Recurring Nightmares: Three Questions About Imagery Rehearsal Therapy

If you have begun delaying bedtime because you dread another nightmare, write that down for the appointment. You can start with what happens to your nights and mornings; you do not need a polished explanation of the dream.

1. Does my description fit the problem this therapy treats?

Nightmares are frightening dreams you wake from and remember. Night terrors differ: someone may move or talk while still asleep and usually will not recall the episode. Tell the clinician what you remember and what a bed partner has observed.¹

The NHS¹ explains that treatment depends on possible causes, which can include medicines, mental health conditions or other sleep conditions. Bring your medicine list and mention any upsetting event you think is relevant. Ask what else needs assessment before choosing a nightmare-focused treatment.¹

2. What would I rehearse while awake?

The AASM describes imagery rehearsal therapy as changing a nightmare into a new version with positive images, then practicing that rewritten scenario while awake. Ask the therapist to explain how they would help you choose and change the dream, and what practice would look like between visits.³

The AASM’s 2018 position paper recommends this therapy for adult nightmare disorder and nightmares associated with post-traumatic stress disorder. It places several other treatments in a less certain category. That recommendation supports a treatment conversation; it does not promise that every person’s nightmares will disappear.²

3. How will we review whether the plan is helping?

A diary can include sleep duration, how long falling asleep takes and how you feel the next day. The NHS¹ recommends this as a way to help identify possible causes. Bring it to the appointment and agree which observations you should keep recording.¹

Ask when you will review the plan and who to contact if you struggle with the practice. The AASM paper says care decisions depend on the individual’s circumstances, available options and resources. Discuss access, cost and support before agreeing to a schedule you cannot manage.²

Did I Do That in My Sleep? includes a 14-Night Lights-Out Record and a Visit Brief. Use them to organize observations and appointment questions alongside your clinician’s treatment plan. See the book.