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The Best Practice Guide endorses treatments based on review of the literature and with agreement by a consensus of the task force.
These guidelines should not, however, be considered inclusive of all proper methods of care or exclusive of other methods of care reasonably directed to obtaining the same results. The ultimate judgment regarding propriety of any specific care must be made by the physician, in light of the individual circumstances presented by the patient, available diagnostic tools, accessible treatment options, and resources.
The AASM expects these recommendations to have an impact on professional behavior, patient outcomes, and, possibly, health care costs.
These assessments reflect the state of knowledge at the time of publication and will be reviewed, updated, and revised as new information becomes available. Recurrent episodes of awakenings from sleep with recall of intensely disturbing dream mentations, usually involving fear or anxiety, but also anger, sadness, disgust, and other dysphoric emotions.
Full alertness on awakening, with little confusion or disorientation; recall of sleep mentation is immediate and clear. At least one of the following associated features is present: i.
Delayed return to sleep after the episodes ii. Occurrence of episodes in the latter half of the habitual sleep period.
Presence of nightmares following a traumatic experience predicts delayed onset of PTSD. It is not clear if these different types of nightmares have a common underlying pathophysiology.
The presence of nightmare disorder can impair quality of life, resulting in sleep avoidance and sleep deprivation, with a consequent increase in the intensity of the nightmares. Nightmare disorder can also predispose to insomnia, daytime sleepiness, and fatigue.
Nightmare disorder can be associated with waking psychological dysfunction, with the frequency of nightmares being inversely correlated with measures of well-being and measures of nightmare distress being associated with psychopathology such as depression and anxiety.
Treatment modalities for nightmare disorder include medications, most prominently prazosin, and several behavioral therapies, of which the nightmare-focused cognitive behavioral therapy variants, especially image rehearsal therapy, are effective.