Sleep-Wake Disorders Center - Behavioral Sleep Medicine Program - Recurrent Nightmares and Disturbing Dreams - New York City - Montefiore Medical Center

How common are nightmares?
Nearly 1 in 20 adults in the United States suffer from nightmares or disturbing dreams, and nearly twice as many children and adolescents experience frequent nightmares.

Nightmares are scary, disturbing, bothersome and can lead to insomnia and daytime consequences such as depression, anxiety and difficulties with memory, irritability, attention and concentration.

Most nightmare sufferers cannot imagine that their nightmares are a treatable problem, and even fewer patients seek treatment for them.

The Behavioral Sleep Medicine Program is part of the multidisciplinary Sleep-Wake Disorders Center, which is staffed by sleep specialists certified by the American Board of Sleep Medicine. When indicated, patient care is coordinated with other Sleep-Wake Disorders Center specialists and with the referring treatment provider.

What is Imagery Rehearsal Therapy (IRT)?
IRT is an evidence-based, non-drug approach to nightmare treatment that was developed by Dr. Barry Krakow. In IRT, patients do not discuss the experience that spurred the nightmares or even the content of their dreams. Instead, they focus on changing the imagery. Patients are taught ways to re-write the dream (even only a scene) and then to practice imagining the new dream during the daytime

What happens in IRT?
The experience of nightmares is unique to each person and is impacted by many factors including life circumstances, coping styles, and biological predispositions. Research has shown that IRT is effective with a wide range of patients, from those who suffer from distressing dreams on a regular basis to those who have nightmares related to Post-Traumatic Stress Disorder (PTSD).

Treatment generally includes: education on the many factors that can cause nightmares and lead to nightmares becoming a "learned behavior," developing healthy and effective sleep behaviors, imagery practice, re-scripting of dreams through imagery practice, and learning skills for calming the mind and managing stress.

How effective is IRT?
Clinical studies have shown IRT is effective for the treatment of nightmares. Some patients report improved daytime mood and functioning as a result of successful treatment of their nightmare disorder.

How long does IRT take?
Although each person's situation is unique, on average 3-4 sessions are usually required for many people to begin seeing improvement in nightmare frequency and distress. Follow-up recommendations are made to make sure that the results are maintained.

What does the treatment cost?
Our services are labeled by health insurance providers as behavioral health or mental health services. Therefore, out of pocket expenses are determined by the type of mental health or behavioral health benefits provided by your health insurance plan and group. Our office staff can help you find out what portion of each service is covered by your insurance plan. Payments are collected at each session at the reception desk when you check in.

What if I am on medication?
You do not have to be off of medication to benefit from Image Rehearsal Therapy. Although some people choose to begin our program without medication, a number of people decide to start our program as a way to learn strategies that will complement their current sleep aids. If you do decide, however, to stop your medication during your treatment, we will work with you and your prescribing doctor to gradually taper your dosage once you feel comfortable doing so and have learned alternative techniques.