about how distressing nightmares are, and how seriously they can impact our quality of sleep as well as life during the day. It is very common to experience nightmares following a traumatic life event (like the Las Vegas Massacre at Route 91), but nightmares can also occur and persist simply as a result of increased chronic anxiety not necessarily related to trauma. 

One effective treatment we have in our field to treat nightmares is called Imagery Rehearsal Therapy (IRT), and it has been used for years with veterans with PTSD, as well as victims of crime or sexual assault. This treatment is intended for either individual or group therapy settings, but here are some basics that may help you out (or you can talk to your current therapist about to see if they are familiar with this treatment).  Please note this document presents a significantly abbreviated summary of the treatment with a lot of important details omitted. If you are currently attending the San Diego Route 91 weekly meetings, we will be discussing this in our in-person session today as well as reviewing previous material shared. 

Basic facts about Nightmares: 

• Nightmares most often occur during our REM (rapid eye movement) stage of sleep (because this is the stage in which we do most of our dreaming anyway)

• Alcohol negatively impacts our normal sleep cycle and increases REM in the second half of the night

• Alcohol increases our chances for nightmares and increases the chances of our remembering them

• There is a negative feedback loop between chronic pain and poor sleep

• Nightmares can wake us up (sleep fragmentation), stress us out (due to the physiological arousal) making it hard to fall back asleep, and may lead us to avoid going to bed at night 

• Events that happen during the day, things we think about before we sleep, anxiety provoking reports on media/news, or other triggers (sounds, smells, sights) sometimes end up in our dreams/nightmares

• Nightmares can become an “unconscious” HABIT (what this means is that your nightmares can take on a life of their own if we do not intervene!!! …what this means is that your nightmares may at some point no longer be occurring because of the traumatic event, which has long passed, but only because it has become an unhealthy habit)

• Nightmares are changeable

So what does Imagery Rehearsal have to do with all of this?  Well, this technique refers to the powerful tool of visualization. This strategy will help us take charge over our nightmare. Essentially, you will “rewrite” your nightmare into a less upsetting dream. Then you will practice imagining the new dream over and over again to create a new habit. 


Choose a nightmare you have that is your worst and most frequent.

Think about the most upsetting part of that nightmare. 

Write the nightmare out in detail, but change the ending.

Rehearse this “new” nightmare (with the alternate ending) DAILY. 

Sleep well and be well.