Management of Nightmare Disorder in Adults

Erin D. Callen, PharmD, BCPS; Tiffany L. Kessler, PharmD, BCPS; Krista G. Brooks, PharmD; Tom W. Davis, MD


US Pharmacist. 2018;43(11):21-26. 

In This Article

Abstract and Introduction


Occasional nightmares are fairly common, but nightmare disorder occurs in 2% to 6% of adults. Recurrent nightmares may be idiopathic, but they are often related to posttraumatic stress disorder (PTSD), underlying psychiatric disorders, or medication use. The American Academy of Sleep Medicine's 2018 position paper provides guidance on nonpharmacologic and pharmacologic treatment. Behavioral intervention with imagery-rehearsal therapy is currently the only treatment strategy recommended for all patients with recurrent nightmares. Prazosin may be used to treat both PTSDassociated and idiopathic nightmare disorder. Antidepressants, anxiolytics, anticonvulsants, antipsychotics, and other agents have been studied, with mixed results.


Nightmares are vivid, disturbing, or frightening nocturnal episodes that often involve intense feelings of dread, humiliation, or failure. The International Classification of Sleep Disorders, Third Edition (ICSD-3), defines nightmare disorder as a parasomnia (i.e., abnormal or unusual nervous-system behavior during sleep) usually associated with rapid-eyemovement sleep. The minimal diagnostic criteria include recurrent episodes of awakenings from disturbed dreams, full alertness on awakening with clear recall of dream, and either delayed return to sleep or occurrence of the episode in the second half of the sleep period.[1–3]