Endorsement of: “Position paper for the treatment of nightmare disorder in adults: An American Academy of Sleep Medicine position paper” by the World Sleep Society

According to the ICSD-3TR, nightmare disorder is characterized by extended, extremely dysphoric, and well-remembered dreams that usually involve threats to survival, security, or physical integrity. The dream experience causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. Nightmare disorder occurs in 2–6% of adults. Nightmares are present in 88 % of patients with post-traumatic stress disorder (PTSD), in 31 % of active-duty military populations and war veterans, and in 93 % of patients with isolated REM sleep behavior disorder (RBD). Nightmares can also occur in the setting of other sleep disorders including severe obstructive sleep apnea, periodic limb movement disorder, non-REM parasomnias and narcolepsy. However, for many available treatment options for nightmare disorder, direct evidence is limited, and numerous research questions remain unanswered. Concerns in therapeutic studies include the etiology and definition of nightmares, their assessment methodologies, the high comorbidities of nightmares with other sleep disorders (especially insomnia, RBD, narcolepsy, and obstructive sleep apnea) and PTSD, outcome measures to assess improvement, the heterogeneous subpopulations (adults, children, military veterans and refugees), and the integration of nightmare treatments into different healthcare systems.