Recently, the Standards of Practice Committee (SPC) of the American Academy of Sleep Medicine (AASM) commissioned a task force to assess the literature on the treatment of NM disorder in general. Therefore, new psychological and pharmacological treatments are emerging and tested to directly reduce NMs. As these NMs disrupt sleep, it can be difficult for the victims to return to sleep and they may adopt unsuitable sleep hygiene, which could lead to insomnia. The idea is that the person, by fearing and avoiding NM content, cannot process the information related to the event and cannot incorporate it. Later, at a second stage, they would become a learned behavior distinct from PTSD symptoms. First, right after the trauma, NMs would be considered as trauma-induced and would be a PTSD symptom. One approach is to conceptualize NMs in two steps after a traumatic event. Emergence of treatments directly targeting nightmares In fact, NMs were found to be treatment resistant, and residual insomnia was also reported. However, studies also reveal that CBTs and SSRIs do not effectively resolve all PTSD symptoms in individuals who no longer meet PTSD diagnosis criteria. They also emphasize the efficacy of selective serotonin reuptake inhibitors (SSRIs) as a pharmacological treatment.
Several meta-analyses, systematic reviews, and guidelines underline that general trauma-focused cognitive and behavioral treatments (CBTs) (through exposure and cognitive restructuring) are superior, or equivalent, to other types of psychological treatments, such as eye movement desensitization and reprocessing (EMDR), psychodynamic psychotherapies, or supportive techniques (e.g., ). Now, it is part of the trauma- and stressor-related disorders in the DSM-5.
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PTSD used to be considered as an anxiety disorder in the fourth edition revised Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). They could even contribute to PTSD symptom maintenance. However, in the particular PTSD context, the presence of NM seems to be related to PTSD prevalence and severity, and therefore, to contribute to the development of PTSD. In the general population, sleep loss impacts daily functioning due to fatigue and cognitive difficulties, leading to poor quality of life. Another distinction is their role in PTSD. Their content may vary from an exact replay to only some components of the trauma, such as changes in time and place. Post-traumatic nightmares (PTNMs) are different from “normal” dreams as they are recurrent frightening dreams of past traumatic events. The prevalence of frequent NM is 70% in individuals with PTSD compared to only 2–5% in the general population. Nightmares (NM) are one of the intrusion symptom clusters of post-traumatic stress disorder (PTSD) in the fifth edition Diagnostic and Statistical Manual of Mental Disorders (DSM-5). These findings are significant to the literature on PTSD and future studies should consider them. Specific NM treatments (Prazosin or CBTs) contribute to PTNM reduction and reduce PTSD and sleep symptoms. Conclusions: Prazosin had a large impact on PTNM reduction, while CBTs had a moderate impact.
The combined effect size (ES) for Prazosin was g = 1.30, 95% CI, and for CBTs, it was g = 0.55, 95% CI. Results: The final sample was composed of 26 studies. Method: A systematic search of English and French clinical studies on any CBTs and Prazosin treatments for PTNMs published from 1980 to 2012 was conducted in PsycINFO, MedLine, PILOTS,and ProQuest Dissertations and Theses. A second aim was to explore the impact of these treatments in general PTSD symptoms and sleep. Objectives: The first objective was to evaluate the impact of CBTs for NM and Prazosin on the reduction of PTNMs in an adult population. New cognitive and behavioral treatments (CBTs) for nightmares (NM) and pharmacological treatments, such as Prazosin, have been developed to directly reduce PTNMs. Post-traumatic nightmares (PTNMs) can be treatment resistant to conventional treatments for post-traumatic stress disorder (PTSD).
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