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Review
. 2019 Aug;28(4):e12820.
doi: 10.1111/jsr.12820. Epub 2019 Jan 29.

Aetiology and treatment of nightmare disorder: State of the art and future perspectives

Annika Gieselmann  1 , Malik Ait Aoudia  2 , Michelle Carr  3 , Anne Germain  4 , Robert Gorzka  5 , Brigitte Holzinger  6 , Birgit Kleim  7 , Barry Krakow  8 , Anna E Kunze  9 , Jaap Lancee  10 , Michael R Nadorff  11 , Tore Nielsen  12 , Dieter Riemann  13 , Hinuga Sandahl  14 , Angelika A Schlarb  15 , Carolin Schmid  16 , Michael Schredl  17 , Victor I Spoormaker  18 , Regina Steil  16 , Annette M van Schagen  19 , Lutz Wittmann  20 , Maria Zschoche  15 , Reinhard Pietrowsky  1
Affiliations
Review

Aetiology and treatment of nightmare disorder: State of the art and future perspectives

Annika Gieselmann et al. J Sleep Res. 2019 Aug.

Abstract

This consensus paper provides an overview of the state of the art in research on the aetiology and treatment of nightmare disorder and outlines further perspectives on these issues. It presents a definition of nightmares and nightmare disorder followed by epidemiological findings, and then explains existing models of nightmare aetiology in traumatized and non-traumatized individuals. Chronic nightmares develop through the interaction of elevated hyperarousal and impaired fear extinction. This interplay is assumed to be facilitated by trait affect distress elicited by traumatic experiences, early childhood adversity and trait susceptibility, as well as by elevated thought suppression and potentially sleep-disordered breathing. Accordingly, different treatment options for nightmares focus on their meaning, on the chronic repetition of the nightmare or on maladaptive beliefs. Clinically, knowledge of healthcare providers about nightmare disorder and the delivery of evidence-based interventions in the healthcare system is discussed. Based on these findings, we highlight some future perspectives and potential further developments of nightmare treatments and research into nightmare aetiology.

Keywords: PTSD; anxiety; evidence-based medicine; exposure; imagery (psychotherapy); nightmare scripts; parasomnias; posttraumatic stress disorders; sleep-disorders.

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Conflict of interest statement

Anne Germain owns equity in and serves as CEO for Rehat, LLC and received a consulting honorarium from Jazz Pharmaceuticals. Barry Krakow sells products and services for the treatment of nightmares via his website and owns and operates the commercial sleep center Maimonides Sleep Arts & Sciences, Ltd. Annika Gieselmann, Malik Ait Aoudia, Michelle Carr, Robert Gorzka, Brigitte Holzinger, Birgit Kleim, Anna E. Kunze, Jaap Lancee, Michael R. Nadorff, Tore Nielsen, Dieter Riemann, Hinuga Sandahl, Angelika A. Schlarb, Carolin Schmid, Michael Schredl, Victor I. Spoormaker, Regina Steil, Annette M. van Schagen, Lutz Wittmann, Maria Zschoche and Reinhard Pietrowsky declare that they do not have any conflict of interests.

Figures

Figure 1
Figure 1
Integrative model of nightmare aetiology
Figure 2
Figure 2
Frequently applied trauma‐focused interventions and proposed alternative approaches
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