Nightmares & Unusual Sleep Experiences

What happens during the night?

You might recognise one or several of these:

• I wake from a frightening dream and remember it. The same theme may repeat, sometimes leaving me afraid to go back to sleep.
• Someone says I scream or look terrified, but I don’t remember it. My eyes may be open, yet I am not fully awake or responsive.
• I wake up but cannot move or speak for a short time. I may sense a presence, hear something or see a frightening image before I can move again.
• I walk, talk or do things while apparently asleep. I might open doors, move objects or attempt everyday activities and remember little afterwards.
• I seem to act out my dreams. I kick, punch, shout or jump out of bed and may injure myself or somebody nearby.
• I see or hear something vivid as I fall asleep or wake. The experience seems real at the time but disappears when I am fully awake.
• Sleep leaves me frightened or exhausted. I avoid bedtime, dread recurring dreams or wake repeatedly, even when nobody has witnessed unusual behaviour.

The first question: Do you remember a dream, wake confused, or experience something only as sleep begins or ends? If anyone is injured during sleep, seek a sleep-specialist assessment.

What might actually help?

If you repeatedly wake from the same frightening dream

Ask about imagery rehearsal therapy (IRT). With a trained therapist, you change the storyline of a nightmare while awake and practise imagining the new version. The aim is to reduce the fear and recurrence of the dream, without having to replay the most distressing details repeatedly.

What happened in research? In a 2026 study of 39 young people aged 14–25 with complex trauma-related symptoms, four IRT sessions were followed by a reduction from 5.7 to 2.8 nightmares per week. However, there was no comparison group, so the change cannot confidently be attributed to therapy alone (Rolling et al., 2026).

In a 2022 experiment with 36 people, everyone practised IRT. Adding carefully timed sounds during REM sleep further reduced nightmares after two weeks. This does not validate commercial sleep-sound apps (Current Biology, 2022).

Where to go: Ask a psychologist or sleep therapist about imagery rehearsal. The Phoenix Australia manual explains the approach. If rehearsing dream content overwhelms you, use a trained therapist rather than forcing yourself through it.

If the nightmares are linked to trauma

Treat the broader trauma-related distress too. Cognitive processing therapy, prolonged exposure and EMDR have evidence for PTSD, but do not guarantee an end to nightmares.

What about medication? The 2023 US VA/DoD guideline gives prazosin a weak recommendation for PTSD-related nightmares, but suggests against it for PTSD overall. Trials conflict, including a large negative study. It can cause low blood pressure, dizziness or fainting, and requires medical supervision. It is not a treatment for every nightmare (VA/DoD guidance).

The same guideline found insufficient evidence to recommend for or against IRT specifically for PTSD-related nightmares, despite promising findings elsewhere (guideline synopsis).

Where to go: A trauma-informed psychologist, psychiatrist or sleep specialist. The VA National Center for PTSD offers free guidance on trauma-focused therapies and sleep problems. If sleep remains disrupted despite treatment for trauma, ask whether insomnia needs its own treatment.

If a child screams, thrashes or seems terrified without fully waking

This may be a night terror, which is usually different from a remembered nightmare. The child may seem to look at you but be difficult to comfort because they are not fully awake. Night terrors are common in younger children and often become less frequent as they grow.

What may help? Keep the sleeping area safe and reduce sleep deprivation. Stay nearby, but don’t force the child awake. If episodes happen predictably, NHS guidance suggests gently waking them 15 minutes beforehand for two weeks. This has no reliable percentage success rate (NHS guidance).

Where to go: Your child’s doctor if episodes are frequent, worsening, causing injury or disrupting daily life. Discuss possible triggers such as insufficient sleep, sleep-disordered breathing, medication or other illnesses. Repeated unusual episodes in an adult also deserve assessment.

If you wake unable to move—or sense somebody in the room

Sleep paralysis occurs when awareness returns before the temporary immobility of REM sleep ends. Vivid sounds, images or a sensed presence do not necessarily indicate a psychotic illness.

What may help? Reduce sleep deprivation, keep more regular hours and consider avoiding sleeping on your back. There are no strong trials establishing a dependable success rate (NHS guidance).

Where to go: Speak with a clinician if episodes are frequent, create fear of sleep or occur alongside severe daytime sleepiness, sudden sleep attacks or emotion-triggered muscle weakness. Those additional symptoms may indicate a need to assess for a sleep-wake disorder such as narcolepsy.

