Position paper for the treatment of nightmare disorder in adults: an American Academy of Sleep Medicine position paper
Morgenthaler TI, et al.
Published in Journal of Clinical Sleep Medicine
Methodology
Literature search using keywords and MeSH terms from the 2010 AASM Best Practice Guide, covering March 2009 to August 2017; a task force developed position statements from a review of the studies plus clinical expertise, approved by the AASM Board of Directors.
Key Findings
This American Academy of Sleep Medicine position paper reviewed behavioural, psychological and drug treatments for nightmare disorder, which affects about 4% of adults, using literature from March 2009 to August 2017. Image rehearsal therapy is the only treatment recommended, for both PTSD-associated nightmares and nightmare disorder. A long list of options "may be used", including cognitive behavioural therapy, exposure/relaxation/rescripting therapy, hypnosis, lucid dreaming therapy, prazosin, gabapentin, trazodone and several antipsychotics. Clonazepam and venlafaxine are explicitly not recommended.
Conclusions
The following therapies may be used for the treatment of PTSD-associated nightmares: cognitive behavioral therapy; cognitive behavioral therapy for insomnia; eye movement desensitization and reprocessing; exposure, relaxation, and rescripting therapy; the atypical antipsychotics olanzapine, risperidone and aripiprazole; clonidine; cyproheptadine; fluvoxamine; gabapentin; nabilone; phenelzine; prazosin; topiramate; trazodone; and tricyclic antidepressants.
Limitations
A position paper based on qualitative assessment and task-force clinical judgement rather than pooled quantitative analysis; most "may be used" options rest on limited or inconsistent evidence.
Related Health Concerns
Study Details
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Disclosures
Funding
American Academy of Sleep Medicine
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