How to Stop Nightmares: An Imagery Rehearsal Plan
How to stop nightmares has a clearer answer than most sleep questions: imagery rehearsal therapy, in which you rewrite the dream while awake and practice the new version daily. It is the one therapy the American Academy of Sleep Medicine listed as recommended for nightmare disorder in its 2018 position paper. This worksheet builds your rehearsal script, the sleep rules around it, and a review date.
Reviewed byMichael Callans, MSWRelated tools & tests
Nightmares most weeks?
A therapist who works with sleep can run imagery rehearsal with you and look at what is feeding the dreams. Free to search our directory.
Therapists Who Work With Sleep and insomnia
A worksheet is a start. These licensed therapists work with the same problem; every member is matched to the federal NPI Registry and board checks are dated on the profile.
-
View profile
Dr. Greggy LubinAPRN
License verified, checked Oct 6, 2026
“Personalized telehealth psychiatric care for adults with ADHD, anxiety, depression, burnout, PTSD, insomnia, and complex medication needs.”
Virginia Telehealth $295 to $995 per session
-
View profile
Dr. Shay BurnsPsyD
License verified, checked Oct 23, 2026
Houma, Louisiana Telehealth and in person $50 to $225 per session
-
View profile
License verified, checked Oct 26, 2026
“To start, I listen carefully to what brings you to therapy, your goals, your efforts to alleviate the issue(s), and why your efforts have failed.”
West Orange, New Jersey Telehealth $325 per session
About this tool
How to stop nightmares is one of the few questions in this part of psychology with a specific, well-tested answer: imagery rehearsal therapy. You write the recurring dream down once, change it from a chosen moment onward, and then rehearse the new version while awake for a few minutes a day. Barry Krakow and Antonio Zadra set out the clinical version in 2006 as roughly four sessions of two hours, and the central idea is that a chronic nightmare behaves like a learned habit of imagery rather than only a symptom to wait out. That reframing is what makes a self-directed plan reasonable.
It helps to be precise about what a nightmare is. In sleep medicine it means a vivid, disturbing dream that wakes you and that you can recall, most often arising from REM sleep and therefore concentrated in the second half of the night. That distinguishes it from a night terror, where the sleeper may scream or thrash with no dream recall at all, and from the dread of lying awake. Nightmare disorder is the label for recurrent nightmares that cause distress or interfere with daytime functioning, sleep, mood or work. A bad dream after a hard week is not that.
Frequent nightmares are more common in adults than most people assume. Sandman and colleagues summarize the survey literature at roughly two to six percent of adults reporting one or more a week, with around thirty-five to forty-five percent reporting at least one a month. In their own large Finnish population study they found frequent nightmares in 3.5 percent of men and 4.8 percent of women, and reports of occasional nightmares rose by about twenty percent between 1972 and 2007. So the experience is ordinary; the version that wakes you several nights a week is not, and it is treatable.
Why do I keep having nightmares is usually answered by a short list. In the Finnish data the strongest associations were with insomnia and with depressive symptoms, which is worth knowing because treating the insomnia often reduces the nightmares. Alcohol in the evening is a common contributor: it suppresses REM sleep early in the night and the rebound in the second half can be vivid and unpleasant. Stress, a recent loss, irregular sleep timing, fever, late heavy meals and sleep deprivation all raise the odds, and so does the night after a short night.
Medication deserves its own line. Several drug classes are associated with vivid dreams or nightmares, including some blood pressure medications, some antidepressants, some drugs used for smoking cessation, and withdrawal from agents that suppress REM sleep. If nightmares started or worsened within weeks of a new prescription or a dose change, write down the dates and ask your prescriber. Do not stop or reduce a prescribed medication on your own: abrupt withdrawal can make dreaming worse and can carry other risks. The timing note you make in the worksheet is exactly what a prescriber needs.
Two different pictures lead here. One is nightmare disorder on its own, where the dreams are the main problem. The other is post-traumatic nightmares, where the dream replays or echoes something that actually happened and sits alongside intrusive memories, hypervigilance and avoidance. Imagery rehearsal has evidence in both, but the second picture usually needs trauma-focused treatment around it rather than a sleep plan alone. The PTSD Test (Post-Traumatic Stress Disorder) screen and the Insomnia Test (ISI) screen are structured ways to organize what you are noticing before a first appointment, not diagnoses.
