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    Nightmares and nightmare disorder

    噩梦与噩梦障碍

    Clinical diagnosis
    Also called
    nightmare disorder, nightmares, dream anxiety disorder, frequent nightmares, imagery rehearsal therapy, IRT

    When do nightmares become nightmare disorder?

    A nightmare is an extended, deeply distressing dream, well remembered on waking, that usually involves threats to survival, safety or the body.[1] Nightmare disorder applies only when nightmares keep recurring, cause marked distress or disrupt daily life, and are not better explained by a drug or another condition.[1][2]

    Often confused with

    All three must apply

    Schematic, not a self-test.

    Select a box for details.
    Schematic: a nightmare problem may count as nightmare disorder only when all three conditions in the middle are met, and only a professional can make that call. The dashed boxes at the top are night terrors and sleep paralysis, often confused with nightmares; below are the severity levels and the recommended treatment. Select a part for details. Select a part for details
    Schematic: a nightmare problem may count as nightmare disorder only when all three conditions in the middle are met, and only a professional can make that call. The dashed boxes at the top are night terrors and sleep paralysis, often confused with nightmares; below are the severity levels and the recommended treatment. Select a part for details. Save as image (PNG)

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    Key points

    • A person waking from a nightmare is soon fully alert and remembers it; someone in a night terror is hard to rouse and recalls little. Nightmares are often mistaken for sleep paralysis.[1][2]
    • Among 8,558 Hong Kong adults, 5.1% had nightmares at least weekly, women more often than men.[3] The American Academy of Sleep Medicine (AASM) puts nightmare disorder at about 4% of adults.[4]
    • In 2018 the AASM recommended only imagery rehearsal: rewriting the nightmare while awake and rehearsing it 10 to 20 minutes a day. Others, such as lucid dreaming therapy, “may be used.”[4]
    • A meta-analysis of imagery rehearsal and related therapies found large pre–post drops in nightmares (g = 1.04).[1] In a trial of 124 Vietnam veterans, imagery rehearsal did no better than a control.[4]

    An example

    After starting a new job, Ms. Wang dreams on several nights that she is trapped in a burning building. She wakes with her heart racing but knows at once where she is and recalls every detail. Whether to seek help depends on whether the nightmares persist and leave her low, tired by day or afraid to sleep.[4]

    Misreadings and limits

    An occasional nightmare, or even a spell of frequent ones, is not nightmare disorder. A diagnosis takes a professional weighing distress, daytime effects and other conditions, not a checklist.[1][2] The opposite mistake is common too: recurring nightmares are often dismissed as a side symptom of something else, though they can be treated in their own right.[1]

    If you need help now

    If you’re struggling to cope or having thoughts of harming yourself:

    If you’re in immediate danger, call your local emergency number.

    Psyfield is not a crisis service. Numbers checked October 2026.

    Sources

    1. 1 Gieselmann, A., Ait Aoudia, M., Carr, M., Germain, A., Gorzka, R., Holzinger, B., Kleim, B., Krakow, B., Kunze, A. E., Lancee, J., Nadorff, M. R., Nielsen, T., Riemann, D., Sandahl, H., Schlarb, A. A., Schmid, C., Schredl, M., Spoormaker, V. I., Steil, R., … Pietrowsky, R. (2019). Aetiology and treatment of nightmare disorder: State of the art and future perspectives. Journal of Sleep Research, 28(4), e12820. doi:10.1111/jsr.12820
    2. 2 World Health Organization (2025). 7B01.2 Nightmare disorder. ICD-11 for mortality and morbidity statistics (2025-01 release). View source
    3. 3 Li, S. X., Zhang, B., Li, A. M., & Wing, Y. K. (2010). Prevalence and correlates of frequent nightmares: A community-based 2-phase study. Sleep, 33(6), 774–780. doi:10.1093/sleep/33.6.774
    4. 4 Morgenthaler, T. I., Auerbach, S., Casey, K. R., Kristo, D., Maganti, R., Ramar, K., Zak, R., & Kartje, R. (2018). Position paper for the treatment of nightmare disorder in adults: An American Academy of Sleep Medicine position paper. Journal of Clinical Sleep Medicine, 14(6), 1041–1055. doi:10.5664/jcsm.7178

    Last checked against sources: October 27, 2026