11 Even with PTSD symptoms abating, nightmares can persist a lifetime. Moreover, having nightmares shortly following a traumatic event predicts more severe PTSD symptoms 6 weeks later. 9, 10 Subjects who reported nightmares prior to trauma exhibited more severe PTSD symptoms after being exposed to a traumatic event than those who did not. However, the presence of nightmares not only influences the development of PTSD but also accelerates the progression of PTSD following trauma exposure. 8 PTSD and nightmares are intertwined in such a manner that nightmares strengthen PTSD symptoms, and PTSD in turn causes nightmares. Finally, we discuss the challenges encountered in the management of these disorders and identify future research needs.Ĭhronic nightmares in PTSD are associated with adverse consequences and decreased psychological and physiological functioning as well as disturbed sleep. We summarize the existing literature on the psychological and pharmacologic treatments of nightmares in patients with PTSD. We review studies exploring the health risks attributed to the co-occurrence of nightmares and PTSD. In this mini-review, we examine the characteristic manifestations of nightmares in PTSD. Among the factors implicated in the importunity of nightmares after trauma are persistence thoughts of helplessness and lack of control, fear and hyper-arousal, and REM disruption. ![]() 6 Irrespective of the triggering events, nightmares often persist for many decades and can be resistant to existing therapy. These patterns of nocturnal sleep disruptions are often associated with excessive somnolence, fatigue, difficulties in concentration, irritability, and feelings of helplessness, which have a detrimental effect on the individual’s quality of life. 5 Awakenings are often accompanied by an intense and prolonged sensation of fear or anxiety which causes delayed return to sleep. In most instances, the nightmares are described as replicative in nature where the trauma is being re-enacted. 4 These nightmares can occur in all stages of sleep but most frequently during the latter part of the night. The exact relation between nightmares and PTSD is still unknown but nightmares and PTSD are closely related, and both show altered activity in the same brain regions. 2 While the majority of individuals afflicted with PTSD experience sleep dysfunction, the prevalence of posttraumatic nightmares in patients with PTSD can be as high as 72%. Not surprisingly, recurrent nightmares are a central feature of posttraumatic stress disorder (PTSD) among both military combat veterans and trauma-exposed civilians. 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.Īccording to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, 1 nightmares, which are considered REM parasomnias, are defined as extreme dysphoric dreams precipitated by a life-threatening event or a perceived harm of individual’s emotional and/or physical sense of safety. This review is aimed at reviewing the available treatment strategies for alleviating nightmares in subjects with PTSD. 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. A lack of a standardized delivery and a high dropout rate continue to pose significant challenges in achieving successful outcomes. 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. Addressing sleep disruption can alleviate the severity of these nocturnal events and augment the effectiveness of other PTSD treatments. ![]() Underlying comorbid conditions, including other sleep disorders, may contribute to worsening symptoms. ![]() 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. Nightmares are considered the hallmark of posttraumatic stress disorder (PTSD).
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