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Nightmares and nightmare disorder in adults

Authors
Rochelle Zak, MD
Anoop Karippot, MD, FAASM
Section Editor
Alon Y Avidan, MD, MPH
Deputy Editors
April F Eichler, MD, MPH
Richard Hermann, MD

INTRODUCTION

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".)

EPIDEMIOLOGY

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 [1]. Approximately 85 percent of adults report having a nightmare at least once a year, and 2 to 6 percent report having frequent (weekly) nightmares [2].

                            
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Literature review current through: Nov 2017. | This topic last updated: Oct 23, 2017.
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References
Top
  1. Gauchat A, Séguin JR, Zadra A. Prevalence and correlates of disturbed dreaming in children. Pathol Biol (Paris) 2014; 62:311.
  2. Levin R, Nielsen TA. Disturbed dreaming, posttraumatic stress disorder, and affect distress: a review and neurocognitive model. Psychol Bull 2007; 133:482.
  3. Schredl M, Reinhard I. Gender differences in nightmare frequency: a meta-analysis. Sleep Med Rev 2011; 15:115.
  4. Yu C. Typical dreams experienced by Chinese people. Dreaming 2008; 18:1.
  5. Nielsen T, Zadra A, Simard V, et al. The typical dreams of Canadian university students. Dreaming 2003; 13:211.
  6. Nielsen T, Levin R. Nightmares: a new neurocognitive model. Sleep Med Rev 2007; 11:295.
  7. Pagel JF. Nightmares and disorders of dreaming. Am Fam Physician 2000; 61:2037.
  8. Pagel JF Jr. Nightmares. Am Fam Physician 1989; 39:145.
  9. Ross RJ, Ball WA, Sullivan KA, Caroff SN. Sleep disturbance as the hallmark of posttraumatic stress disorder. Am J Psychiatry 1989; 146:697.
  10. Beauchemin KM, Hays P. Dreaming away depression: the role of REM sleep and dreaming in affective disorders. J Affect Disord 1996; 41:125.
  11. Hartmann E. The underlying emotion and the dream relating dream imagery to the dreamer's underlying emotion can help elucidate the nature of dreaming. Int Rev Neurobiol 2010; 92:197.
  12. Hublin C, Kaprio J, Partinen M, Koskenvuo M. Nightmares: familial aggregation and association with psychiatric disorders in a nationwide twin cohort. Am J Med Genet 1999; 88:329.
  13. Sjöström N, Waern M, Hetta J. Nightmares and sleep disturbances in relation to suicidality in suicide attempters. Sleep 2007; 30:91.
  14. Tanskanen A, Tuomilehto J, Viinamäki H, et al. Nightmares as predictors of suicide. Sleep 2001; 24:845.
  15. Tribl GG, Wetter TC, Schredl M. Dreaming under antidepressants: a systematic review on evidence in depressive patients and healthy volunteers. Sleep Med Rev 2013; 17:133.
  16. Anderson KN, Bradley AJ. Sleep disturbance in mental health problems and neurodegenerative disease. Nat Sci Sleep 2013; 5:61.
  17. Pagel JF, Helfter P. Drug induced nightmares--an etiology based review. Hum Psychopharmacol 2003; 18:59.
  18. Foral P, Knezevich J, Dewan N, Malesker M. Medication-induced sleep disturbances. Consult Pharm 2011; 26:414.
  19. Thompson DF, Pierce DR. Drug-induced nightmares. Ann Pharmacother 1999; 33:93.
  20. Westerlund A. Central nervous system side-effects with hydrophilic and lipophilic beta-blockers. Eur J Clin Pharmacol 1985; 28 Suppl:73.
  21. Kierlin L, Littner MR. Parasomnias and antidepressant therapy: a review of the literature. Front Psychiatry 2011; 2:71.
  22. Ivani G, Vercellino C, Tonetti F. Ketamine: a new look to an old drug. Minerva Anestesiol 2003; 69:468.
  23. American Academy of Sleep Medicine. International Classification of Sleep Disorders, 3rd ed, American Academy of Sleep Medicine, Darien, IL 2014.
  24. Krakow B, Neidhardt J. Conquering Bad Dreams and Nightmares: A Guide to Understanding, Interpretation, and Cure, Berkley, New York 1992.
  25. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington, VA 2013.
  26. Boursoulian LJ, Schenck CH, Mahowald MW, Lagrange AH. Differentiating parasomnias from nocturnal seizures. J Clin Sleep Med 2012; 8:108.
  27. Paul F, Schredl M, Alpers GW. Nightmares affect the experience of sleep quality but not sleep architecture: an ambulatory polysomnographic study. Borderline Personal Disord Emot Dysregul 2015; 2:3.
  28. Simor P, Horváth K, Gombos F, et al. Disturbed dreaming and sleep quality: altered sleep architecture in subjects with frequent nightmares. Eur Arch Psychiatry Clin Neurosci 2012; 262:687.
  29. Germain A, Nielsen TA. Sleep pathophysiology in posttraumatic stress disorder and idiopathic nightmare sufferers. Biol Psychiatry 2003; 54:1092.
  30. Llorente MD, Currier MB, Norman SE, Mellman TA. Night terrors in adults: phenomenology and relationship to psychopathology. J Clin Psychiatry 1992; 53:392.
  31. Lopes FL, Nardi AE, Nascimento I, et al. Nocturnal panic attacks. Arq Neuropsiquiatr 2002; 60:717.
  32. Sarísoy G, Böke O, Arík AC, Sahin AR. Panic disorder with nocturnal panic attacks: symptoms and comorbidities. Eur Psychiatry 2008; 23:195.
  33. Freud S. The Interpretation of Dreams, Hogarth Press, London 1953.
