Medicines for Nightmares

What it is

Nightmares are frightening or distressing dreams that usually wake the person, who often remembers the dream and may feel scared, anxious or upset on waking. They happen during the dreaming (REM) stage of sleep, typically in the later part of the night. Nightmares are very common, especially in children (in whom they often peak in the preschool and early school years), and most children have them from time to time as a normal part of development; adults have them too. They are different from night terrors, where a child appears terrified but is still asleep, does not fully wake, and has no memory of it. Occasional nightmares are harmless. However, frequent or recurrent nightmares can sometimes be linked to stress or anxiety, a frightening experience, being overtired, illness or fever, certain medicines, or, in some people, a difficult event or trauma (recurrent nightmares are a feature of post-traumatic stress). When nightmares are frequent and distressing enough to affect sleep and daytime wellbeing, they are worth addressing.

How it is treated

Occasional nightmares need no specific treatment beyond comfort and reassurance. For a child having a nightmare, comforting and reassuring them, and helping them feel safe, is the main response, and they usually settle back to sleep. To reduce frequent nightmares, helpful measures include good sleep habits (a calm, consistent bedtime routine, enough sleep, and avoiding frightening books, films or screens before bed), reducing daytime stress and worries, and talking about any fears in the daytime. A comforting bedtime environment and reassurance help children feel secure. Where nightmares are frequent, persistent, and distressing enough to affect sleep and daytime life, or where they follow a distressing or traumatic event, further support is helpful — a GP can advise, and specific psychological approaches (such as techniques to rework distressing recurring dreams, and treatment for any underlying anxiety or post-traumatic stress) can be effective. Reviewing any medicine that might contribute is also worthwhile. The reassuring message is that nightmares are common and usually harmless, and frequent or distressing nightmares can be helped by good sleep habits, addressing stress, and, where needed, specific support.