Nightmares CLINICAL PEARLS • Nightmares are common in children and typically resolve by age six (but may increase again during adolescence), reassurance of parental anxiety is important. • Nightmares are a core feature in Post-Traumatic Stress Disorder and are also seen in anxiety and affective disorders; ruling out an underlying diagnosis is important. • Nightmares and other sleep disturbances can cause stress on family systems. • First-line treatment should include psychoeducation and behavioral management. • Medications (if indicated) for treatment should be short-term and in conjunction with behavioral therapy. • Nightmares differ from night terrors, which are often more distressing to the family opposed to the child. RATING SCALES • Limited scales for assessment, consider use of a sleep log that documents sleep and nightmares. https://www.choc.org/wp/wp-content/uploads/2016/04/Children-Sleep-Diary-Vers_2.pdf TREATMENT APPROACH Stage 1: Review current prescribed and over-the-counter medications to ensure they are not exacerbating problem (e.g. antidepressants, stimulants and neuroleptics). 1A: Sleep Hygiene (see resources below). Stage 2: In-office techniques; progressive muscle relaxation, imagery rehearsal, etc. (see resources below). Stage 3: Refer to licensed therapist. Stage 4: If therapy not effective, consider use of prazosin1 (important to counsel family on the expectation of decreased number of nightmares as opposed to total elimination).* *Long-term treatment with medications is not recommended.
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