Best practice guide for the treatment of nightmare disorder in adults.
Author(s): Aurora RN, Zak RS, Auerbach SH, Casey KR, Chowdhuri S, Karippot A, Maganti RK,
Ramar K, Kristo DA, Bista SR, Lamm CI, Morgenthaler TI; Standards of Practice
Committee; American Academy of Sleep Medicine.
Affiliation(s): Mount Sinai Medical Center, New York, NY, USA.
Publication date & source: 2010, J Clin Sleep Med. , 6(4):389-401
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.
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