title: Best practice guide for the treatment of nightmare disorder in adults.
abstract: 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.
authors: Mount Sinai Medical Center, New York, NY, USA.
authors: R Nisha
authors: RN
authors: Aurora
authors: Rochelle S
authors: RS
authors: Zak
authors: Sanford H
authors: SH
authors: Auerbach
authors: Kenneth R
authors: KR
authors: Casey
authors: Susmita
authors: S
authors: Chowdhuri
authors: Anoop
authors: A
authors: Karippot
authors: Rama K
authors: RK
authors: Maganti
authors: Kannan
authors: K
authors: Ramar
authors: David A
authors: DA
authors: Kristo
authors: Sabin R
authors: SR
authors: Bista
authors: Carin I
authors: CI
authors: Lamm
authors: Timothy I
authors: TI
authors: Morgenthaler
mesh_terms: D000328:Adult; D003000:Clonidine / Q000627:therapeutic use; D015928:Cognitive Behavioral Therapy / Q000379:methods; D004325:Dreams / Q000187:drug effects / Q000523:psychology*; D019317:Evidence-Based Medicine; D057169:Eye Movement Desensitization Reprocessing; D006801:Humans; D006990:Hypnosis; D009638:Norepinephrine / Q000037:antagonists & inhibitors; D011224:Prazosin / Q000627:therapeutic use; D011619:Psychotropic Drugs / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D012064:Relaxation Therapy; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000628:therapy*
chemical_list: D011619:Psychotropic Drugs; D003000:Clonidine; D009638:Norepinephrine; D011224:Prazosin