nightmare

Etiology

• post-traumatic stress disorder (PTSD)

Epidemiology

• 4% of adults

Clinical manifestations

• generally well-remembered in the morning
• tend to occur later in sleep, when REM sleep is more frequent Complication:
  • risk factor for suicidal ideation
  • childhood nightmares may portend adolescent psychosis
  • nightmares in middle-age & older adults may predict cognitive decline & dementia

Management

• reassurance, no treatment generally indicated
• for recurrent nightmares, treatment should be directed at the underlying psychopathology
• nightmares associated with PTSD
  • non-pharmaceutical measures
    • image rehearsal therapy is recommended
    • cognitive behavioral therapy (CBT)
      • CBT for insomnia; eye movement desensitization & reprocessing
    • exposure, relaxation, & rescripting therapy
  • pharmaceutical therapy*
    • olanzapine, risperidone, aripiprazole, clonidine, cyproheptadine, fluvoxamine, gabapentin, nabilone, phenelzine, prazosin, topiramate, trazodone, & tricyclic antidepressants
• nightmares without PTSD
  • non-pharmaceutical measures
    • cognitive behavioral therapy (CBT)
    • exposure, relaxation, & rescripting therapy
    • hypnosis
    • lucid dreaming therapy
    • progressive deep muscle relaxation
    • self-exposure therapy
    • systemic desensitization
    • testimony method
  • pharmaceutical therapy*
    • nitrazepam, prazosin, & triazolam

* clonazepam * venlafaxine not recommended to treat nightmares

More general terms

• parasomnia