When Nightmares Won't Go Away

Nightmare therapy may put chronic nightmares to rest.

From the WebMD Archives


Plagued by Nightmares

Now 29 years old and living in New York City with her husband and 4-month-old son, Levy says she endured years of fractured sleep and persistent anxiety because of chronic nightmares. It never occurred to her that help was available.

"People have nightmares," Levy says. "I had mine, and that was that. I didn't think it was the sort of problem that could be treated."

It's a common misconception.

"Lots of people think that nightmares can't be treated," says Shelby Harris, PsyD, director of the behavioral sleep medicine program at Montefiore Medical Center's Sleep-Wake Disorders Center in New York City. "But there are effective treatments."

Help for Chronic Nightmares

One treatment option is psychodynamic psychotherapy, in which patients meet regularly with a therapist to discuss their nightmares and consider any emotional problems that might be causing them.

Another option is taking prazosin, a medication usually prescribed for high blood pressure; studies have shown that nightly doses of the drug are effective against chronic nightmares in people with posttraumatic stress disorder.

But Levy found relief not in pills or psychotherapy but from a simple behavioral technique she learned from Harris after seeking treatment not for nightmares but for insomnia.

Changing Nightmare Scripts

The technique that Levy used, known as imagery rehearsal therapy (IRT), grew out of research conducted in the 1990s. It's been steadily gaining favor as a treatment for chronic nightmares since 2001 when a landmark study published in the Journal of the American Medical Association found that it not only curbed nightmares among victims of sexual assault but also reduced PTSD symptoms.

"Studies show that 70% to 80% of people who try IRT get significant relief," says Barry Krakow, MD, director of the Maimonides International Nightmare Treatment Center in Albuquerque, N.M. He's one of the researchers who worked on the JAMA study and the author of four books on sleep medicine, including Sound Sleep, Sound Mind.

IRT is surprisingly easy to learn and to use. The basic technique can often be mastered in a few hours; once learned, it's used for only a few minutes a day for a matter of days or weeks.