Treatment of Night Terrors

First-Line Treatments

The American Academy of Sleep Medicine recommends Image Rehearsal Therapy (IRT) as the first-line treatment for nightmare disorders, including night terrors, showing significant reductions in nightmare frequency (60-72%) 1, 2, 3
IRT involves recalling the nightmare, changing negative elements to positive ones, and rehearsing the rewritten dream scenario for 10-20 minutes daily 3, 2

Prazosin is the most established medication for PTSD-related nightmares, with Level A evidence, and a starting dose of 1 mg at bedtime, gradually increasing by 1-2 mg every few days until clinical response 4, 2
The American Academy of Sleep Medicine guidelines recommend clonidine (0.2-0.6 mg in divided doses) as a primary alternative to prazosin with Level C evidence 5, 3
Trazodone may be used with an effective dose range of a standard medication dose, shown to reduce nightmare frequency from several nights per week to one night per week 5, 3

The treatment algorithm starts with Image Rehearsal Therapy as first-line treatment, followed by prazosin as the first medication option if response is inadequate 3, 2, 4
If prazosin is ineffective or poorly tolerated, consider clonidine as the next alternative 5, 3

Monitor blood pressure when using prazosin or clonidine due to potential hypotensive effects 4, 2
Untreated nightmares significantly impair quality of life, causing sleep avoidance and exacerbating psychiatric symptoms 4, 3
The American Academy of Sleep Medicine specifically does not recommend clonazepam and venlafaxine for nightmare disorder 1, 3