Nightmares are vivid, frightening dreams that typically lead to full awakening with detailed recollection of the dream sequence and content. Following a nightmare, heart rate and blood pressure are elevated, and residual anxiety may interfere with the ability to return to sleep. They occur almost exclusively during REM (Rapid Eye Movement) sleep.
- Anxiety or other psychiatric disturbances (such as post-traumatic stress disorder, delirium, mood disorders, schizophrenia, and adjustment disorders).
- Medications: beta-blockers, sedative/hypnotics, amphetamines and other stimulants, dopamine agonists, and antidepressants.
- Withdrawal from REM-suppressing drugs: antidepressants, benzodiazepines, and alcohol.
- Brain disorders. CNS infections, brain tumors and other structural problems of the brain.
Psychotherapeutic interventions can be helpful for patients whose nightmares are related to stress/anxiety or an underlying psychiatric condition.
Pharmacologic management - case studies and anecdotal reports suggest the following drugs may be effective:
- Atypical antipsychotics: risperidone and olanzapine
- Alpha-1 antagonists: prazosin
- Tricyclic antidepressants
- Other: cyproheptadine and topiramate
See reference for more information.
Adapted from Malhotra S, Arnold R, Patterson K. Nightmares. Palliative Care Network of Wisconsin. Fast facts and concepts #88. Internet. Accessed on May 6, 2018.