Sleep-Wake Disorders
Nightmare Disorder
ICD-10-CM: F51.5
1. Criteria
DSM Criteria
Criterion A
- There are repeated occurrences of extended, extremely dysphoric, and well-remembered dreams that usually involve efforts to avoid threats to survival, security, or physical integrity.
DSM Criteria
Criterion B
- On awakening from the dysphoric dreams, the person rapidly becomes oriented and alert.
DSM Criteria
Criterion C
- The sleep disturbance causes clinically significant distress or impairment.
DSM Criteria
Criterion D
- The nightmare symptoms are not attributable to a substance or medication.
DSM Criteria
Criterion E
- Coexisting mental and medical disorders do not adequately explain the predominant complaint of dysphoric dreams.
2. Context
- Nightmare disorder involves repeated, vividly remembered dysphoric dreams that typically center on threats to survival, safety, or physical integrity and leave the person alert and distressed after awakening. The diagnosis becomes clinically relevant when the dreams are recurrent enough to disrupt sleep, mood, or daytime functioning.
- Recall is usually clear: Unlike some other parasomnias, patients usually awaken quickly and can recall the dream content in detail.
- Daytime effect: The dreams matter most clinically when they begin causing avoidance, sleep loss, anticipatory anxiety, or daytime impairment.
- Context matters: Trauma history, PTSD symptoms, medications, and substance use are important parts of the workup.
- Clinical focus: Useful when tracking recurrence and treatment response over time.
3. Validated scales
Nightmare Frequency Questionnaire
Useful when tracking recurrence and treatment response over time.
Pittsburgh Sleep Quality Index
Helpful for broader sleep disruption around nightmares.
PCL-5
Important when trauma-related nightmares are part of a broader PTSD picture.
4. FDA approved treatments
Diagnosis-specific FDA indications
This prototype does not list a core nightmare-disorder-specific FDA medication indication; management often depends on cause, trauma context, and sleep history.
No diagnosis-specific FDA medication entry is listed in this prototype section.
Common off-label medications
Interventional psychiatry modalities
- Imagery rehearsal therapy is often a more central intervention than medication alone.
- Interventional psychiatry procedures are not standard treatments for nightmare disorder itself.
- ECT, TMS, and ketamine are not standard nightmare-disorder treatments.
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5. Top management articles
- Management review for Nightmare Disorder PubMed search
- Nightmare Disorder treatment guideline PubMed search
- Nightmare Disorder pharmacotherapy or psychotherapy review PubMed search