Psychiatria pre prax 2/2014

Nightmares and the possibilities of their treatment

Nightmares are dreamlike experiences filled with fear and anxiety. They accompany mankind from everlasting. The first mention of nightmares is already in the Bible. Nightmares may occur both in persons with mental illness as well as may be accompanied by a mental disorder. They are often associated with posttraumatic stress dissorder (PTSD). Themes of nightmares may be related to past events, when during nightmares reoccur memories on traumatic, unresolved or inadequately mastered event, or may be related to the future. After waking from nightmare is an individual fastly awake and able to react. Pacient remembers his dream both immediately after waking up, as well as in the morning. Topics of nightmares often repeat. Rarerly patients come to psychiatrist directly with complains of nightmares. More often they entrust with them during describing their sleep problems. They are classified into group of parasomnias. Nightmares may be also induced by variety of drugs. They may also occur in abrupt withdrawal of drugs that suppress REM phase of sleep. Generally, in case of nightmares related to past events, it is appropriate to return to these events during therapy or consider behavioral changes. In case of nightmares regarding to the future the therapy should focus on problem solving or assistance with concrete steps. The goal of the treatment is not just “improving sleep”. There are several possible therapeutic approaches useful in treatment of nightmares in PTSD. As for psychotropic drugs, prazosin was assessed, with a positive effect on sleep architecture. As for psychotherapeutical approaches, clinical effect was observed in the cognitive-behavioral therapy focused on nightmares (imagery rehearsal therapy – IRT).

Keywords: nightmares, posttraumatic stress dissorder, cognitive behavioral therapy, imagery rehearsal therapy.