“Scared to death” might not be just a saying, as far as nightmares are concerned.

People who have frequent nightmares appear to have a tripled risk of premature death, according to a new study presented at the European Academy of Neurology’s (EAN) annual meeting.

Those folks also show signs of significantly accelerated biological aging, with their bodies reflecting wear and tear greater than what their birth date might reflect, researchers said.

This is likely due to the stress that nightmares can place on a sleeping body, researchers said.

“Our sleeping brains cannot distinguish dreams from reality,” lead researcher Dr. Abidemi Otaiku, a neuroscientist at Imperial College London in the U.K., said in a news release.

“That’s why nightmares often wake us up sweating, gasping for breath, and with our hearts pounding—because our fight-or-flight response has been triggered,” he explained. “This stress reaction can be even more intense than anything we experience while awake.”

For the study, researchers pooled data from more than 2,400 children aged 8 to 10 and 183,000 adults aged 26 to 86 who took part in U.S. health studies.

Participants’ biological aging was assessed by the length of their telomeres—small DNA sequences that cap the end of chromosomes and prevent them from unraveling, similar to the plastic tips of shoelaces.

Telomere length has been established as a means of determining whether a person’s cells are aging at a faster rate than their actual age might reflect, researchers said.

Adults reporting weekly nightmares were more than three times as likely to die before age 70 during 19 years of follow-up, results show.

These nightmares were a stronger predictor of premature death than other risk factors like smoking, obesity, bad diet and lack of exercise, researchers said.

Children and adults with more frequent nightmares also exhibited faster biological aging, researchers found.

This accelerated aging accounted for about 40% of participants’ increased risk of death, researchers estimate.

“Nightmares lead to prolonged elevations of cortisol, a stress hormone closely linked to faster cellular aging. For those who frequently experience nightmares, this cumulative stress may significantly impact the aging process,” Otaiku said.

“Additionally, nightmares disrupt both sleep quality and duration, impairing the body’s essential overnight cellular restoration and repair,” Otaiku continued. “The combined effects of chronic stress and disrupted sleep likely contribute to the accelerated aging of our cells and bodies.”

Frequent nightmares appear to affect everyone about the same, regardless of age, sex, ethnicity or mental health, researchers found.

And even monthly nightmares were linked to faster aging and increased risk of death, compared to rare or no nightmares, researchers said.

“The good news is that nightmares can be prevented and treated,” Otaiku said. “Simple measures like avoiding scary movies, maintaining good sleep hygiene, managing stress and seeking treatment for anxiety or depression can be effective.”

Sleep specialists might be able to help folks whose nightmares don’t respond to lifestyle changes, he added.

“Given how common and modifiable nightmares are, they should be taken far more seriously as a public health concern,” Otaiku concluded.

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