Enhancing identification and diagnosis of nightmare disorder in active duty patients at a sleep disorders center: A quality improvement initiative.
Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine January 22, 2026 Amanda Radtke, Zahari Tchopev, Philip Cushman et al.
Nightmare Disorder is underdiagnosed in active duty U.S. military personnel despite causing significant impairment. At a sleep disorders center, baseline diagnosis rate was 0.60%, yet 59.28% of referred service members reported nightmares and 19.76% screened positive for probable NDO. A quality improvement initiative using three Plan-Do-Study-Act cycles standardized Nightmare Disorder Index documentation on polysomnography reports, provided targeted provider education, and flagged charts of patients screening positive. After seven months, the diagnosis rate increased from 0.60% to 9.12%, and the recognition rate rose from 3.03% to 55.32%, surpassing the goal of 5% without delaying care or increasing staff burden.