Best practice guide for the treatment of nightmare disorder in adults

R. Nisha Aurora, Rochelle S. Zak, Sanford H. Auerbach, Kenneth R. Casey, Susmita Chowdhuri, Anoop Karippot, Rama K. Maganti, Kannan Ramar, David A. Kristo, Sabin R. Bista, Carin I. Lamm, Timothy I. Morgenthaler, Sharon L. Tracy

Research output: Contribution to journalReview article

Abstract

Prazosin is recommended for treatment of Posttraumatic Stress Disorder (PTSD)-associated nightmares. Level A Image Rehearsal Therapy (IRT) is recommended for treatment of nightmare disorder. Level A Systematic Desensitization and Progressive Deep Muscle Relaxation training are suggested for treatment of idiopathic nightmares. Level B Venlafaxine is not suggested for treatment of PTSD-associated nightmares. Level B Clonidine may be considered for treatment of PTSD-associated nightmares. Level C The following medications may be considered for treatment of PTSD-associated nightmares, but the data are low grade and sparse: trazodone, atypical antipsychotic medications, topiramate, low dose Cortisol, fluvoxamine, triazolam and nitrazepam, phenelzine, gabapentin, cyproheptadine, and tricyclic antidepressants. Nefazodone is not recommended as first line therapy for nightmare disorder because of the increased risk of hepatotoxicity. Level C The following behavioral therapies may be considered for treatment of PTSD-associated nightmares based on low-grade evidence: Exposure, Relaxation, and Rescripting Therapy (ERRT); Sleep Dynamic Therapy; Hypnosis; Eye-Movement Desensitization and Reprocessing (EMDR); and the Testimony Method. Level C The following behavioral therapies may be considered for treatment of nightmare disorder based on low-grade evidence: Lucid Dreaming Therapy and Self-Exposure Therapy. Level C No recommendation is made regarding clonazepam and individual psychotherapy because of sparse data.

Original languageEnglish (US)
Pages (from-to)389-401
Number of pages13
JournalJournal of Clinical Sleep Medicine
Volume6
Issue number4
StatePublished - Aug 15 2010

Keywords

  • Aripiprazole
  • Clonazepam
  • Clonidine
  • Cognitive behavioral therapy
  • Cortisol
  • Cyproheptadine
  • Exposure relaxation and rescripting therapy
  • Fluvoxamine
  • Gabapentin
  • Hypnosis
  • Imagery rehearsal therapy
  • Lucid dreaming therapy
  • Nefazodone
  • Nightmare disorder
  • Nightmares
  • Nitrazepam
  • Olanzapine
  • Phenelzine
  • Prazosin
  • Progressive deep muscle training
  • Psychotherapy
  • Risperidone
  • Self-exposure therapy
  • Sleep dynamic therapy
  • Systematic desensitization
  • Testimony method
  • Topiramate
  • Trazodone
  • Triazolam
  • Tricyclics
  • Venlafaxine

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Neurology
  • Clinical Neurology

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  • Cite this

    Aurora, R. N., Zak, R. S., Auerbach, S. H., Casey, K. R., Chowdhuri, S., Karippot, A., Maganti, R. K., Ramar, K., Kristo, D. A., Bista, S. R., Lamm, C. I., Morgenthaler, T. I., & Tracy, S. L. (2010). Best practice guide for the treatment of nightmare disorder in adults. Journal of Clinical Sleep Medicine, 6(4), 389-401.