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

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.

The pathophysiology of nightmare disorder: Signs of impaired sleep regulation and hyperarousal

“…This idea is supported by the lack of evidence presented in the review concerning sleep microstructural abnormalities in nightmare disorder. The authors propose that future studies are warranted to “clarify whether phenomena such as (micro‐) arousals during REM sleep and REM sleep fragmentation […] are also observed in nightmares” (Gieselmann et al., , p. 9). Here, we would like to highlight some of the already existing studies on the pathophysiology of nightmare disorder, that in fact suggest that enhanced hyperarousal and impaired sleep regulation are prominent features of this sleep disorder.…”

“…Current diagnostics (based on self-report questionnaires) and treatment protocols (e.g. Imagery Rehearsal Therapy) presented in the review of Gieselmann et al (2019) suggest that nightmare disorder is mainly a subjective complaint that can only be captured by the subjective reports of the patients. This idea is supported by the lack of evidence presented in the review concerning sleep microstructural abnormalities in nightmare disorder.…”

Remediation of PTSD in a Combat Veteran: A Case Study

“…Extinction methods are suppressive (Dunsmoor, Niv, Daw, & Phelps, 2015). They compete against unwanted learning by building up preferred learning and reactions intended to override and suppress the adverse response (Gieselmann et al, 2019). Furthermore, extinction is imperfect, and while some emotional responses may weaken and discontinue, other less desirable emotions are evoked or triggered due to unforeseen circumstances (Pfitzer, 2008).…”

Bad dreams, bedtime anxiety, and trait anxiety in school-aged children

“…The prevalence of frequent nightmares, typically defined as one nightmare or more per week, is estimated to be around 5% in children [1,14]. Nightmare etiology is best explained by a diatheses-stress model, i.e., genetics, trait factors, as well as state factors con-tribute to the occurrence of nightmares [8,13]. Most of the research looking into factors associated with nightmares, however, has focused on young adults [8,13].…”