Are Nightmares Always a Sign of Trauma?
A common assumption is that nightmares are always caused by trauma. And while it's true that the two are pretty strongly correlated, distressing events are certainly not the only explanation. But here's what's even more important to know: We don't have to determine the cause to solve the problem. However they started, the remedy is largely the same.
That may surprise you, especially if you've spent years trying to figure out what your nightmares mean. Many people think they have to "get to the root of it" before they can address it. My perspective as a CBT therapist is a little different. We can get right to the solution without getting too much in the weeds.
Yes, Trauma Can Cause Nightmares
Let's establish something first. Trauma is one of the leading causes of chronic nightmares. Nightmares are a symptom of PTSD, and they can stick around even after the rest of the PTSD has improved. But that's only part of the picture.
Trauma Isn't the Only Cause of Nightmares
Nightmares can develop for many reasons, including:
without any identifiable trigger (idiopathic nightmare disorder)
as a medication side effect
as part of narcolepsy
in people with untreated obstructive sleep apnea
during periods of significant stress
when your emotional state at bedtime influences the content of your dreams
My philosophy as a sleep specialist is to consider multiple possible explanations before assuming it must be trauma. I try to stay curious before drawing conclusions.
The Story That Changed How I Think About This
When I completed my advanced CBT-I training, one of the instructors shared a case example that will probably stay with me for the rest of my career—if not my life.
A woman sought help for frequent nightmares. She repeatedly told her therapist she had no history of trauma. The therapist became convinced she must have repressed memories of childhood abuse and eventually referred her to a support group for incest survivors, which the woman attended for some time. Ultimately, it was discovered that the nightmares were actually a medication side effect. She stopped the medication, and the nightmares went away.
I think of that story as a cautionary tale about becoming too attached to one explanation while overlooking other possibilities. When we become too attached to one theory, we stop asking good questions. Trauma absolutely causes nightmares. But trauma isn't the only explanation. Sometimes the simplest explanation turns out to be the correct one.
Why I Don't Spend Much Time Interpreting Dreams
People sometimes ask me what their nightmares mean. My answer is usually a little different than they expect. Personally, I don't believe there's much evidence that every nightmare has one hidden, symbolic meaning waiting to be discovered.
Experts haven't reached a consensus about why humans dream, but I'll share my thoughts on the matter. Nightmares often reflect stress. They may also be part of the brain's attempt to make sense of something difficult. Ultimately, I think our brains simply combine whatever ingredients happen to be available—memories, emotions, worries, experiences—and turn them into a story because human brains naturally look for patterns and narratives. Think of it like making soup with whatever happens to be in your kitchen.
Could we speculate about what a nightmare means? Sure. But I couldn't confidently tell you that one particular interpretation is the correct one.
More importantly, we don't need to know exactly why a nightmare started to help it stop. Whether your nightmare began because of trauma, stress, medication, or something we never fully identify, the behavioral treatment is remarkably similar. That's where I prefer to spend our time.
What If My Nightmares Are Trauma-Related?
People with trauma-related nightmares usually come to me in one of two situations.
The first is after they've completed trauma treatment, and the nightmares are the one symptom that stuck around. That can happen. So we target the nightmares directly.
The second is when someone doesn't feel ready to plunge into trauma treatment but still wants some symptom relief. In that case, we can address just the nightmares and eliminate at least one significant source of distress.
For many people, getting better sleep first actually makes the rest of therapy feel more manageable.
We Don't Have to Solve the Mystery to Solve the Problem
One of the things I appreciate most about CBT is that it's practical. We don't always have to know exactly how a problem started to know how to help it. If someone develops insomnia after a stressful divorce, we don't need to keep revisiting the divorce for the insomnia to improve. We focus on the behaviors that are keeping the insomnia going now. I think nightmares often work the same way.
Understanding how the nightmare started can certainly be interesting. But understanding what's keeping it going is often more useful. That's where treatment can make a real difference.
The Good News
Whether your nightmares started because of trauma, stress, medication, a sleep disorder, or something you'll never fully identify…they don't have to stay. Nightmares are learned patterns. And learned patterns can change. The brain learned something. The brain can learn something different.
If you'd like to learn more about how behavioral treatment for nightmares works, you can read my article, Nightmare Treatment: Why You Don't Have to Live With Chronic Nightmares.
If you've been wondering why you keep having the same nightmare over and over, I also wrote about why recurring nightmares become habits—and why that's actually one of the reasons they're so treatable.
You Don't Have to Keep Searching for the Perfect Explanation
If you've spent years wondering whether your nightmares are trying to tell you something, I hope this article gives you permission to ask a different question.
Instead of asking:
"What does this nightmare mean?"
Try asking:
"What would help it stop?"
The answer to the second question gives us the path out.
If recurring nightmares are disrupting your sleep or making you dread bedtime, I’d love for you to learn more about how I work with nightmares. Nightmare disorder is highly treatable, and you don't have to keep living with it.
About the Author
Jessica Fink, LCSW-S, is a therapist in private practice in Austin, Texas. She has 19 years of experience in the mental health field and has previously worked with trauma, perfectionism, OCD, and chronic pain. She now heavily specializes in sleep disorders, including nightmares. She has training in Cognitive Behavioral Therapy for Nightmares, a new, evidence-based treatment for chronic nightmares.