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Nightmares often improve with successful treatment of the primary psychiatric disorder (eg, anxiety, depression, PTSD). (See 'Treatment of co-occurring psychiatric disorders' above.) Severe and chronic nightmares – Treatments include psychotherapy and medication. The choice can be individualized according to patient preferences and access to Level C. The following medications may be considered for treatment of PTSD-associated nightmares, but the data are low grade and sparse: trazodone, atypical antipsychotic medications, topiramate, low dose cortisol, fluvoxamine, triazolam and nitrazepam, phenelzine, gabapentin, cyproheptadine, and tricyclic antidepressants. The dosage can vary widely depending on the individual’s needs and response to the medication. Generally, the starting dose might be around 300 mg per day, taken in divided doses, and can be increased up to 3600 mg per day in some cases. Gabapentin is often used in combination with other treatments for PTSD. The following medications may be considered for treatment of PTSD-associated nightmares, but the data are low grade and sparse: trazodone, atypical antipsychotic medications, topiramate, low dose cortisol, fluvoxamine, triazolam and nitrazepam, phenelzine, gabapentin, cyproheptadine, and tricyclic antidepressants. On day 3, the gabapentin was increased to 300 mg b.i.d., which further reduced his irritability. His sleep increased to 6 hours a night without awakenings. Over the course of 3 months, Mr. A noted a distinct reduction in nightmares and flashbacks, and his depression improved. The following medications may be considered for treatment of PTSD-associated nightmares, but the data are low grade and sparse: trazodone, atypical antipsychotic medications, topiramate, low dose cortisol, fluvoxamine, triazolam and nitrazepam, phenelzine, gabapentin, cyproheptadine, and tricyclic antidepressants. Gabapentin: Gabapentin does a few different things. It’s an anticonvulsant, but it can also help with neuropathic pain, anxiety, and sleep. Only one small study was reported to support its use for nightmares. The dosage of phenelzine varied between 45 and 75 mg. Phenelzine eliminated nightmares entirely within 1 month with no recurrence on long-term follow-up (up to 18 months) and 3 out of the 5 patients remaining nightmare-free without medication. However, gabapentin was successful in treating anxiety, nightmares, and insomnia in patients with post-traumatic stress disorder, including those who also suffered from MDD [216, 217]. Gabapentin Dosage and Administration for Sleep. When it comes to using gabapentin for sleep, determining the right dosage is crucial for maximizing benefits while minimizing potential side effects. The typical dosage range for sleep can vary widely, but most studies have used doses between 300mg and 600mg taken before bedtime. The gabapentin was often first prescribed to facilitate sleep. The majority (77%) of patients showed moderate or greater improvement in duration of sleep, and most noted a decrease in the frequency of nightmares. The dose range was 300-3600 mg/day. Sedation and mild dizziness were the most commonly reported side effects. I take a small dose of 200 mg at night and 100 mg in the morning for neuropathy. I’ve been having weird dreams which sometimes include vivid smells. This morning at 4:30 I smelled eggs frying and my husband, who I saw on the stairs, said there are scrambled eggs if you want some. Posttraumatic stress disorder (PTSD) can be a chronic and disabling condition. Post-traumatic nightmares (PTNs) form a core component of PTSD and are highly prevalent in this patient population. Nightmares in PTSD have been associated with significant distress, functional impairment, poor health outcomes, and decreased quality of life. Nightmares in PTSD are also an independent risk factor for Gabapentin: A single retrospective study of gabapentin in patients with PTSD showed a marked or moderate improvement in sleep, as well as a decreased frequency or intensity of nightmares. 28 Detailed Gabapentin dosage information for adults and children. Includes dosages for Restless Legs Syndrome, Epilepsy and Postherpetic Neuralgia; plus renal, liver and dialysis adjustments. PTSD-associated nightmares, but the data are low grade and sparse: trazodone, atypical antipsychotic medications, topi-ramate, low dose cortisol, fluvoxamine, triazolam and nitraz-epam, phenelzine, gabapentin, cyproheptadine, and tricyclic antidepressants. Nefazodone is not recommended as first line Level C The following medications may be considered for treatment of PTSD-associated nightmares, but the data are low grade and sparse: trazodone, atypical antipsychotic medications, topiramate, low dose Cortisol, fluvoxamine, triazolam and nitrazepam, phenelzine, gabapentin, cyproheptadine, and tricyclic antidepressants. Consider alternative treatments beyond prazosin for managing PTSD-related nightmares. Gabapentin Gabapentin is approved to treat seizures and postherpetic neuralgia and also is used to treat neuropathic pain. When 300 to 3,600 mg/d (mean dosage, 1,300 mg/d) of gabapentin was added to medication regi-mens, most patients reported decreased fre - quency or intensity of nightmares. 9 Monitor patients for sedation, dizziness, mood a decrease in the frequency of nightmares. The dose range was 300–3600 mg/day. Sedation tion treatments, gabapentin dose, duration of treat-ment with gabapentin
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