If you sleepwalk, leave the bed or do things you cannot remember

Make safety the immediate priority. Clear floors, secure dangerous objects, make stairs and windows safer, and consider a discreet door alarm if there is a risk of leaving the house. For children, avoid top bunks. Sleepwalking often happens during deep sleep early in the night and is commonly associated with sleep deprivation or other sleep disturbances.

What may help? Address sleep deprivation, alcohol, medicines, sleep apnoea or other triggers. There is no universal treatment with a reliable percentage benefit for sleepwalking. Most children improve without intensive treatment (NHS guidance).

Where to go: Ask a GP or sleep specialist if sleepwalking has started in adulthood, involves leaving the home, eating or sexual behaviour during sleep, poses a risk of injury, or occurs with daytime exhaustion. A clinician may need to distinguish it from nocturnal seizures or other conditions. Do not assume that a person is fully aware of their actions during a verified sleep episode; seek professional advice about safety and safeguarding where needed.

If you punch, kick or act out vivid dreams

Arrange a medical assessment, particularly if this is new in adulthood. Sometimes a person begins moving forcefully during REM sleep instead of remaining mostly still. This may be REM sleep behaviour disorder (RBD), although other problems—including certain medicines, untreated sleep apnoea and nocturnal seizures—can resemble it.

What may help? Protect both sleepers immediately: move sharp or breakable objects away, pad dangerous furniture and consider separate sleeping spaces until episodes are controlled. A sleep specialist can consider overnight video sleep monitoring and a review of medicines.

The 2023 American Academy of Sleep Medicine guideline conditionally supports specialist use of immediate-release melatonin or clonazepam for selected adults with RBD. “Conditionally” means the evidence and balance of benefits and harms are not strong enough to recommend the same treatment for everyone. Clonazepam may cause sedation, falls and problems for people with sleep apnoea; neither medicine should be started simply because a partner says you move in your sleep (AASM guideline).

RBD beginning in later adulthood can sometimes precede certain neurological conditions. Acting out a dream does not mean you are destined to develop one. Accurate diagnosis and follow-up are more useful than panic.

What about dream apps, lucid dreaming and supplements?

Some people use meditation, relaxation recordings, lucid-dreaming exercises, sleep trackers, smart headbands or supplements to try to change their dreams.

A calming bedtime routine may make sleep more comfortable, but there is not enough good evidence to claim that a generic app, herbal product or sound recording treats recurrent nightmares, sleep paralysis, sleepwalking or RBD. Small laboratory studies using precisely timed stimulation are not validation of consumer devices.

Avoid using alcohol or sedating medicines to suppress frightening nights. They may worsen breathing problems, impair alertness or increase risk during sleep. If an unusual experience continues when you are fully awake, rather than only during sleep transitions, discuss it with a clinician instead of assuming it is sleep paralysis.

Real programmes and resources

• NHS: Night terrors and nightmares — Understand the differences and how to support a child during a night terror.
• NHS: Sleep paralysis — What it feels like, common triggers and when to seek help.
• NHS: Sleepwalking — Practical home safety advice and when specialist assessment is appropriate.
• Phoenix Australia: Imagery rehearsal manual — Clinician-oriented information on nightmare rescripting; a guide, not an available course or therapist directory.
• VA National Center for PTSD — Reliable information on trauma-related nightmares, PTSD treatment and sleep.
• AASM guidance for REM sleep behaviour disorder — Clinical evidence for specialist management of dream enactment.

One thing to do this week

Write down what happened during one unusual night, as soon as you reasonably can. Did you wake and remember a dream? Did someone else witness movement or shouting? Could you move? What time did it happen? Was there an injury, medication change, poor sleep or alcohol involved?

If somebody witnessed the episode, ask for their description. You don’t need to record yourself or buy a sleep tracker. Use that information to choose one next step: discuss recurring nightmares with a therapist, reduce sleep deprivation, make sleepwalking safer, or arrange a sleep-specialist assessment for dream enactment or unexplained episodes.

Seek prompt medical advice if you or somebody else is injured during sleep, you begin acting out dreams, you have possible seizures, or the episodes cause substantial daytime impairment. If you experience severe distress or suicidal thoughts associated with sleep or trauma, seek urgent mental-health support.