Nightmares & PTSD: What Works Now and What’s Emerging

Maša Nobilo, Sleep Coach
Sep 30
6 min read

If you dread bedtime because of recurring nightmares or 3 a.m. adrenaline spikes, you are not alone.

Nightmares are common after stress and trauma, and they can make nights feel unsafe and days feel heavy. The good news is that there are proven, compassionate ways to reduce nightmare frequency and intensity without wrecking your sleep.

In this guide, you will learn what treatments have the strongest evidence right now, what looks promising, and how to try gentle, sleep-friendly steps at home.

If you would like personal guidance at any point, you can book a free discovery call for 1:1 Sleep & Dream Coaching with me. If you prefer community learning, you can join my free online platform where I share prompts, mini-experiments, and support.

What Actually Works for Nightmares (Right Now)

The most evidence-based psychological treatment for frequent nightmares is Imagery Rehearsal Therapy (IRT). In IRT, you rewrite the nightmare while you are awake and practice the new version daily. Over time, your brain learns a safer pathway, which reduces both nightmare frequency and distress. Related approaches—such as Exposure, Relaxation, and Rescripting Therapy (ERRT)—also show meaningful reductions in nightmares and improvements in sleep.

If you want help selecting and personalizing the right approach, I offer 1:1 support to create a plan that respects your nervous system and your schedule.

How to Do Imagery Rehearsal Therapy at Home (Step by Step)

You do not have to relive trauma in detail. IRT is focused on changing the ending and rehearsing it in a calm, controlled way.

Choose one dream that you feel ready to work with. Start with a moderate one, not the most intense.
Outline the dream in brief, neutral language—just the main beats.
Rescript the ending so the scene becomes neutral or safe. You escape, a helper appears, the alarm sounds, the location changes—choose a version that feels believable for you.
Rehearse the new script for 5–10 minutes during the day. Picture it unfolding smoothly, and end on safety or relief.
Repeat daily for 1–2 weeks and then reassess. If distress spikes, downshift to a milder dream or add calming skills first.

If you would like a steady companion through this process, I can guide you through IRT step by step in coaching sessions and provide gentle adjustments when you feel stuck.

ERRT in a Nutshell (A Close Cousin of IRT)

Exposure, Relaxation, and Rescripting Therapy (ERRT) blends education about nightmares, simple relaxation skills, limited exposure to the dream material, and a rescripted ending. Many people find that the package—relaxation, rehearsal, and consistent practice—creates a safer landscape for sleep and reduces wake-after-nightmare stress. If you want an ERRT-style routine tailored to your life, we can build it together in 1:1 coaching.

What About Lucid Dreaming Therapy (LDT)?

Lucid Dreaming Therapy teaches you to recognize that you are dreaming while the dream continues, and then to make a small, kinder change from within the dream. Because lucidity can be verified in sleep labs, we know this is a real state, not wishful thinking. The research base for LDT is smaller than for IRT, but early studies suggest it can help some people—especially those who already have basic dream recall and feel curious about light skill practice.

You do not need to become a frequent lucid dreamer for this to help. Think of “lucidity-lite” as noticing a dream sooner and choosing a softer response. That’s it.

What recent studies show:

A 2025 randomized controlled trial tested a 6-day online lucid-dream workshop for adults with chronic PTSD. Compared with a wait-list control, the workshop group had significant reductions in PTSD symptoms and nightmare distress, with benefits still present at one-month follow-up. Interestingly, the symptom improvements were not strictly tied to whether a lucid dream occurred, suggesting the broader package—sleep education, gentle dream skills, and rescripting plans—may drive much of the benefit.
A 2023 pilot of the same workshop model reported large, clinically meaningful drops in PTSD symptoms and nightmare distress after six days of guided dreamwork and lucid-dream skills practice.
A 2023 systematic review concluded that Lucid Dreaming Therapy (LDT) shows promise for lowering nightmare frequency, while calling for larger, rigorous trials—exactly the kind of work now emerging.

How to try it safely (once per week max):

Evening phrase (10 seconds): As you get drowsy, whisper, “When I’m dreaming, I become aware that I am dreaming.”
If you naturally wake near morning: Sit up in very low light for 5–10 minutes, glance at your IRT rescript (the safer ending you’re practicing), then return to bed calmly. Don’t push; the priority is an easy return to sleep.
If awareness pops up in a dream: Aim small. Turn toward the scene with curiosity, call in a helper, lower the “volume/brightness,” or walk to a safer room. One kinder move is enough.
Stop if it feels activating. If your sleep gets lighter or anxiety rises, drop lucidity-lite and continue with IRT/ERRT only. The evidence above supports that gentle, skills-based packages can help even without a lucid dream that night.

