Nightmares can be described as horrifying dreamlike content, typically occurring during rapid eye movement sleep (REM) sleep. Occasional nightmares occur for all people. When nightmares occur 3 or more nights per week, for at least 3 months, with related sleep loss and impact on functioning, this classifies as a “Nightmare Disorder”. Many patients with nightmare disorder suffer from sleep avoidance (as they fear going to sleep) and prolonged nighttime awakenings (because they fear return to sleep). Often nightmare disorders occur in patients who have experienced trauma and often also have symptoms of Post Traumatic Stress Disorder (PTSD). In such scenarios, we typically recommend that patients start with evaluation and management of PTSD, before focusing on the nightmare disorder. If ongoing nightmares are present even after trauma symptoms are managed, we then often suggest working with a Behavioral Sleep Medicine specialist to try Imagery Rehearsal Therapy.