Nightmare Disorder Treatment & Management

Updated: Aug 08, 2018
  • Author: Daniel R Neuspiel, MD, MPH, FAAP; Chief Editor: Caroly Pataki, MD  more...
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Medical Care

Reassurance and conservative management is the only treatment required for sporadic nightmares.

Daytime stressors should be identified and resolution attempted. Bedtime should become a safe and comfortable time when parents read to and talk with the child. Parents should monitor media exposure, as this influences dream content. [15] Television viewing should be avoided for about 2 hours prior to bedtime. [16]

The most common strategies reported by children for handling their nightmares include ignoring/distraction, talking to parents, or hugging soft toys. [3]

Several different cognitive-behavioral methods have been reported to be effective in treating nightmares in children. [17]

Hypnosis has been reported to be effective in treating nightmares and other parasomnias in children and adults. [16]

If the nightmare is recurrent, discussing dream content and rescripting may help.

In adults with PTSD-associated nightmares, image rehearsal therapy is recommended. Other treatments that may be considered for PTSD-associated nightmares include cognitive behavioral therapy; eye movement desensitization and reprocessing; exposure, relaxation, and rescripting therapy; the atypical antipsychotics olanzapine, risperidone, and aripiprazole; clonidine; cyproheptadine; fluvoxamine; gabapentin; nabilone; phenelzine; prazosin; topiramate; trazodone; and tricyclic antidepressants. [Morgenthaler et al, 2018]

In adults with nightmare disorder, the following treatments may be considered: cognitive behavioral therapy; exposure, relaxation, and rescripting therapy; hypnosis; lucid dreaming therapy; progressive deep muscle relaxation; sleep dynamic therapy; self-exposure therapy; systematic desensitization; testimony method; nitrazepam; prazosin; and triazolam. [18]

Clonazepam and venlafaxine are not recommended for the treatment of nightmare disorder in adults. [18]



Psychiatric intervention may be warranted for various therapies.

Psychological evaluation is indicated for patients whose nightmares occur more than twice a week over a period of several months or when the nightmares are of great severity.