The evidence is unusually tidy for a self-help topic. The American Academy of Sleep Medicine's 2018 position paper, led by Timothy Morgenthaler, reviewed the literature and listed image rehearsal therapy as the one therapy recommended for both post-traumatic nightmares and nightmare disorder, drawing on nine randomized controlled trials covering more than 900 participants in all. The best known of those is Krakow and colleagues' 2001 trial in JAMA, which randomized 168 women with chronic nightmares after sexual assault and found reductions in nightmare frequency and in symptom severity. Cognitive behavioral therapy, hypnosis and several medications fell into a weaker may-be-used category, and two drugs, clonazepam and venlafaxine, were listed as not recommended.
The limits are real and the task force said so. Most trials are small, few compare treatments head to head, and the clearest effects are on how often nightmares happen and how much distress they cause rather than on every outcome measured. Rehearsal does not work for everyone, and a reduction rather than an end to nightmares is a common result. Expect to practice for two to four weeks before judging it, and expect the dream to show up again during stressful stretches. That is a cue to return to the rehearsal, not evidence that it failed.
Doing it yourself follows the same sequence. Write the nightmare once, briefly, and stop before the worst moment if writing it is distressing. Then pick the point where you want it to go differently and change everything from there, which is the part people get wrong: the aim is a version you would be willing to watch, not a heroic battle won. Rehearse only the new version, for five to ten minutes, in the daytime rather than as you fall asleep, with your eyes closed and in enough sensory detail to hold your attention. Never rehearse the original.
Put the sleep basics around it, because rehearsal works better on a regular schedule. A fixed wake time every day, alcohol kept well away from bedtime, the last big meal a few hours earlier, a dark cool room, and a plan for what to do at three in the morning other than lying there replaying the dream. The Sleep Hygiene Checklist covers the factors worth changing, and the Sleep Diary gives you two weeks of data, which matters because memory for how often nightmares happen is unreliable in both directions.
Lucid dreaming gets recommended widely online and the evidence for it is thin. The main controlled study, by Spoormaker and van den Bout in 2006, randomized 23 people with chronic nightmares to individual lucid dreaming treatment, a group version, or a waiting list; nightmare frequency fell in the treatment groups, while sleep quality and post-traumatic stress severity did not change significantly. The authors could not say which part did the work, and some participants improved without becoming lucid at all. Treat it as an interesting lead with small, inconsistent trials behind it rather than a first choice.
Some things on this page are not the right tool. If a bed partner reports that you act out dreams physically, punching, kicking or leaving the bed, that pattern needs assessment by a sleep physician rather than a rewriting exercise. If nightmares began after a trauma and bring intrusive daytime memories with them, a trauma-focused therapist should hold the plan. And if dread of sleep itself has crept in, so that nights get shortened to avoid dreaming, the avoidance will make everything worse and is a good reason to get help sooner rather than after another month of practice.
References
- Krakow B, Zadra A. Clinical management of chronic nightmares: imagery rehearsal therapy. Behavioral Sleep Medicine. 2006;4(1):45-70. https://doi.org/10.1207/s15402010bsm0401_4
- Morgenthaler TI, Auerbach S, Casey KR, et al. Position paper for the treatment of nightmare disorder in adults: an American Academy of Sleep Medicine position paper. Journal of Clinical Sleep Medicine. 2018;14(6):1041-1055. https://doi.org/10.5664/jcsm.7178
- Krakow B, Hollifield M, Johnston L, et al. Imagery rehearsal therapy for chronic nightmares in sexual assault survivors with posttraumatic stress disorder: a randomized controlled trial. JAMA. 2001;286(5):537-545. https://doi.org/10.1001/jama.286.5.537
- Sandman N, Valli K, Kronholm E, et al. Nightmares: prevalence among the Finnish general adult population and war veterans during 1972-2007. Sleep. 2013;36(7):1041-1050. https://doi.org/10.5665/sleep.2806
- Sandman N, Valli K, Kronholm E, et al. Nightmares: risk factors among the Finnish general adult population. Sleep. 2015;38(4):507-514. https://doi.org/10.5665/sleep.4560
- Spoormaker VI, van den Bout J. Lucid dreaming treatment for nightmares: a pilot study. Psychotherapy and Psychosomatics. 2006;75(6):389-394. https://doi.org/10.1159/000095446
- American Academy of Sleep Medicine. International Classification of Sleep Disorders. 3rd ed. American Academy of Sleep Medicine; 2014.
