Management of nightmares in patients with posttraumatic stress disorder: current perspectives.
Ali A El-Solh
Nature and Science of Sleep November 26, 2018 DOI: 10.2147/nss.s166089 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Review Randomized Peer reviewed |
|---|---|
| Topics | Cannabis Dreaming PTSD |
| Keywords | Prazosin Pharmacotherapy Nightmares Posttraumatic stress disorder Cognitive-behavioral therapy Image rehearsal therapy |
| Key findings | The review concludes that PTSD-related nightmares involve central brain dysfunction and neurochemical imbalance, that comorbid sleep disorders can worsen symptoms, and that treating sleep disruption may alleviate nightmares and augment other PTSD treatments. It argues that behavioral therapies remain limited by inconsistent delivery and high dropout, while pharmacological evidence is weakened by methodological limitations and missing large randomized controlled trials, supporting a call for pragmatic, individually tailored future trials. |
Abstract
Nightmares are considered the hallmark of posttraumatic stress disorder (PTSD). Although the characteristics of these distressing dreams may vary with the type of traumatic event, the pathophysiology exposes central dysfunction of brain structures at the level of the hippocampus, amygdala, and locus coeruleus, modulated by neurochemical imbalance in nor-adrenergic, dopaminergic, and serotonin pathways. Underlying comorbid conditions, including other sleep disorders, may contribute to worsening symptoms. Addressing sleep disruption can alleviate the severity of these nocturnal events and augment the effectiveness of other PTSD treatments. The expansion of behavioral treatment modalities for PTSD-related nightmares has been encouraging, but the core of these interventions is heavily structured around memory manipulation and imagery rescripting. A lack of a standardized delivery and a high dropout rate continue to pose significant challenges in achieving successful outcomes. The efficacy of existing pharmacological studies, such as α-adrenergic blocking agents, antidepressants, and atypical antipsychotics, has been undermined by methodological limitations and absence of large randomized controlled trials. This review is aimed at reviewing the available treatment strategies for alleviating nightmares in subjects with PTSD. Given the intricate relationship between PTSD and nightmares, future clinical trials have to adopt a more pragmatic approach focused not only on efficacy of novel interventions but also on adjunctive iteration of existing therapies tailored to individual socio-cultural background.
Comparable studies
Other narrative reviews on PTSD, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Psychedelic Psychiatry's Brave New World. | 2020 | Review | |
| Reviewing the Potential of Psychedelics for the Treatment of PTSD | 2020 | Review | |
| Novel psychopharmacological therapies for psychiatric disorders: psilocybin and MDMA. | 2016 | Review | |
| MDMA-assisted psychotherapy for PTSD: Are memory reconsolidation and fear extinction underlying mechanisms? | 2018 | Review | |
| Clinical applications of hallucinogens: A review. | 2016 | Review |
Citations in the library
Cited by 22
- The effectiveness of lucid dreaming therapy in patients with nightmares: A systematic review. L'Encephale October 1, 2023
- The phenomenology of nightmares in post-traumatic stress disorder and complex post-traumatic stress disorder European Journal of Trauma & Dissociation June 30, 2023
- Cannabis-assisted psychotherapy for complex dissociative posttraumatic stress disorder: A case report Frontiers in Psychiatry February 9, 2023
- Bad dream, nightmares and psychopathology: a systematic review Frontiers in Psychiatry October 8, 2024
- The Effectiveness of Imagery Rescripting Interventions for Military Veterans With Nightmares and Sleep Disturbances: A Systematic Review and Meta‐Analysis Clinical Psychology & Psychotherapy July 1, 2024
and 17 more in the library
Cites 22
- Mitigation of post‐traumatic stress symptoms by Cannabis resin: A review of the clinical and neurobiological evidence Drug Testing and Analysis June 26, 2012
- An Ambulatory Polysomnography Study of the Post-traumatic Nightmares of Post-traumatic Stress Disorder Sleep November 21, 2017
- Position Paper for the Treatment of Nightmare Disorder in Adults: An American Academy of Sleep Medicine Position Paper. Journal of Clinical Sleep Medicine June 15, 2018
- Treatment of Post-Traumatic Stress Disorder Nightmares at a Veterans Affairs Medical Center. Journal of Clinical Medicine December 16, 2016
- Nightmares and Suicide in Posttraumatic Stress Disorder: The Mediating Role of Defeat, Entrapment, and Hopelessness. Journal of Clinical Sleep Medicine March 1, 2016
and 17 more in the library