Nightmare Disorder Treatment

First-Line Treatment

• The American Academy of Sleep Medicine recommends Image Rehearsal Therapy (IRT) as the first-line treatment for nightmare disorder, showing a 60-72% reduction in nightmare frequency 1, 3.

Pharmacological Options for Nightmares

• For PTSD-associated nightmares, the American Academy of Sleep Medicine suggests prazosin as the most established medication with Level A evidence, starting at 1 mg at bedtime and titrating by 1-2 mg every few days 4.
• Clonidine (0.2-0.6 mg divided doses) is an alternative with Level C evidence for PTSD-associated nightmares 4.
• For non-PTSD nightmare disorder, prazosin, nitrazepam, and triazolam may be used 1.
• The American Academy of Sleep Medicine notes that clonazepam and venlafaxine are not recommended for nightmare disorder, as they show no benefit over placebo 1, 2, 5.

Monitoring Requirements

• Blood pressure should be monitored when using prazosin or clonidine due to the risk of orthostatic hypotension 4, 2, 5.
• Trazodone carries a risk of priapism, daytime sedation, and dizziness 4, 5.