The first big challenge you have to face when you’re quitting drugs is withdrawal. You’ve been using drugs frequently over an extended period of time and your body has gotten used to them. It has even started depending on them to fulfil some functions. Going cold turkey shocks the body and it has to rush to adapt.
Many of the most difficult withdrawal symptoms are well-known. Intense nausea and vomiting, cold sweats, and restlessness are indeed common and can cause significant distress. However, one symptom that does not get too much attention is the vivid dreams that can be triggered by withdrawal.
Nightmares may not seem like such a terrible symptom to the outsider, but considering how real they seem and their intensity, they are worth talking about. They can make detox even more difficult than the person expects, as even sleep provides no respite.
In this article, we’re going to discuss why nightmares occur when a person is going through withdrawals and what can be done about them.
Why Nightmares are Linked to Drug Withdrawals
The science of dreams and why they occur is, in general, murky. Many theories suggest the possible utility of dreams, but it is difficult to ascertain anything definite, especially as the actual experience of dreaming is subjective and very tough to even begin to describe.
However, we do know that dreams occur at a specific time: during rapid eye movement (REM) sleep. Contrary to a common misconception, this is not the deepest phase of sleep. Rather, your brain still resembles a low state of wakefulness which is why it is still possible to dream. In contrast, deep sleep precludes the possibility of dreaming.
REM sleep is very important to psychological wellbeing as it allows for the processing of emotions and consolidation of memories at the end of each day. Drugs often disrupt the normal sleeping process by suppressing REM sleep.
When the person stops using substances, REM sleep is suddenly no longer suppressed. The brain attempts to compensate for the months or years without proper REM sleep, creating a rebound effect. Dreams become vivid and intense. Very often, they’re distressing as well.
Why does the person have nightmares and not just regular dreams? There are a few reasons:
- Neurotransmitters which play a significant role in regulating sleep and dreams, are dysregulated by substance use.
- Since the body and mind are going through the pain of other withdrawal symptoms, the person’s dreams reflect how they feel in waking life.
- Withdrawal also causes disruptions in sleep, with sleep fragmentation and frequent awakenings throughout the night. This exacerbates the perception of nightmares by creating a sense of disorientation.
Let’s dive more deeply into these phenomena.
The Psychological and Neurological Factors Contributing to Nightmares
Drugs impact the balances of a number of neurotransmitters, in many cases causing highs by flooding the person’s brain with those responsible for positive mood or pleasure. Withdrawal therefore causes significant neurochemical deficiencies that contribute to the emergence of intense nightmares.
Neurotransmitters such as dopamine, serotonin, and norepinephrine play a critical role not just in regulating mood, but in arousal and sleep patterns as well. A person without sufficient levels of these neurotransmitters therefore experiences heightened emotional sensitivity and sleep dysregulation, including vivid dreams.
This isn’t the only way sleep is dysregulated. Sleep during withdrawals tends to be fragmented, with the person waking up every few minutes or hours, falling in and out of consciousness. This creates a sense of confusion as to what is real and what is happening in the dreams.
Another key factor is the heightened stress response experienced during withdrawal. The amygdala, the brain’s center for processing emotions such as fear and anxiety, becomes hyperactive in the absence of substances that previously numbed its activity. This leads to an increased likelihood of experiencing nightmares filled with themes of fear, helplessness, or trauma.
Many people also experience symptoms similar to post-traumatic stress disorder (PTSD) during withdrawal, including intrusive thoughts and heightened anxiety. Withdrawal-related nightmares often reflect the psychological turmoil experienced during recovery. In addition, research suggests that a history of trauma or chronic stress makes a person more vulnerable to nightmares in general.
How Different Substances Lead to Nightmares in Withdrawals
Not all withdrawal nightmares are the same in intensity, emotional impact, and content. Different substances are responsible for these vivid dreams in specific ways.
Opioid withdrawal significantly disrupts the body’s endorphin regulation, which plays a key role in pain relief and emotional stability. As the brain struggles to adjust to the absence of opioids, REM rebound occurs, leading to intensely vivid and disturbing nightmares. These nightmares often revolve around themes of distress, pain, or withdrawal symptoms themselves, further reinforcing psychological distress during the recovery process. Given the strong physical dependency opioids create, nightmares can be particularly severe, contributing to the anxiety and insomnia that many recovering individuals experience.
