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Behavioral Sleep Clinics | April 2011 | Sleep Review

A New Home for Nightmare Treatment

behavioral-nightmareMilitary personnel returning from wars in Afghanistan and Iraq show increasing rates of post-traumatic stress disorder (PTSD) and post-traumatic nightmares. Media coverage of these two vexing mental health conditions is also intensifying and raising public awareness about the need for more effective therapeutic options. With growing attention focused on patients with nightmares, sleep centers have an opportunity to engage these patients. Successfully doing so hinges on applying a standard of care for nightmare assessment and treatment through behavioral sleep medicine specialists.


Traditionally, nightmares reflect emotional turmoil that needs venting through the process of dreaming. This psychological perspective fuels the entrenched and enduring focus on dream interpretation therapy as one of two core treatments for this potent sleep disrupter. The other primary approach known as exposure therapy is gaining ascendency in the mental health community because of the prevailing view that PTSD—the cause of the disturbing dreams—must be treated first. As the theory goes, the nightmares will resolve when their cause is treated. Yet, both these treatment paradigms (dream interpretation and exposure) trigger treatment avoidance among nightmare patients because of their fear of unmasking unpleasant mental health issues. Although this paradox creates an opening for nightmare patients to seek help outside of mental health facilities, it is rare for sleep medicine clinics to encounter patients seeking treatment exclusively for nightmares.