From the Guidelines
Bad dreams are commonly associated with alcohol withdrawal, as part of the withdrawal syndrome that includes vivid, disturbing dreams or nightmares. These typically occur within 24-72 hours after the last drink and may persist for several days to weeks. The nightmares happen because alcohol suppresses REM sleep (the dream phase of sleep), and when alcohol is removed, the brain experiences REM rebound with intensified dream activity. This is part of the brain's attempt to restore normal sleep architecture after alcohol dependence. Other withdrawal symptoms that often accompany these nightmares include:
- Anxiety
- Tremors
- Sweating
- Increased heart rate
- In severe cases, hallucinations or seizures. For those experiencing alcohol withdrawal, medical supervision is recommended, as severe withdrawal can be dangerous 1. Medications like benzodiazepines (such as diazepam, chlordiazepoxide, or lorazepam) are often prescribed to manage withdrawal symptoms, including sleep disturbances, as they are considered the ‘gold standard’ treatment for AWS, given their efficacy to reduce both withdrawal symptoms and the risk of seizures and/or delirium tremens 1. These medications are typically given on a tapering schedule over 3-7 days. Maintaining hydration, proper nutrition, and avoiding caffeine can also help reduce the intensity of withdrawal symptoms, including bad dreams. It is also important to note that diminished cognitive function due to thiamine deficiency is common in patients with alcohol use disorder, and thiamine should thus be given to all patients with AWS (100-300 mg/day) and maintained for 2-3 months following resolution of their withdrawal symptoms 1.
From the Research
Association Between Bad Dreams and Alcohol Withdrawal
- Bad dreams are a common phenomenon in individuals undergoing alcohol withdrawal, with studies indicating a link between the two 2.
- Research suggests that sleep disturbances, including bad dreams, are prevalent in the early stages of recovery from alcohol dependence and may persist for several months despite continued abstinence 3.
- A study found that patients with alcohol dependency during withdrawal and abstinence reported a more negatively toned subjective dream experience compared to healthy controls 2.
- Another study reported a case of acute REM sleep behavior disorder associated with alcohol withdrawal, characterized by terrifying nightmares and violent behaviors in sleep 4.
Characteristics of Bad Dreams in Alcohol Withdrawal
- Bad dreams in alcohol withdrawal are often described as negatively toned and may involve themes related to alcohol use 2.
- Patients with alcohol dependency may dream significantly more often about alcohol during withdrawal and abstinence 2.
- The frequency and intensity of bad dreams may decrease with continued abstinence, as sleep quality improves 2.
Treatment and Management
- Benzodiazepines have been found to be useful in treating sleep disturbances, including bad dreams, in individuals undergoing alcohol withdrawal 4, 5.
- A symptom-triggered regime, rather than a fixed tapering dose regime, is often favored in the management of alcohol withdrawal syndrome 5.
- Supportive care, including the use of vitamins and addressing co-occurring sleep and affective symptoms, is essential in the management of alcohol withdrawal 5.