  34. Wright ST, Kerr CW, Doroszczuk NM, et al. The impact of dreams of the deceased on bereavement: a survey of hospice caregivers. Am J Hosp Palliat Care 2014; 31:132.
  35. Begovac B, Begovac I. Dreams of deceased children and countertransference in the group psychotherapy of bereaved mothers: clinical illustration. Death Stud 2012; 36:723.
  36. Aurora RN, Zak RS, Auerbach SH, et al. Best practice guide for the treatment of nightmare disorder in adults. J Clin Sleep Med 2010; 6:389.
  37. Parasomnias: Clinical Characteristics and Treatment, Kothare SV, Ivanenko A (Eds), Springer-Verlag, New York 2013. p.187.
  38. Krakow B, Johnston L, Melendrez D, et al. An open-label trial of evidence-based cognitive behavior therapy for nightmares and insomnia in crime victims with PTSD. Am J Psychiatry 2001; 158:2043.
  39. Escamilla M, LaVoy M, Moore BA, Krakow B. Management of post-traumatic nightmares: a review of pharmacologic and nonpharmacologic treatments since 2010. Curr Psychiatry Rep 2012; 14:529.
  40. Levrier K, Marchand A, Belleville G, et al. Nightmare Frequency, Nightmare Distress and the Efficiency of Trauma-Focused Cognitive Behavioral Therapy for Post-Traumatic Stress Disorder. Arch Trauma Res 2016; 5:e33051.
  41. Ho FY, Chan CS, Tang KN. Cognitive-behavioral therapy for sleep disturbances in treating posttraumatic stress disorder symptoms: A meta-analysis of randomized controlled trials. Clin Psychol Rev 2016; 43:90.
  42. Seda G, Sanchez-Ortuno MM, Welsh CH, et al. Comparative meta-analysis of prazosin and imagery rehearsal therapy for nightmare frequency, sleep quality, and posttraumatic stress. J Clin Sleep Med 2015; 11:11.
  43. Krakow B, Hollifield M, Johnston L, et al. Imagery rehearsal therapy for chronic nightmares in sexual assault survivors with posttraumatic stress disorder: a randomized controlled trial. JAMA 2001; 286:537.
  44. Harb GC, Phelps AJ, Forbes D, et al. A critical review of the evidence base of imagery rehearsal for posttraumatic nightmares: pointing the way for future research. J Trauma Stress 2013; 26:570.
  45. Krakow B, Kellner R, Neidhardt J, et al. Imagery rehearsal treatment of chronic nightmares: with a thirty month follow-up. J Behav Ther Exp Psychiatry 1993; 24:325.
  46. Forbes D, Phelps A, McHugh T. Treatment of combat-related nightmares using imagery rehearsal: a pilot study. J Trauma Stress 2001; 14:433.
  47. George KC, Kebejian L, Ruth LJ, et al. Meta-analysis of the efficacy and safety of prazosin versus placebo for the treatment of nightmares and sleep disturbances in adults with posttraumatic stress disorder. J Trauma Dissociation 2016; 17:494.
  48. Khachatryan D, Groll D, Booij L, et al. Prazosin for treating sleep disturbances in adults with posttraumatic stress disorder: a systematic review and meta-analysis of randomized controlled trials. Gen Hosp Psychiatry 2016; 39:46.
  49. Raskind MA, Peterson K, Williams T, et al. A trial of prazosin for combat trauma PTSD with nightmares in active-duty soldiers returned from Iraq and Afghanistan. Am J Psychiatry 2013; 170:1003.
  50. Ahmadpanah M, Sabzeiee P, Hosseini SM, et al. Comparing the effect of prazosin and hydroxyzine on sleep quality in patients suffering from posttraumatic stress disorder. Neuropsychobiology 2014; 69:235.
  51. Raskind MA, Peskind ER, Hoff DJ, et al. A parallel group placebo controlled study of prazosin for trauma nightmares and sleep disturbance in combat veterans with post-traumatic stress disorder. Biol Psychiatry 2007; 61:928.
  52. Department of Veterans Affairs, Department of Defense. Clinical practice guideline for management of post-traumatic stress, version 2.0. Published October 2010. Available at: http://www.healthquality.va.gov/guidelines/MH/ptsd (Accessed on January 23, 2017).
  53. Taylor FB, Martin P, Thompson C, et al. Prazosin effects on objective sleep measures and clinical symptoms in civilian trauma posttraumatic stress disorder: a placebo-controlled study. Biol Psychiatry 2008; 63:629.
  54. Southwick SM, Bremner JD, Rasmusson A, et al. Role of norepinephrine in the pathophysiology and treatment of posttraumatic stress disorder. Biol Psychiatry 1999; 46:1192.
  55. Geracioti TD Jr, Baker DG, Ekhator NN, et al. CSF norepinephrine concentrations in posttraumatic stress disorder. Am J Psychiatry 2001; 158:1227.
  56. Nadorff MR, Lambdin KK, Germain A. Pharmacological and non-pharmacological treatments for nightmare disorder. Int Rev Psychiatry 2014; 26:225.
  57. Taylor F, Raskind MA. The alpha1-adrenergic antagonist prazosin improves sleep and nightmares in civilian trauma posttraumatic stress disorder. J Clin Psychopharmacol 2002; 22:82.
  58. Detweiler MB, Pagadala B, Candelario J, et al. Treatment of Post-Traumatic Stress Disorder Nightmares at a Veterans Affairs Medical Center. J Clin Med 2016; 5.
  59. Jetly R, Heber A, Fraser G, Boisvert D. The efficacy of nabilone, a synthetic cannabinoid, in the treatment of PTSD-associated nightmares: A preliminary randomized, double-blind, placebo-controlled cross-over design study. Psychoneuroendocrinology 2015; 51:585.