Does Alcohol Withdrawal Cause Nightmares?

Robert Gerchalk

Robert is our health care professional reviewer of this website. He worked for many years in mental health and substance abuse facilities in Florida, as well as in home health (medical and psychiatric), and took care of people with medical and addictions problems at The Johns Hopkins Hospital in Baltimore. He has a nursing and business/technology degrees from The Johns Hopkins University.

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Can You Get Nightmares With Alcohol Withdrawal?

Living with alcohol use disorder can seem like a daily nightmare for people struggling with this form of addiction. But what about when a person gets into treatment and starts to work through that first, difficult stage of detox? Do people experience real nightmares during the withdrawal process?

The short answer is yes. Experiencing nightmares during alcohol withdrawal is not universal, however. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), anywhere from 25% to 75% of detoxing drinkers can expect a period of frequent nightmares.

The good news is that these nightmares will eventually go away. It takes longer for some clients than others. For a very small percentage of people who continue to suffer frequent nightmares weeks or months after they get sober, the cause of the problem may be something other than the past use of alcohol, or an additional factor.

Before we get too far in-depth, let’s back up for an overview of this important element of alcoholism recovery for many people.

How Significant Is the Nightmare Phenomenon?

It must be stated that people struggling to free themselves from alcohol addiction often fail early on because of terrible nightmares. That’s why attempting to quit drinking outside a formal treatment setting can be so difficult. Many people relapse quickly just to avoid nightmares.

Furthermore, frequent nightmares can disrupt the sleep cycle. Not getting a proper amount of sleep each night can be a significant problem for anyone, alcoholic or not. Thus, this added dysfunction is a double whammy for people striving for recovery.

Once you add in other kinds of withdrawal symptoms associated with detox, such as delirium tremens, nausea, powerful headaches, and more, the experience of nightmares just makes experiencing detox worse!

How Big Is the Concern?

One problem associated with the onset of nightmares during withdrawal is that they are too often ignored or neglected. Even some professional treatment providers just assume the nightmare issue will “take care of itself.” While that may be true in most cases, not ignoring nightmares and having a strategy to cope with this issue is a better way to go.

The bottom line is that if nightmares can be eliminated faster, the likelihood of a continued path toward recovery becomes much stronger. Fortunately, some steps can be taken to mitigate nightmares.

Scientists know that nightmares are produced in part by the disruption of Rapid Eye Movement (REM). There are four stages of sleep:

  • Awake
  • Light sleep
  • Deep sleep
  • REM sleep

In the REM stage, sleepers move their eyes back and forth from side to side rapidly beneath closed eyelids. This is the case for everyone, not just recovering alcoholics. 

It is also well understood that the onset of REM indicates that a person is dreaming. People undergoing detox will often fail to achieve the onset of REM sleep. They may exhibit rapid eye movement before or after this stage. While REM is a sure sign that a person is dreaming, that dream may very well be a bad one — a nightmare.

Fear of future nightmares — and remembering them the next day — can be deeply traumatic. For people struggling to free themselves from addiction, this can be a devastating problem.

When Does It Become a “Nightmare Disorder”?

Keep in mind that most people experience nightmares from time to time. The Sleep Foundation reports that about 75% of the population has nightmares. You don’t have to be an alcoholic to have a nightmare. Many non-addictive people develop what psychologists call the “Nightmare Disorder.” This condition affects 2% to 8% of the general population, according to the Sleep Foundation. 

Other causes can be PTSD, childhood abuse, sexual abuse or trauma, mental disorders, such as schizophrenia, and other causes. Some people have nightmares simply by watching the news and being upset by all the negative events that are happening in the world, such as wars, crime, or natural disasters.

Researchers at the Cleveland Clinic have identified three levels of nightmare severity:

  • Mild: Average of less than one nightmare per week.
  • Moderate: One or more nightmares per week.
  • Severe: Nightmares every night.

Nightmare disorders are also judged by the duration of the problem:

  • Acute: Nightmares occur for a month or less.
  • Subacute: Nightmares keep happening for up to six months.
  • Chronic: Nightmares are ongoing for six months or longer.

Note that other addictive substances also produce nightmares. That includes marijuana because “smoking weed” can diminish the amount of time a brain spends in the REM sleep stage. Addiction to cocaine or amphetamines is strongly associated with the onset of nightmares as well.

Can Nightmares Be Considered a Byproduct of Alcohol Withdrawal?

The answer is yes. Keep in mind, however, that nightmares will not be an outcome for all alcoholics who are detoxing. Again, any substance that disturbs the normal four stages of sleep can lead to nightmares.

