When nightmares make you afraid to sleep after a car crash
Guidance from a trauma sleep psychologist on rest and treatment options
The crash may play again in your dreams. You may put off bedtime to avoid it, then feel worn out the next day. Pain, medicines and a possible concussion may also disrupt sleep. A trauma sleep psychologist wouldn’t assume one cause explains every night. The first job is to make sleep safer and more predictable. If the problem continues, the next step is targeted help. [1, 2]
Track the pattern without watching yourself all night
For one week, jot down about when you went to bed and how long you think it took to fall asleep. Note whether a nightmare woke you and how you got through the next day. Add pain flares, new medicines and alcohol. If someone else notices odd breathing or movements while you sleep, write that down too. A short log can help a clinician tell nightmares apart from insomnia or another sleep problem. Don’t let it turn into one more chore that keeps you awake. [1]
Make waking from a nightmare less confusing
Make a simple plan while you’re awake. When you wake from a nightmare, turn on a soft light. Say where you are and today’s date. Notice one thing in the room that belongs to the present. Drinking water or sitting with your feet on the floor may help. [1, 3]
There’s no need to force yourself to retell the dream. Someone you trust can learn the plan and ask what kind of support you’d like. [1, 3]
Tell a clinician soon about certain signs. These include acting out your dreams, falling out of bed or hurting yourself. Choking spells or pauses in breathing count too. Signs like these may call for a different kind of sleep evaluation. [1]
Protect your sleep without risky shortcuts
Try waking at the same time each day. Make your sleeping space comfortable and safe. Ask the clinician treating you whether your pain treatment could work better at night. Go over your medicines before you add a sleep aid. [1, 4]
Alcohol may make you feel sleepy at first, yet it can make your sleep worse. Some sleep medicines cause drowsiness the next day. Some also interact dangerously with alcohol or opioid pain medicines. [1, 4]
- What keeps me awake most often: pain, fear of a dream, noise or a medicine effect?
- What does my partner or helper notice while I’m asleep?
- What would make tonight safer without creating a new problem tomorrow?
Treatments that can help
For insomnia that won’t let up, cognitive behavioral therapy for insomnia, or CBT I, is a well supported treatment. It goes beyond a list of sleep tips. A trained clinician helps you change the habits that keep insomnia going. [1, 4, 5]
For nightmares that keep coming back, a clinician may bring up imagery rehearsal therapy. While awake, you work with a changed version of the dream. It should move at a pace you can handle. [1, 4, 5]
Trauma treatment may ease some sleep symptoms. Even so, insomnia or nightmares can need their own care. Ask your clinician which problem will be treated first and how progress will be measured. More medicine isn’t the only option. [1, 4]
Signs it's time to reach out
Contact a health professional if poor sleep is making driving, work, caregiving or taking care of yourself unsafe. Do the same if your fear of sleep is growing. Get help right away if you might harm yourself. In the United States, call or text 988 for a mental health crisis. Call 911 if you’re in immediate danger. [1]
What to say at your next visit
Tell your clinician: “I am avoiding sleep because of nightmares. Can we review pain, medicines and whether sleep treatment would help?” A question like that opens the door to a full assessment.
Sources and further reading
- 1VA: Sleep problems and PTSD
- 2CDC: Concussion symptoms
- 3VA: Coping with stress reactions
- 4VA: Sleep treatment review
- 5AASM: Nightmare treatment options
This is general U.S. information from a trauma and sleep psychology point of view. New or severe sleep trouble may also come from an injury, a medicine or another health problem. Ask a clinician to assess you personally.
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