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What Is The Best Treatment For Nightmare Disorder?

Nightmare disorder is a disorder characterized by many nightmares more than once a week. It is marked by threatening and frightening dreams that disrupt sleep. It leads to a chain of negative thoughts in the mind such as fear or anxiety after waking up. It is usually induced by stress, anxiety and any traumatic event in life. It can affect anyone at any age. It affects females than males. In certain cases, may remain throughout life in adults. If its underlying causes are detected and treated well, then nightmares can be managed well.

What Is The Best Treatment For Nightmare Disorder?

What Is The Best Treatment For Nightmare Disorder?

Nightmare disorder is called parasomnia in which undesirable experiences appear in the dream that wakes you up. It appears in the second stage of sleep.(1) It can develop at any age. Females are more affected by males. It can affect small children between 3 to 6 years. But in adults, it may remain throughout their lives.(3)

Nightmares may happen rarely in one’s life or may happen frequently or many times in a single night. Its episodes may occur frequently briefly that may awaken you at night. It becomes very difficult to get back to sleep after waking up.(3)

According to Morgenthaler et al, 2018, the treatment of nightmares accompanied by PTSD (post-traumatic stress disorder) is different as both of them form a different disorder. Such cases of nightmares associated with PTSD are treated with cognitive behavioral therapy, cognitive behavioral therapy of insomnia, image rehearsal therapy, and therapy that focus on exposure, relaxation and rescripting the dream. Image rehearsal therapy is considered the best treatment option for nightmare disorder associated with PTSD.(2)

Image rehearsal therapy affects one’s way of thinking. It changes the ending of the remembered nightmare which usually disrupts your sleep. These dreams prohibit sleeping back. These dreams trigger a negative feeling like sadness, fright, anxiety, etc. with this therapy. The dreams are no longer threatening. You are asked to rehearse for the new ending of the dream in your mind. This therapy has the potential to reduce nightmares associated with PTSD.(3)

Medicines such as clonidine, prazosin, gabapentin, etc. are used to treated nightmares with PTSD. Prazosin is the best medicine to treat high blood pressure, anxiety and PTSD. It is most research and regularly used for nightmares and PTSD.(2)

Nightmare disorder without PTSD is treated with psychological treatments such as hypnosis, cognitive behavioral therapy, lucid dreaming therapy, sleep dynamic therapy, self-exposure therapy, exposure, relaxation, and rescripting therapy, and systematic desensitization. Many medicines are helpful to treat nightmares. It involves prazosin and triazolam. Prazosin is the best medicine for treating nightmares and sleep disorders. It works by decreasing the outflow of sympathetic impulses from the brain. it is the first line of choice for treatment of nightmares.(2)

Exposure, relaxation and rescripting therapy is modified form of image rehearsal therapy but not researched well. It reduces anxiety and helps in coping strategies. It can decrease the intensity and frequency of nightmares.(2)

Sleep dynamic therapy can be also a promising treatment for nightmares as it focuses on sleep hygiene, sleep quality, and stimulus control. It can decrease the incidences of nightmares that are long-lasting.(2)

When the underlying cause of nightmares is detected, then management of the medical condition may help in treating nightmares. Your physician can help to treat nightmares in association with a mental health professional if stress or anxieties are found to be the cause of the nightmares.(3)


Nightmare disorder is represented by negative feelings such as fear or anxiety. If it is associated with PTSD, its best treatment is image rehearsal therapy. If it is not associated with PTSD, its best treatment is psychological therapies such as sleep dynamic therapy, behavioral cognitive therapy, and others mentioned above.


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Sheetal DeCaria, M.D.
Sheetal DeCaria, M.D.
Written, Edited or Reviewed By: Sheetal DeCaria, M.D. This article does not provide medical advice. See disclaimer
Last Modified On:October 14, 2019

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