From the Guidelines
Relationship Between Nightmares and Insomnia
Nightmares are closely linked to insomnia, as they can significantly disrupt sleep patterns and contribute to the development of insomnia symptoms.
- The presence of nightmares can lead to sleep avoidance and deprivation, as individuals may fear falling asleep due to the distressing nature of their nightmares 1.
- Nightmare disorder is associated with psychopathology, such as depression and anxiety, which can further exacerbate insomnia symptoms 1.
- Cognitive Behavioral Therapy for Insomnia (CBT-I) has been shown to be effective in reducing nightmare frequency and improving sleep quality in individuals with nightmare disorder 1.
- The treatment of nightmares, such as through image rehearsal therapy, can also lead to improvements in insomnia symptoms, including reduced daytime fatigue and sleepiness, and improved sleep quality 1.
- The relationship between nightmares and insomnia is complex, and treatment of one condition can have a positive impact on the other; therefore, a comprehensive treatment approach that addresses both conditions is often necessary 1.
From the Research
Relationship Between Nightmares and Insomnia
The relationship between nightmares and insomnia is complex and bidirectional. Studies have shown that insomnia and nightmares are highly comorbid and can exacerbate each other 2, 3.
- Insomnia can increase the likelihood of experiencing nightmares, and nightmares can in turn lead to sleep loss and nonrestorative sleep 2.
- The mechanisms of their mutual influence are different, with insomnia changing the nature of dreams and frequent recurring unpleasant and frightening dreams increasing the frequency of nocturnal awakenings and worsening the quality of sleep 3.
- Dysfunctional cognitions related to sleep play a major role in both insomnia and nightmares, and are closely related to anxiety 4.
Temporal Dynamics of Nightmare Occurrence and Sleep Architecture
Research has also explored the temporal dynamics of nightmare occurrence and sleep architecture.
- One study found that nightmares were predicted by increased sleep disturbance the night before the nightmare, but not on the same night or 2 nights before 5.
- Another study found that insomnia was specifically related to obsessions, above and beyond that with other obsessive compulsive symptoms 6.
Therapeutic Approaches
The comorbidity of insomnia and nightmares should be taken into account when choosing a therapeutic approach, with priority given to drugs that do not cause nightmares as a side effect, as well as psychotherapy 3.
- Some psychological interventions, such as Imagery Rehearsal Therapy, might be effective in alleviating both nightmares and insomnia symptoms 2.