Should You Interrupt Someone’s Nightmare?

September 3, 2012
Daily Health News
Barry Krakow, MD

A friend recently told me that her husband has nightmares several times a week, during which he tosses and turns with a look of concern on his face.

Her dilemma: Should she wake him from these disturbing dreams or let them run their course? And does he need to see a sleep specialist and/or a mental health professional?

To get some guidance for my friend, I called Barry Krakow, MD, founder and medical director of Maimonides International Nightmare Treatment Center in Albuquerque, New Mexico.


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About half of all adults have occasional nightmares—unpleasant dreams that cause strong negative responses, such as fear, horror, anxiety or sadness, said Dr. Krakow. Why? Nightmares often help dreamers understand upsetting events of the day and their emotional responses to them. Therefore, occasional nightmares are usually healthy, according to Dr. Krakow.

But sometimes nightmares can be unhealthy. And when they become unhealthy, you may need to wake the sleeper and/or refer him or her to a sleep specialist and/or a mental health professional. To learn how to tell the difference, here’s the first question to ask yourself…


In most cases, said Dr. Krakow, a nightmare is mild, and in that situation, it’s best not to wake the person who is having the nightmare. For example, if the person is simply tossing and turning, looking concerned and/or whispering to himself, leave him be. But nightmares vary in intensity. The only time it’s worth waking someone up, he said, is when the nightmare appears to be severe. For instance, if he’s thrashing about violently, some gentle words and a nudge to wake him are in order because you don’t want him to injure himself (or you).

To figure out whether you should encourage the person to see a sleep specialist and/or a mental health professional, you need to ask yourself a second question…


Most people who have nightmares get them only occasionally—once every few months or less—which is nothing to be concerned about, according to Dr. Krakow. But up to 8% of all adults develop chronic nightmares, having them several times a week, which, of course, is more troublesome. Chronic nightmares can interfere with the amount of sleep that a person gets, so anyone with chronic nightmares—whether the nightmares are mild or severe—should see a sleep specialist and/or a mental health professional.

It may prove to be particularly important to see both types of experts because chronic nightmares can sometimes signal a more serious problem, such as sleep apnea or post-traumatic stress disorder (PTSD).


When treatments for sleep apnea and/or PTSD don’t do the trick, or if neither sleep apnea nor PTSD is the cause of the chronic nightmares, Dr. Krakow and his colleagues offer patients a cognitive behavioral treatment called imagery rehearsal therapy (IRT), which has been shown in research to stop chronic nightmares in up to 70% of sufferers.

IRT involves three to five group or individual sessions over the course of a few weeks in which the patient talks through his recurring dream with a counselor (and sometimes with other patients) or writes it down…and then creates a “script” for a positive “new dream.” The patient then “rehearses” this new dream on his own three or four times each day by reading the “script” aloud. After a few weeks, nightmares tend to dissipate.

To find an IRT therapist near you, look for a behavioral medicine specialist at a sleep center in your area by searching www.SleepCenters.org and ask if he or she can teach you IRT. Most insurance plans will cover IRT, said Dr. Krakow. For self-instruction, Dr. Krakow offers a four-hour IRT educational CD called Turning Nightmares into Dreams. It contains therapeutic instructions divided into 20 sessions and a study workbook. It costs $70, and there is a digital version of the material available for $40. For more information, click here.