If you want a sleep-first plan that blends IRT with these emerging lucid-dream skills—and keeps your nervous system front and center—book a free discovery call with me. Prefer learning with others? Join my free online platform where I share weekly prompts and we troubleshoot together.

A Clear, Sleep-First Weekly Plan for Nightmares

What you need (keep it simple)

A notebook and pen on your nightstand.
A 5–10 minute daytime slot you can protect (set a calendar reminder).
Optional: a soft alarm for the morning (avoid harsh tones).

Your everyday rhythm (do this daily)

Morning (1–2 minutes) — “Night Notes”

Before you touch your phone, write 3–5 quick bullets about any dream fragments: people, places, feelings, one image, or one line of dialogue. Then rate:

Nightmare distress last night (0–10)
How long it took to settle back down (minutes)
How rested you feel now (0–10)

Daytime (5–10 minutes) — IRT/ERRT practice

Work with one target dream this week.

Write a neutral outline of the dream (headlines only).
Rescript a safer ending that feels believable for you (escape, help arrives, scene softens).
Rehearse the new version slowly with a calm breath. If imagery is hard, read it out loud once or twice.

Evening (10–20 minutes) — Wind-down

Dim lights. Do one calming practice:

4–6 breathing (inhale 4, exhale 6) for 3–5 minutes, or
A brief body scan (head to toes), or
Progressive muscle relaxation (gently tense and release major muscle groups).End by reminding yourself: “If a dream gets intense tonight, I’ll remember my new ending.”

What to do if you wake from a nightmare tonight (SOS card)

Ground: Feel your feet, press your palms together, notice three sounds in the room.
Breathe: 4–6 breathing for 90 seconds. Longer exhales calm the body.
Mini-rescript: Whisper your new ending once. Keep it short: “I lock the door and a helper arrives. I’m safe.”
Return to sleep: Turn the pillow, adjust the covers, and invite drowsiness. If you stay alert, read a dull page in very low light for a minute or two, then try again.

Safety, Boundaries, and When to Get Extra Help

Nightmare work should make life gentler, not harder. If you live with active trauma symptoms—such as flashbacks, severe avoidance, or significant dissociation—please do this work with a trauma-informed clinician. Pause or scale back if practice makes your sleep lighter or your days edgier. If you notice red flags (worsening self-harm thoughts, reliance on substances to sleep, or frequent panic at bedtime), reach out for professional support immediately.

If you need help deciding where to start and how to pace things, book a free discovery call. We can map a plan that honors your nervous system.

Why This Matters in Everyday Life

When nightmares quiet down, people often report clearer thinking, steadier mornings, and more emotional bandwidth for relationships and work. IRT gives you a way to pre-decide how you will meet the hardest part of the night. Lucid dreaming adds a gentle option for those moments when awareness appears in the dream: notice sooner, choose softer, and carry that skill into daytime stress. You do not need to be a “lucid dreamer” to benefit. You only need a kind, repeatable process and enough support to keep going.

If you want that support, I’m here. You can book a free discovery call for 1:1 Sleep & Dream Coaching, or join my free online platform to learn alongside others at your own pace.

— Maša | Sleep & Dream Coach, Restful Sleep

FAQs

What is Imagery Rehearsal Therapy (IRT) for nightmares?

IRT is a brief, evidence-based technique where you rewrite a nightmare while awake and practice the new version daily. Over time, your brain learns a safer pathway, which reduces nightmare frequency and distress.

Can lucid dreaming help PTSD nightmares?

Lucid Dreaming Therapy is promising but still emerging. Some people find it helpful, especially alongside recall and gentle rescripting skills. It should be approached slowly and never at the expense of sleep health. For many, IRT remains the first-line option.

How long does it take to see results with IRT?

Many people notice changes within two to four weeks of consistent daily practice. The key is short, regular rehearsal rather than long, intense sessions.

What if I struggle to visualize?

You can still benefit. Use simple words, stick figures, or bullet points. The brain learns from repeated, calm rehearsal, not from perfect imagery.

Is it safe to do nightmare work at home?

Yes, if you keep it gentle and pause when distress rises. If you experience active trauma symptoms, please work with a trauma-informed clinician and consider coaching support for pacing and accountability.