Nightmares and nightmare disorder in adults
- Rochelle Zak, MD
Rochelle Zak, MD
- Associate Physician
- UCSF Sleep Disorders Center
- Anoop Karippot, MD, FAASM
Anoop Karippot, MD, FAASM
- Medical Director
- AKANE Institute of Allergy Asthma and Sleep Medicine
- Section Editor
- Alon Y Avidan, MD, MPH
Alon Y Avidan, MD, MPH
- Section Editor — Parasomnias and Sleep Related Movement Disorders
- Professor of Neurology
- David Geffen School of Medicine at UCLA
- Deputy Editors
- April F Eichler, MD, MPH
April F Eichler, MD, MPH
- Senior Deputy Editor — UpToDate
- Deputy Editor — Neurology and Sleep Medicine
- Assistant Professor of Neurology
- Harvard Medical School
- Richard Hermann, MD
Richard Hermann, MD
- Deputy Editor — Psychiatry
- Associate Professor
- Tufts University School of Medicine
Nightmares are common beginning early in childhood and extending throughout the lifespan. The condition is strongly associated with stress, anxiety, and trauma.
While nightmares are not by definition pathologic, those that are frequent or disabling and impair social, occupational, emotional, and physical wellbeing are considered a disorder and are often a sign of underlying and treatable psychopathology. Common causes include stress, negative life events, the experience of trauma as in posttraumatic stress disorder (PTSD), depression, other psychiatric disorders, and medication side effects.
This topic reviews the causes, differential diagnosis, evaluation, and management of nightmares in adults. Nightmares in children and other parasomnias in children and adults are reviewed separately. (See "Sleepwalking and other parasomnias in children" and "Disorders of arousal from non-rapid eye movement sleep in adults".)
The true prevalence of nightmares and nightmare disorder is uncertain due to varying terminology and criteria for defining nightmares across studies. Nonetheless, it is clear that the occurrence of an occasional nightmare is common, and that nightmare disorder is much less common, particularly in adults.
Approximately 50 percent of children report ever having nightmares, and up to 20 percent report having frequent nightmares . Approximately 85 percent of adults report having a nightmare at least once a year, and 2 to 6 percent report having frequent (weekly) nightmares .To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- Depression and other psychiatric disorders
- Withdrawal from medications
- Idiopathic frequent nightmares
- CLINICAL FEATURES
- Nightmare disorder
- DIFFERENTIAL DIAGNOSIS
- REM sleep behavior disorder
- Sleep terrors (pavor nocturnus)
- Nocturnal panic attack
- Hypnopompic/hypnagogic hallucinations
- Bereavement-related dysphoric dreams
- DIAGNOSTIC EVALUATION
- General approach
- Lifestyle modification and good sleep hygiene
- Withdrawal of causative medications
- Treatment of co-occurring psychiatric disorders
- Nightmare-focused psychotherapy
- Pharmacologic therapies
- - Prazosin
- - Drugs of possible benefit
- SUMMARY AND RECOMMENDATIONS