Cite this source
Psychology.com. (2026, November 6). How to Stop Nightmares. Psychology.com. https://psychology.com/tools/how-to-stop-nightmares
How to Stop Nightmares FAQ
How do you stop nightmares fast?
There is no same-night fix for how to stop nightmares, but two things can be done tonight. Keep alcohol away from bedtime, since the rebound in the second half of the night is a common trigger, and write your rehearsal script now so there is something to practice tomorrow. Most people who respond to imagery rehearsal notice a change over two to four weeks of daily practice rather than after one session. If the dreams are nightly and you are starting to avoid sleep, that is a reason to see a clinician this month rather than to practice harder alone.
Why do I keep having the same nightmare?
A repeating nightmare behaves less like a message to decode and more like a rehearsed sequence of imagery that your sleeping brain has gotten good at running. That is the premise behind imagery rehearsal therapy: the dream has become a habit, and habits of imagery can be practiced in a different direction while awake. Repetition is also more common when insomnia, depressive symptoms or unresolved trauma are in the picture, so a recurring dream that has run for months sits alongside those rather than separate from them. Rewriting the sequence addresses the dream; the other pieces usually need their own attention.
Does imagery rehearsal therapy actually work?
It is the best-supported option available. The American Academy of Sleep Medicine's 2018 position paper reviewed nine randomized controlled trials covering more than 900 participants and listed image rehearsal therapy as the only therapy it recommended, for post-traumatic nightmares and for nightmare disorder. The largest well-known trial, published in JAMA in 2001, randomized 168 women with chronic nightmares after sexual assault and found reduced nightmare frequency. The caveats matter too: trials are mostly small, direct comparisons between treatments are rare, and a reduction rather than an end to nightmares is the usual result.
Can alcohol or medication cause nightmares?
Both can. Alcohol suppresses REM sleep in the first part of the night, and the rebound later on is often vivid and unpleasant, which is why an evening of drinking frequently produces a four-in-the-morning nightmare. Several medication classes are also associated with vivid dreaming, including some blood pressure drugs, some antidepressants and some smoking cessation drugs, and withdrawal from agents that suppress REM sleep can do the same. If the dreams started within weeks of a new prescription or a dose change, note the dates and raise it with your prescriber. Never stop or reduce a prescribed medication on your own.
What is the difference between nightmares and night terrors?
Nightmares wake you and you can describe the dream afterward, and they arise mostly from REM sleep, which is concentrated in the second half of the night. Night terrors come out of deep non-REM sleep early in the night, often involve sitting up, shouting or looking terrified while still asleep, and typically leave no dream recall at all, so the sleeper may not remember the episode while someone else in the house certainly does. The distinction matters because imagery rehearsal is built for recalled dreams, while frequent night terrors belong with a sleep physician for assessment.
Is lucid dreaming a good way to stop nightmares?
The evidence is weak rather than absent. The main controlled study, by Spoormaker and van den Bout in 2006, randomized 23 people with chronic nightmares and found that nightmare frequency fell in the lucid dreaming groups compared with a waiting list, while sleep quality and post-traumatic stress severity did not change significantly. The authors noted they could not say whether exposure, mastery or lucidity did the work, and some people improved without ever becoming lucid. Given a small inconsistent literature next to nine trials behind imagery rehearsal, lucid dreaming is a reasonable second experiment, not the first thing to spend a month on.
When should I see someone about nightmares?
Book an appointment when nightmares happen weekly or more and have lasted longer than a month, when they followed a trauma and bring intrusive daytime memories with them, when they are keeping your sleep short enough to affect your work or mood, or when you find yourself putting off bedtime to avoid dreaming. Acting out dreams physically during sleep, reported by a bed partner, needs assessment by a sleep physician rather than a rewriting exercise. Bring the filled-in worksheet and a two-week count: a clinician can do more with dates and frequencies than with a description from memory.