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By K K Jain MD

Nightmares are also known as or subsume Dream anxiety attacks and Incubus. -ed.

The American Academy of Sleep Medicine classifies nightmares as one of the REM sleep parasomnias and defines them as "disturbing mental experiences that usually awaken the dreamer from REM sleep." Nightmares are associated with a number of neurologic and neuropsychiatric disorders, which include Parkinson disease, posttraumatic stress disorder, schizophrenia, and temporal lobe epilepsy. Adverse effects of several drugs manifest as nightmares. This clinical article includes a discussion of possible pathomechanisms and differential diagnoses of nightmares. Approaches to management include behavioral or psychological treatment programs as well as pharmacotherapy including drugs such as gabapentin and prazosin.

Key Points

  • Infrequent nightmares are common.
  • Frequent nightmares may occur in association with some psychiatric and neurologic disorders.
  • Behavioral or psychological treatment approaches have been used with a variable degree of success.
  • A number of pharmacological agents such as benzodiazepines and antiepileptic drugs have been used for symptomatic control.
  • An alpha1-adrenergic antagonist prazosin has been proposed as a treatment for nightmares associated with posttraumatic stress disorder.