Nightmares

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 prazosin 1 (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.

REFERENCES

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4. Akinsanya, A., Marwaha, R., Tampi, R.R. (2017) Prazosin in Children and Adolescents With Posttraumatic Stress Disorder Who Have Nightmares: A Systematic Review. Journal of Clinical Psychopharmacology, 37(1):84–88.

Moturi, S., Avis, K. (2010) Assessment and Treatment of Common Pediatric Sleep Disorders. Psychiatry, 7(6):24–37.

Roberts, J. M., Lennings, C. J. (2011) Nightmares. Encyclopedia of Adolescence:1887–1894. doi:10.1007/978-1-4419-1695-2_100

Stores, G. (2001) A clinical guide to sleep disorders in children and adolescents. Cambridge: Cambridge University Press.

OTHER RESOURCES

American Academy of Sleep Medicine: https://aasm.org/ National Sleep Foundation: https://www.sleepfoundation.org/articles/children-and-bedtimefears-and-nightmares