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nightmare

Etiology: - post-traumatic stress disorder (PTSD) Epidemiology: - 4% of adults Clinical manifestations: 1) generally well-remembered in the morning 2) tend to occur later in sleep, when REM sleep is more frequent Complication: - risk factor for suicidal ideation [2] - childhood nightmares may portend adolescent psychosis [3] - nightmares in middle-age & older adults may predict cognitive decline & dementia [5] Management: 1) reassurance, no treatment generally indicated 2) for recurrent nightmares, treatment should be directed at the underlying psychopathology 3) nightmares associated with PTSD a) non-pharmaceutical measures - image rehearsal therapy is recommended - cognitive behavioral therapy (CBT) - CBT for insomnia; eye movement desensitization & reprocessing - exposure, relaxation, & rescripting therapy b) pharmaceutical therapy [3]* - olanzapine, risperidone, aripiprazole, clonidine, cyproheptadine, fluvoxamine, gabapentin, nabilone, phenelzine, prazosin, topiramate, trazodone, & tricyclic antidepressants 4) nightmares without PTSD a) 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 b) pharmaceutical therapy [3]* - nitrazepam, prazosin, & triazolam * clonazepam * venlafaxine not recommended to treat nightmares [3]

General

parasomnia

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
  2. Nadorff MR et al. Insomnia symptoms, nightmares, and suicidal ideation in a college student sample. Sleep 2011 Jan 1; 34:93. PMID: 21203379
  3. Fisher HL et al Childhood Parasomnias and Psychotic Experiences at Age 12 Years in a United Kingdom Birth Cohort. Sleep. March 2014 http://www.journalsleep.org/ViewAbstract.aspx?pid=29352
  4. Morgenthaler TI, Auerbach S, Casey KR et al Position Paper for the Treatment of Nightmare Disorder in Adults: An American Academy of Sleep Medicine Position Paper. J Clin Sleep Med. 2018 Jun 15;14(6):1041-1055. PMID: 29852917 PMCID: PMC5991964 Free PMC article. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5991964/
  5. Brooks M Not Just a Bad Dream: Nightmares May Predict Dementia. Medscape. Sept 26, 2022 https://www.medscape.com/viewarticle/981468