Alcohol withdrawal also leads to an REM rebound, often with particularly disturbing nightmares. These nightmares frequently feature themes of fear, guilt, or past traumatic experiences that were previously numbed by alcohol use. The severity of alcohol-related nightmares often correlates with the intensity of withdrawal symptoms, including delirium tremens, which can create hallucinatory, dream-like states even while awake.
Benzodiazepine withdrawal is notorious for causing distressing and hyper-realistic nightmares. Since benzodiazepines act as central nervous system depressants, their prolonged use suppresses REM sleep more directly than most other substances. When a person stops using them, their body compensates with particularly excessive REM activity, leading to long and vivid nightmares that can persist for weeks. These nightmares often include sensations of suffocation, panic, or extreme fear, mirroring the heightened anxiety that withdrawal from these medications typically induces. As a result, people withdrawing from benzodiazepines often struggle with both sleep paralysis and night terrors.
Stimulant withdrawal, particularly from drugs like cocaine and methamphetamine, leads to dramatic changes in dopamine regulation, which directly influences sleep and dream activity. When a person quits stimulants, the brain goes into overdrive, producing nightmares characterized by paranoia, hallucinations, and high emotional intensity. Given that stimulant withdrawal often coincides with depressive episodes, nightmares can take on a deeply disturbing and melancholic nature, further worsening an individual’s mental state. These distressing dreams, combined with the hypersomnia typical of stimulant withdrawal, can create a prolonged period of emotional turmoil and sleep disturbances.
The nightmares caused by withdrawals can, like many other symptoms, cause severe distress. Ideally, the best way to avoid them is to prevent dependence in the first place. Unfortunately, substance addiction is a disease and public health initiatives have had limited effect in decreasing its occurrence.
But it’s not all doom and gloom. Not only are the nightmares caused by withdrawal temporary, but there are also treatments and coping mechanisms that help many people get through them. In a medical detox during rehab, addiction recovery professionals are on hand to ensure you are safe and can help you process the nightmares and learn to navigate them.
Coping Strategies and Treatment Approaches
Managing the nightmares caused by withdrawals can be achieved through treatment that addresses both physiological and psychological factors. One of the most simple yet effective strategies is improving sleep hygiene, which includes maintaining a consistent sleep schedule, creating a comfortable sleep environment, and avoiding stimulants such as caffeine before bedtime.
Medications are sometimes prescribed to help regulate sleep and mitigate nightmares. Melatonin supplements can support the natural sleep-wake cycle, while certain antidepressants and alpha-blockers like prazosin have shown effectiveness in reducing the severity of nightmares, particularly in individuals experiencing PTSD-like symptoms. However, medication should always be used under the supervision of a healthcare provider to avoid dependency or unwanted side effects.
Cognitive behavioral therapy for insomnia (CBT-I) is a proven psychological intervention that can help individuals develop healthier sleep patterns and address negative thought patterns contributing to distressing dreams. Additionally, trauma-focused therapy may be beneficial for those whose nightmares are linked to past experiences or psychological distress.
Holistic approaches such as mindfulness, dietary adjustments, and physical activity can also play a significant role in improving sleep quality and reducing nightmare severity. Mindfulness techniques, such as guided imagery and progressive muscle relaxation, help calm the nervous system, making sleep less disrupted. A balanced diet rich in nutrients that support brain health, such as omega-3 fatty acids and magnesium, can aid in neurotransmitter regulation and improve overall sleep quality.
Conclusion
On the surface, nightmares may not seem like much to worry about. However, due to their vividness and intensity, they can be extremely difficult side effects of withdrawal to manage. While nightmares can continue for weeks or months after a person stops using substances, there are treatments that help you learn coping mechanisms, lessening the frequency and intensity of the nightmares and empowering you to diminish their impact.
Sources
- BMC: Sleep abnormalities associated with alcohol, cannabis, cocaine, and opiate use: a comprehensive review. Accessed February 2025.
- Cambridge Core: Parasomnias in patients with addictions—a systematic review. Accessed February 2025.
- Oxford Academic: Dependence, withdrawal and rebound of CNS drugs: an update and regulatory considerations for new drugs development. Accessed February 2025.
- The American Journal of Addictions: Clinical correlates of drug-related dreams in opioid use disorder. Accessed February 2025.
