Most of the treatments were assessed to patients with PTSD. The most efficient is an alpha-blocker, Prazosin, which reduces tone during sleep by blocking noradrenergic receptors. Prazosin would significantly decrease the number of PTSD related nightmares and would therefore improve sleep quality. However, only few studies considered the effect of Prazosin in idiopathic nightmares. Benzodiazepines are also often used to treat nightmare disorder, despite the lack of efficacy demonstrated in empirical studies. Some patients were also treated with atypical antipsychotic medications. Olanzapine has quickly decreased the nightmares. Two studies have shown the positive effects of Risperidone. Aripiprazole is more tolerated than olanzapine and has demonstrated substantial improvement in the nightmare frequency. Some other drugs as clonidine, cyproheptadine, fluvoxamine, gabapentin, nabilone, phenelzine, topiramate or trazodone have presented an amelioration of the nightmares. But some further researches are needed. Epidemiology
About 4% of American adults are affected by nightmare disorders. Women seem to be more affected than men, the ratio being 2-4 : 1. This inequality decreases with aging because of a less high prevalence in elderly women. However, it is still unclear if the difference of prevalence between men and women is real or if it reflects a higher dream recall capacity of women.According to studies, children at the age of 6–10 years are 41% more likely to experience nightmares and 22% at the age of 11. Children with persistent nightmares range from 10% to 50%. However, only 1% of children meet the criteria of a nightmare disorder.
Nightmares can also have negative impact on the bed partners life. Content of idiopathic nightmares
Physical aggression is the main theme of nightmares. Other fields, such as interpersonal conflict, failure, helplessness, apprehension, being chased, accidents, evil forces, disasters, insects and environmental abnormalities may also feature in nightmares. Fear is the most frequent emotion associated with nightmares, even if other emotions such as sadness, anger, and confusion can also be present. Criteria
According to the International Classification of Sleep Disorders, the criteria needed to diagnose a nightmare disorder are the following. First, the presence of frequent nightmares that imply danger for the person and impact mood in a negative way is needed. Second, when waking up from nightmares, the person behaves in an alert way. Finally, the disorder has to have a significant impact on the patients personal, social or professional functioning, in areas like mood, sleep, cognition, behaviour, fatigue, family and occupation. Causes
Nightmares can be caused by extreme pressure or irritation if no other mental disorder is discovered. The death of a loved one or a stressful life event can be enough to cause a nightmare but conditions such as post-traumatic stress disorder and other psychiatric disorders have been known to cause nightmares as well. If the individual is on medication, the nightmares may be attributed to some side effects of the drug. Amphetamines, antidepressants, and stimulants like cocaine and caffeine can cause nightmares.