The evidence basis for this Best Practice Guide includes only those PTSD studies in which improvement in nightmares could be specifically identified as an evaluable outcome measure.Įach search was run separately and findings were merged. Although the majority of studies of both pharmacologic and nonpharmacologic treatments of posttraumatic stress disorder (PTSD) assess improvement of global manifestations, very few of these studies have isolated nightmares for evaluation of response to intervention and may not have included “nightmares” as a keyword. “Post-traumatic stress disorder,” alone, was not a search term. A second search using the keyword combination “anxiety dreams” with no limits was also conducted in February 2010. The PubMed search was conducted with no start date limit until February 2008, and subsequently updated in March 2009 to include the most current literature. Other databases such as PsychLit and Ovid were not searched, since it was felt that these databases would not include clinically relevant material. A search for articles on the medical treatment of nightmare disorder was conducted using the PubMed database, so that clinically relevant articles on the treatment of nightmare disorder could be collected and evaluated. Work began in December 2007 to review and grade evidence in the peer-reviewed scientific literature regarding the treatment of nightmare disorder in adults. The SPC of the AASM commissioned among its members 7 individuals to conduct this review and develop best practice principles. No recommendation is made regarding clonazepam and individual psychotherapy because of sparse data. The following behavioral therapies may be considered for treatment of nightmare disorder based on low-grade evidence: Lucid Dreaming Therapy and Self-Exposure Therapy. 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. Nefazodone is not recommended as first line therapy for nightmare disorder because of the increased risk of hepatotoxicity. 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. Level BĬlonidine may be considered for treatment of PTSD-associated nightmares. Venlafaxine is not suggested for treatment of PTSD-associated nightmares. Systematic Desensitization and Progressive Deep Muscle Relaxation training are suggested for treatment of idiopathic nightmares. Image Rehearsal Therapy (IRT) is recommended for treatment of nightmare disorder. Prazosin is recommended for treatment of Posttraumatic Stress Disorder (PTSD)-associated nightmares.
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