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.

Causes
- Anxiety or other psychiatric disturbances (e.g., post-traumatic stress disorder, delirium, mood disorders, schizophrenia, adjustment disorders)
- Medications, such as beta-blockers, sedative/hypnotics, amphetamines and other stimulants, dopamine agonists, and antidepressants
- Withdrawal from REM-suppressing drugs (e.g., antidepressants, benzodiazepines, alcohol)
- Brain disorders (e.g., central nervous system infections, brain tumors, other structural problems of the brain)
- Hypoglycemia

Psychotherapeutic interventions may be helpful for patients whose nightmares are related to stress/anxiety or an underlying psychiatric condition.

Pharmacologic Management
Case studies and anecdotal reports suggest that the following drugs may be effective:
- atypical antipsychotics (e.g., risperidone, olanzapine)
- alpha-1 antagonists (e.g., prazosin)
- benzodiazepines
- tricyclic antidepressants
- others (e.g., cyproheptadine, 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.