Chronic nightmares arise from an interaction between elevated hyperarousal and impaired fear extinction, facilitated by trait affect distress from traumatic experiences, early childhood adversity, trait susceptibility, elevated thought suppression, and potentially sleep-disordered breathing. Treatment options target nightmare meaning, chronic repetition, or maladaptive beliefs. The paper reviews epidemiological findings, aetiology models for traumatized and non-traumatized individuals, and evidence-based interventions, noting gaps in healthcare provider knowledge and delivery. Future perspectives for nightmare treatment and aetiology research are outlined.
Nightmares are a strong and changeable predictor of higher suicide risk and poor mental health outcomes, yet they are rarely screened for or treated, even in sleep clinics. In two U.S. surveys, only 37.8% of people with clinically significant nightmares in one sample and 11.1% in another had discussed them with a healthcare provider. Among those with significant nightmares, fewer than one-third believed nightmares were treatable. Greater nightmare severity made people more likely to report them but also less likely to believe they could be treated. The findings indicate that nightmares are seldom reported to healthcare providers, which may explain why effective treatments are underused, and support routine nightmare screening.
Nightmare disorder is clinically significant and linked to post-traumatic stress disorder, other psychiatric conditions, and suicidality. Imagery rehearsal therapy and prazosin are leading treatments. The paper proposes using these treatments as first-line interventions for PTSD and as adjunctive therapy to reduce suicide risk in individuals with nightmares.