Drugs That Make Alcohol-Related Nightmares Worse

Many people who abuse alcohol also take an array of other drugs, including prescription medicines prescribed by a doctor. The combination of these pharmaceuticals with alcohol dramatically increases the occurrence of nightmares.

They are:

  • Antidepressants
  • Antihistamines
  • Blood pressure medications
  • Steroids
  • Cholesterol medications
  • Parkinson’s medications

For those seeking help with alcohol addiction and who take one or more of the drugs described above, you must tell your therapists about all the medications you take. You may require additional medical supervision as you undergo detox and stop using alcohol long-term.

Nightmares That Persist After Quitting

A certain number of people find that they have more nightmares after they have been sober for an extended time. They may be weeks or months beyond detox and are “staying clean.” Even though their formal treatment for alcoholism may be months behind them, the nightmares persist.

This is because the brain needs time to return to normal functioning. While drinking, the brain is forced to basically “go into overdrive” because it is struggling to maintain all the normal functions it is supposed to do while being impaired by alcohol.

Heavy drinkers may not feel like their brains are in “overdrive” because alcohol is suppressing the central nervous system at the same time. Indeed, being drunk all the time may feel like the opposite of experiencing a hyperactive brain.

Whatever the case, the brain needs time to readjust to the “new normal” of not being intoxicated all the time. The brain may have been overstimulated for months or years while the central nervous system was being suppressed. The reset from this state of affairs does not automatically start from the point of drinking cessation.

By the way, the same issues that produce nightmares can trigger other common side effects of withdrawal, such as excessive muscle spasms, irritation, sweating, and even seizures.

What About Delirium Tremens?

One of the most talked about withdrawal symptoms for severe alcoholics who are ceasing to drink is delirium tremens, often referred to as “The DTs.” This is a frightening condition that produces some severe effects, including:

  • Seizures
  • Nightmares
  • Extreme hallucinations, both auditory and visual
  • Vomiting 
  • Heavy sweating
  • Fever
  • Rapid heart rate
  • Bodily tremors

One of the causes of DTs is the release of a chemical called GABA into the brain. GABA, or gamma-aminobutyric acid, is a natural neurotransmitter, which is the brain’s “chemical messengers.” So, GABA is a brain chemical that has a normal and important function in the brain. It helps the brain slow down when it needs to slow down. 

The neurotransmitter has a calming effect on the brain and thus a person’s experience. GABA is what’s needed to control the kind of nerve cell hyperactivity that is associated with anxiety, fear reactions, stress, and more. 

GABA is the substance that should be helping to make us calm when we need to be. The problem with alcohol, however, is that many people drink it because they believe that it makes them calm. It’s common to hear someone say: “I need a drink to calm my nerves.” But when people use alcohol to feel calmer, they start messing with the natural production of GABA in the brain.

What happens, then, when a person stops drinking suddenly is that the normal function of GABA for calming stops working properly. It takes a while for the brain to detox from alcohol and then return to its normal production of GABA. Understanding the role of GABA goes a long way toward explaining why some people suffer delirium tremens when they detox. 

The onset of delirium tremens is usually two to three days after individuals decide to stop drinking. They most often peak in five to seven days after their last drink. Obviously, this is an incredibly difficult stage in the recovery process. The DTs can even cause death if left untreated. The people most at risk are those who are already suffering from high blood pressure or heart conditions. 

Delirium tremens treatment options include:

  • Medication
  • Supportive care
  • Other medical procedures

The most common medications used are Phenobarbital, Diazepam, and Clonazepam. Some clients will be prescribed an IV to help manage the condition.

It is important to note that the DTs should be considered an emergency care medical situation. Treatment must start immediately to avoid the risk of death.

Can a client suffer from nightmares during a two- to seven-day period of DTs? The answer is yes. Nightmares are usually a significant feature of the DT experience. 

Ending the Nightmare and Nightmares of Alcohol Addiction

Even if you must endure nightmares as part of the pathway to sobriety, the good news is that quitting alcohol is the way out of a lifestyle that features both nightmares while sleeping and a daily, waking existence that can seem like a nightmare all the time.

Take heart in the fact that professional treatment experts have an arsenal of tools at their disposal that can alleviate the problem of nightmares and minimize the period in which you must endure these terrible and negative experiences.

Even if nightmares endure for months or more, the day will come when nightmares will be relegated to a rare experience. Remember that just about everyone has a nightmare occasionally whether they suffer from an addiction or not. But a sober lifestyle is the key to having fewer nightmares — and more happy dreams. 

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