ABSTRACT
Sleep medicine specialists view the problem of chronic nightmare disorder as an independent sleep disorder. When patients seek treatment for chronic nightmares, a direct intervention may be offered regardless of the putative causes. In contrast, sleep medicine does not view nightmares exclusively as a symptomatic feature of a primary disorder, whereas the psychiatric community and its nosology have long maintained that nightmares are best understood as a secondary phenomenon for which treatment need only be directed at the inciting disorder. This chapter presents a direct nightmare treatment with either desensitization techniques or imagery rehearsal therapy (IRT) markedly decreasing chronic nightmare frequency as well as distress-symptom severity, notably anxiety and posttraumatic stress symptoms. At the locations where IRT was in more frequent use, individual practitioners described the approach of offering a patient a starting point with either IRT for nightmares or exposure therapy for Posttraumatic Stress Disorder (PTSD).
